{"hospital_name":"Providence Health and Services - Oregon","last_updated_on":"2026-04-01","version":"3.0.0","location_name":["Providence Medford Medical Center"],"hospital_address":["1111 Crater Lake Ave, Medford, OR 97504"],"license_information":{"license_number":"14-0734","state":"OR"},"type_2_npi":["1689755670","1508949884"],"attestation":{"attestation":"To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.","confirm_attestation":true,"attester_name":"Susan Sauder"},"financial_aid_policy":["25% off of standard gross charges."],"modifier_information":[{"description":"Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities","code":"TC","modifier_payer_information":[{"payer_name":"Allcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"AllCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Regence All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Regence Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareOregon","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareOregon","plan_name":"Medicare 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":"Coordinated Care","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Choice","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthNet","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthNet","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Moda","plan_name":"Beacon Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Moda","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Moda","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Moda","plan_name":"Non-OEBB All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Moda","plan_name":"OEBB All Commercial Plans","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":"Pacificsource","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pacificsource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pacifisource","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Providence Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Providence Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Providence Health Plan","plan_name":"PEBB Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Providence Health Plan","plan_name":"Signature/Choice/Intel/Connect/Extend All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Payer 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."}]}],"standard_charge_information":[{"description":"HC HEMOCONCENTRATOR HPH400TS","code_information":[{"code":"Px0000101088L","type":"CDM"}],"standard_charges":[{"gross_charge":305.3,"discounted_cash":228.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC INST BIOP 18GAX10 MC1810","code_information":[{"code":"Px0000101281L","type":"CDM"}],"standard_charges":[{"gross_charge":83.03,"discounted_cash":62.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MAXCORE INST BX 14GX10CM MC1410","code_information":[{"code":"Px0000101283L","type":"CDM"}],"standard_charges":[{"gross_charge":82.69,"discounted_cash":62.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SET MINICAP EXT LIFE PD TRANS 5C4482","code_information":[{"code":"Px0000101371L","type":"CDM"}],"standard_charges":[{"gross_charge":193.82,"discounted_cash":145.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC INTERCEED 3X4 4350 CDM","code_information":[{"code":"Px0000104075L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1332.7,"discounted_cash":999.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SET PNEUMOTHORAX G03301","code_information":[{"code":"Px0000105784L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":601.09,"discounted_cash":450.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TRAY CHEST PERC 28FR G04226","code_information":[{"code":"Px0000105884L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":566.96,"discounted_cash":425.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC HEMOSTATIC SURGICEL 2X3 1953","code_information":[{"code":"Px0000106030L","type":"CDM"}],"standard_charges":[{"gross_charge":221.88,"discounted_cash":166.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC HEMOSTAT SURGCEL 2X14IN 1951","code_information":[{"code":"Px0000106034L","type":"CDM"}],"standard_charges":[{"gross_charge":377.99,"discounted_cash":283.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC HEMOSTATIC SURGICEL 4X8 1952","code_information":[{"code":"Px0000106035L","type":"CDM"}],"standard_charges":[{"gross_charge":263.1,"discounted_cash":197.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT LUMBAR CATHETER ACCESSORY 910121","code_information":[{"code":"Px0000106040L","type":"CDM"}],"standard_charges":[{"gross_charge":483.0,"discounted_cash":362.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT CATH SUPRAPUBIC BARD 12FR 143112","code_information":[{"code":"Px0000109527L","type":"CDM"}],"standard_charges":[{"gross_charge":242.0,"discounted_cash":181.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE MINNESOTA 0092220","code_information":[{"code":"Px0000109716L","type":"CDM"}],"standard_charges":[{"gross_charge":899.0,"discounted_cash":674.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GUIDEWIRE .035 X 68CM AW14735","code_information":[{"code":"Px0000112720L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.85,"discounted_cash":21.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE TRANSGASTRIC JEJUN 18FR 025018","code_information":[{"code":"Px0000114857L","type":"CDM"}],"standard_charges":[{"gross_charge":633.0,"discounted_cash":474.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC OLCOTT TORQUE DEVICE PIN VISE G13811","code_information":[{"code":"Px0000114971L","type":"CDM"}],"standard_charges":[{"gross_charge":31.63,"discounted_cash":23.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GLIDEWIRE ANG .018X180CM GR1806","code_information":[{"code":"Px0000115448L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":167.01,"discounted_cash":125.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GUIDEWIRE BENTSON .035 145CM G00691","code_information":[{"code":"Px0000115848L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":34.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH GLIDE ANG TAPER 5FR 65CM CG507","code_information":[{"code":"Px0000117231L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.38,"discounted_cash":78.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC ACCUSTICK II INTRODUCER KIT M001207030","code_information":[{"code":"Px0000117521L","type":"CDM"}],"standard_charges":[{"gross_charge":211.0,"discounted_cash":158.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GUIDEWIRE TFE 035 145CM THG G27033","code_information":[{"code":"Px0000117985L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":66.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE TRACH METAL 6 NON FEN","code_information":[{"code":"Px0000120102L","type":"CDM"}],"standard_charges":[{"gross_charge":1393.08,"discounted_cash":1044.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH DRN MP 6SP 10.2F 45CM G09766","code_information":[{"code":"Px0000122632L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":232.99,"discounted_cash":174.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH DAWSON-MUELLER 8.5FR 25CM G09705","code_information":[{"code":"Px0000122635L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":191.0,"discounted_cash":143.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GLIDEWIRE ANG EXCH .035 260CM GR3509","code_information":[{"code":"Px0000123611L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TRAY THORACIC 11FR 10CM TV1110","code_information":[{"code":"Px0000124606L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":665.05,"discounted_cash":498.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE TRACH METAL 4 NON FEN","code_information":[{"code":"Px0000125438L","type":"CDM"}],"standard_charges":[{"gross_charge":1705.67,"discounted_cash":1279.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE TRACH METAL 5 NON FEN","code_information":[{"code":"Px0000126316L","type":"CDM"}],"standard_charges":[{"gross_charge":1705.67,"discounted_cash":1279.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GLIDECATH 4FR 65CM ANGLE TAPER CG415","code_information":[{"code":"Px0000127226L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.94,"discounted_cash":114.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL COAXIAL ACHIEVE BIOPSY 18G X 11CM CA1811","code_information":[{"code":"Px0000127687L","type":"CDM"}],"standard_charges":[{"gross_charge":161.68,"discounted_cash":121.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GLIDEWIRE SS ANG EX .035 260 GS3509","code_information":[{"code":"Px0000127738L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.82,"discounted_cash":115.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GLIDEWIRE .035X150CM SS ANG GS3506","code_information":[{"code":"Px0000128054L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":149.63,"discounted_cash":112.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GUIDEWIRE SUPER STIFF 75CM","code_information":[{"code":"Px0000128211L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.6,"discounted_cash":56.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH MAC-LOC 10.2FR 25 CLDM HC G09706","code_information":[{"code":"Px0000128498L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":191.0,"discounted_cash":143.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH MAC-LOC 12FR 25CM CLM RH G09503","code_information":[{"code":"Px0000128499L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.51,"discounted_cash":154.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH DRAINAGE 14.0P-6S CLM RH G09504","code_information":[{"code":"Px0000128500L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.51,"discounted_cash":154.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TRAY THORACIC 11FR 13CM TV1113","code_information":[{"code":"Px0000128513L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":665.05,"discounted_cash":498.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL BIOP COAXIAL ACHIEVE 18X15","code_information":[{"code":"Px0000128518L","type":"CDM"}],"standard_charges":[{"gross_charge":161.68,"discounted_cash":121.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL COAXIAL ACHIEVE BIOPSY 18G X 20CM CA1820","code_information":[{"code":"Px0000128519L","type":"CDM"}],"standard_charges":[{"gross_charge":102.89,"discounted_cash":77.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL BIOP COAXIAL ACHIEVE 20X11 CA2011","code_information":[{"code":"Px0000128520L","type":"CDM"}],"standard_charges":[{"gross_charge":102.89,"discounted_cash":77.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL COAXIAL ACHIEVE BIOPSY 20G X 15CM CA2015","code_information":[{"code":"Px0000128521L","type":"CDM"}],"standard_charges":[{"gross_charge":102.89,"discounted_cash":77.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC HEMOSTAT SURGCEL NUKNIT 3X4IN 1943","code_information":[{"code":"Px0000128560L","type":"CDM"}],"standard_charges":[{"gross_charge":235.0,"discounted_cash":176.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL BIOP COAX ACHIEVE 14G 11CM CA1411","code_information":[{"code":"Px0000128898L","type":"CDM"}],"standard_charges":[{"gross_charge":157.37,"discounted_cash":118.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GLIDEWIRE ANG .035 180CM GR3508","code_information":[{"code":"Px0000128901L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":93.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC ACURE HOOKWIRE 20GX7.5CM BLN20075","code_information":[{"code":"Px0000129928L","type":"CDM"},{"code":"C1819","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.57,"discounted_cash":65.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC ACURA HOOKWIRE 5CM BLN2005","code_information":[{"code":"Px0000130296L","type":"CDM"},{"code":"C1819","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.57,"discounted_cash":65.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL KOPAN HOOK 21GA 7CM G03507","code_information":[{"code":"Px0000130297L","type":"CDM"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":58.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE FEEDING MIC-KEY 24FR 2.5 01202425","code_information":[{"code":"Px0000132298L","type":"CDM"}],"standard_charges":[{"gross_charge":263.32,"discounted_cash":197.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SHEATH BRITE TIP 7F 11CM 401711M","code_information":[{"code":"Px0000132416L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":36.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SHEATH BRITE TIP 6FR 23CM 401623M","code_information":[{"code":"Px0000132485L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.65,"discounted_cash":49.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC WIRE AMPLATZ SS ST .035 180CM M001465251","code_information":[{"code":"Px0000132748L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.93,"discounted_cash":77.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GWIRE VASC ANG .035INX180CM GS3508","code_information":[{"code":"Px0000132914L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.35,"discounted_cash":115.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SHEATH BRITE TIP 4F 11CM 401411M","code_information":[{"code":"Px0000133229L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":36.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SHEATH BRITE TIP 6FR 11CM 401611M","code_information":[{"code":"Px0000133231L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":36.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH DUO LUM URET ACCESS G17323","code_information":[{"code":"Px0000133398L","type":"CDM"},{"code":"C1758","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":89.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH INFU CRAG-MCN 5FR 100/20 4105101","code_information":[{"code":"Px0000134022L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":249.0,"discounted_cash":186.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH NEPH FLEX REG 12 X 25 M001271810","code_information":[{"code":"Px0000134619L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.29,"discounted_cash":163.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH KUMPE BT 5F 65CM G09469","code_information":[{"code":"Px0000138161L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.09,"discounted_cash":46.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SHEATH BRITE TIP 8FR 11CM 401811M","code_information":[{"code":"Px0000138229L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":36.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CASE HRTMTE TRAVEL","code_information":[{"code":"Px0000138468L","type":"CDM"},{"code":"Q0508","type":"HCPCS"}],"standard_charges":[{"gross_charge":469.0,"discounted_cash":351.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE FEEDING MIC-KEY 20FR 2.3","code_information":[{"code":"Px0000138545L","type":"CDM"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":192.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH FOGARTY 5.5FR 12TLW805F35","code_information":[{"code":"Px0000139737L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":243.0,"discounted_cash":182.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT CATH MAHURKAR 11.5FR 16CM","code_information":[{"code":"Px0000140060L","type":"CDM"},{"code":"C1752","type":"HCPCS"}],"standard_charges":[{"gross_charge":319.0,"discounted_cash":239.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SHEATH BRITE TIP 7FR 23CM 401723M","code_information":[{"code":"Px0000140220L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":48.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SHEATH AVANTI 5F 11CM 504605X","code_information":[{"code":"Px0000140632L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":18.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC ANCHR SUT COPE GI G04474","code_information":[{"code":"Px0000141533L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":219.75,"discounted_cash":164.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC STENT GLIDEX 8FR X 26CM M001245520","code_information":[{"code":"Px0000141651L","type":"CDM"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":263.7,"discounted_cash":197.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH BIL 10.2FR 40CM CLB RH G09498","code_information":[{"code":"Px0000142230L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":157.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH BIL MACLC 8.5FR 40 CLB RH G09497","code_information":[{"code":"Px0000142231L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":157.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC COIL HELICAL 18-6-6 M0013120331","code_information":[{"code":"Px0000142614L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.29,"discounted_cash":116.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE TRANSGASTRIC JEJUN 22FR 025022","code_information":[{"code":"Px0000143925L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":633.0,"discounted_cash":474.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH BIL MACLOC 14FR 40 CLB RH G09500","code_information":[{"code":"Px0000143926L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":157.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SHEATH PINNACLE 6F 10CM RSS602","code_information":[{"code":"Px0000144473L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":20.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SHEATH PINNACLE 7FR 10CM RSS702","code_information":[{"code":"Px0000144474L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":20.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SHEATH PINN 8FR 10CM RSS802","code_information":[{"code":"Px0000144475L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":20.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC ACURA HOOKWIRE 3CM BLN2003","code_information":[{"code":"Px0000144840L","type":"CDM"},{"code":"C1819","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.57,"discounted_cash":65.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC ACURA HOOKWIRE 10CM BLN2010","code_information":[{"code":"Px0000144844L","type":"CDM"},{"code":"C1819","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.57,"discounted_cash":65.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SHEATH PINNACLE 5F 10 CM RSS502","code_information":[{"code":"Px0000145003L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.28,"discounted_cash":13.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC DRAIN SET TQAS POLYU 41CM 20FR G06345","code_information":[{"code":"Px0000145079L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":268.0,"discounted_cash":201.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH GORDON 22FR 40 MPA GLD HC","code_information":[{"code":"Px0000145119L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.98,"discounted_cash":159.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH NEPH FLEX REG 10 X 25 M001271800","code_information":[{"code":"Px0000145418L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.0,"discounted_cash":163.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC STENT GLIDEX 8FR X 22CM M001245500","code_information":[{"code":"Px0000147877L","type":"CDM"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":263.7,"discounted_cash":197.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL CATH YUEH 5FR 19GA 7CM G09489","code_information":[{"code":"Px0000149891L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":36.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE JEJUNAL FEED MIC 18FR 026018","code_information":[{"code":"Px0000150440L","type":"CDM"}],"standard_charges":[{"gross_charge":879.0,"discounted_cash":659.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TRAY PARACENTESIS THORA COMBO TPT1000","code_information":[{"code":"Px0000152208L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":167.01,"discounted_cash":125.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CLIP ULTRACLIP TISSUE MARKER PPU","code_information":[{"code":"Px0000154661L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":220.0,"discounted_cash":165.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SHEATH PEELAWAY 24FR .038 13CM G06446","code_information":[{"code":"Px0000155539L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":58.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL CATH YUEH 4FR 20GA 7CM G09488","code_information":[{"code":"Px0000155690L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":36.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH OMNI FLUSH 5FR 65CM H787107322035","code_information":[{"code":"Px0000155867L","type":"CDM"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":40.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT PARACENTESIS","code_information":[{"code":"Px0000156015L","type":"CDM"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":123.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GUIDEWIRE TFE 035 145CM COO G02356","code_information":[{"code":"Px0000156078L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.38,"discounted_cash":46.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH BIL DRAIN 18FR 40CM G09829","code_information":[{"code":"Px0000156887L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":268.3,"discounted_cash":201.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH INFU CRAG-MCN 5FR 135/20 4105701","code_information":[{"code":"Px0000157257L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":249.0,"discounted_cash":186.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH INFU CRAG-MCN 5FR 135/30 4105801","code_information":[{"code":"Px0000157258L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":249.0,"discounted_cash":186.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC DIL URET SET G14185","code_information":[{"code":"Px0000158419L","type":"CDM"}],"standard_charges":[{"gross_charge":706.23,"discounted_cash":529.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE FEED MIC JEJU 18FR 0200-18 020018","code_information":[{"code":"Px0000158646L","type":"CDM"}],"standard_charges":[{"gross_charge":381.0,"discounted_cash":285.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH DRAIN 6F MPL2625","code_information":[{"code":"Px0000159234L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":237.0,"discounted_cash":177.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH DRAIN SKATER 8FR 25CM","code_information":[{"code":"Px0000159248L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.56,"discounted_cash":202.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH DRAIN SKATER 10FR 25CM","code_information":[{"code":"Px0000159249L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":202.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH DRAIN SKATER 12FR 25CM","code_information":[{"code":"Px0000159250L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.56,"discounted_cash":202.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH DRAIN SKATER 14FR 25CM","code_information":[{"code":"Px0000159251L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.56,"discounted_cash":202.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GWIRE AMPL SS ST EXC .035 260 M001465261","code_information":[{"code":"Px0000159521L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.73,"discounted_cash":80.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC AMPLATZ SS 260CM .035 3MMJ M001465021","code_information":[{"code":"Px0000159523L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.73,"discounted_cash":80.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GUIDEWIRE TFE 038 80CM COON","code_information":[{"code":"Px0000159640L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GUIDEWIRE COPE 018 60CM SS ST G09395","code_information":[{"code":"Px0000160276L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":71.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SHEATH PEELWY 20FR .038 13CM G06445","code_information":[{"code":"Px0000160468L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":86.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE TRACH METAL 6 REG FEN","code_information":[{"code":"Px0000160915L","type":"CDM"}],"standard_charges":[{"gross_charge":2977.27,"discounted_cash":2232.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH PICC IV GRSH DL 5FR 7927500","code_information":[{"code":"Px0000161749L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":298.0,"discounted_cash":223.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SPLINT - MULTI PODUS MED","code_information":[{"code":"Px0000161844L","type":"CDM"},{"code":"L4396","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.0,"discounted_cash":104.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SPLINT - MULTI PODUS LG","code_information":[{"code":"Px0000161845L","type":"CDM"},{"code":"L4396","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.0,"discounted_cash":104.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SPLINT WRIST BLK MED RT 8IN","code_information":[{"code":"Px0000162037L","type":"CDM"},{"code":"L3908","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.73,"discounted_cash":21.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE JEJUNAL MIC 14FR 20CC BL 020014","code_information":[{"code":"Px0000200836L","type":"CDM"}],"standard_charges":[{"gross_charge":381.0,"discounted_cash":285.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE JEJUNAL FEED 16FR 20CC BL 020016","code_information":[{"code":"Px0000200837L","type":"CDM"}],"standard_charges":[{"gross_charge":381.0,"discounted_cash":285.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GUIDEWIRE COPE 018 60CM SS G05183","code_information":[{"code":"Px0000204935L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":55.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH INFU CRAG-MCN 5FR 65/10 4104701","code_information":[{"code":"Px0000204946L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":224.15,"discounted_cash":168.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH BERENSTEIN 4/100/035 H787107235015","code_information":[{"code":"Px0000205072L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.15,"discounted_cash":33.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC DRAINAGE THAL TQAS-1800-J G06343","code_information":[{"code":"Px0000205542L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":268.0,"discounted_cash":201.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GUIDEWIRE SPARTACORE 5/190 1005202","code_information":[{"code":"Px0000206332L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":136.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC WIRE SUPRA CORE 35/190CM 100270301","code_information":[{"code":"Px0000206549L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":136.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE TRANSGASTRIC JEJUANL 16F 025016","code_information":[{"code":"Px0000207319L","type":"CDM"}],"standard_charges":[{"gross_charge":633.0,"discounted_cash":474.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH BERENSTEIN 5/65 5/BX H787107221045","code_information":[{"code":"Px0000207503L","type":"CDM"}],"standard_charges":[{"gross_charge":36.12,"discounted_cash":27.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE FEEDING MIC-KEY 18FR 2.0 01201820","code_information":[{"code":"Px0000208620L","type":"CDM"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":192.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE FEEDING MIC-KEY 18FR 3.0 01201830","code_information":[{"code":"Px0000208648L","type":"CDM"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":202.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GUIDEWIRE TFE 035 260CM AES G03562","code_information":[{"code":"Px0000208927L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":45.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE FEEDING MIC-KEY 14FR 1.0 01201410","code_information":[{"code":"Px0000208961L","type":"CDM"}],"standard_charges":[{"gross_charge":263.0,"discounted_cash":197.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE FEEDING MIC-KEY 18FR 2.5 01201825","code_information":[{"code":"Px0000209080L","type":"CDM"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":202.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SPLINT THUMB AND WRIST RT LG","code_information":[{"code":"Px0000210683L","type":"CDM"},{"code":"A4570","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GUIDEWIRE SENSOR .035 ST M0066703081","code_information":[{"code":"Px0000210877L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":65.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GUIDEWIRE ANGIO .035 3MM H965970002021","code_information":[{"code":"Px0000211230L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.95,"discounted_cash":30.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH NDL CENTESIS 1STEP 4FR 7C","code_information":[{"code":"Px0000211299L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":41.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH NDL CENTESIS 1STEP 5FR 7C","code_information":[{"code":"Px0000211300L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.27,"discounted_cash":43.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC VALVE SPEAKING PASSY-MUIR PMV2001","code_information":[{"code":"Px0000215999L","type":"CDM"},{"code":"L8501","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.65,"discounted_cash":161.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL VERT FACET INTRO 11G 5IN","code_information":[{"code":"Px0000216652L","type":"CDM"}],"standard_charges":[{"gross_charge":181.0,"discounted_cash":135.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL VERT FACET INTRO 13G 5IN","code_information":[{"code":"Px0000216653L","type":"CDM"}],"standard_charges":[{"gross_charge":158.0,"discounted_cash":118.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL VERT BONE BIOPSY KIT 11G","code_information":[{"code":"Px0000216656L","type":"CDM"}],"standard_charges":[{"gross_charge":144.75,"discounted_cash":108.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL VERT BONE BIOPSY KIT 13G","code_information":[{"code":"Px0000216657L","type":"CDM"}],"standard_charges":[{"gross_charge":181.0,"discounted_cash":135.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL BIOPINCE 18X10CM 360108001","code_information":[{"code":"Px0000216900L","type":"CDM"}],"standard_charges":[{"gross_charge":151.2,"discounted_cash":113.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL BIOPINCE 18X15CM 360158001","code_information":[{"code":"Px0000216901L","type":"CDM"}],"standard_charges":[{"gross_charge":151.2,"discounted_cash":113.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC INTD BIOPINCE COAXIAL US MCXS1815BP","code_information":[{"code":"Px0000216904L","type":"CDM"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":37.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GUIDEWIRE SENSOR .038 ST M0066703121","code_information":[{"code":"Px0000217020L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":96.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GELMARK ULTRACOR S CLIP 14G GMUTC005SS","code_information":[{"code":"Px0000217039L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":255.0,"discounted_cash":191.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TRAY PERCARDIOCENTISIS PIGTAIL PC101","code_information":[{"code":"Px0000217584L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":278.2,"discounted_cash":208.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE TRACH BIVONA 8.0","code_information":[{"code":"Px0000217955L","type":"CDM"}],"standard_charges":[{"gross_charge":516.86,"discounted_cash":387.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SHEATH RCFW 12F 30CM CHECK-FLO G08956","code_information":[{"code":"Px0000218349L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":144.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SHEATH PEELWY 22FR .038 13CM G04096","code_information":[{"code":"Px0000219489L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.07,"discounted_cash":80.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SHEATH BRITETIP 10F 11CM 401011M","code_information":[{"code":"Px0000219896L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":36.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE TRACH BIVONA 6.0 75HA60","code_information":[{"code":"Px0000220590L","type":"CDM"}],"standard_charges":[{"gross_charge":517.0,"discounted_cash":387.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT PERCLOSE PROGLIDE 6FR 1267303","code_information":[{"code":"Px0000221040L","type":"CDM"},{"code":"C1760","type":"HCPCS"}],"standard_charges":[{"gross_charge":483.45,"discounted_cash":362.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GUIDEWIRE ST BENTSON .35X150","code_information":[{"code":"Px0000221296L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GUIDEWIRE TFE 035 145CM AUS G09954","code_information":[{"code":"Px0000222635L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":43.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH SKATER BILIARY DRAIN 8F","code_information":[{"code":"Px0000227386L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.56,"discounted_cash":202.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH SKATER NEPHRO DRAIN 8F","code_information":[{"code":"Px0000227387L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.56,"discounted_cash":202.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL CATH YUEH 5FR 19G 10CM G09490","code_information":[{"code":"Px0000231047L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":36.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MARKER TISS ULTRACLIP2 10CM","code_information":[{"code":"Px0000231455L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.2,"discounted_cash":111.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TRACH VALVE PASSY MUIR PMV007","code_information":[{"code":"Px0000232900L","type":"CDM"},{"code":"L8501","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.65,"discounted_cash":161.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT SURG PREP BONE BIO W/IMP 2067100","code_information":[{"code":"Px0000236527L","type":"CDM"}],"standard_charges":[{"gross_charge":264.96,"discounted_cash":198.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SHEATH PEELAWAY 18FR .038 13CM G06444","code_information":[{"code":"Px0000238758L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":90.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT TRACH PERCUT DIL 7.0MM","code_information":[{"code":"Px0000238815L","type":"CDM"}],"standard_charges":[{"gross_charge":811.79,"discounted_cash":608.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SHEATH SUPER ARROWFLX 6FR 24CM CL07624","code_information":[{"code":"Px0000239750L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.95,"discounted_cash":125.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GLIDECATH 4FR 100CM ANGLE TAPER CG416","code_information":[{"code":"Px0000240903L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":114.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GUIDEWIRE ROSEN 035 80CM 1.5MM G01774","code_information":[{"code":"Px0000241168L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":27.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL COAXIAL ADJ 18G X 11CM","code_information":[{"code":"Px0000244328L","type":"CDM"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":114.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL COAXIAL ADJ 18GX20CM","code_information":[{"code":"Px0000244329L","type":"CDM"}],"standard_charges":[{"gross_charge":9.0,"discounted_cash":6.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL COAXIAL ADJ 20GX15CM ACT2015","code_information":[{"code":"Px0000244330L","type":"CDM"}],"standard_charges":[{"gross_charge":171.41,"discounted_cash":128.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL COAXIAL ADJ 20GX20CM ACT2020","code_information":[{"code":"Px0000244331L","type":"CDM"}],"standard_charges":[{"gross_charge":10.36,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH MAC-LOC 8.5FR 25CM CLM RH G09501","code_information":[{"code":"Px0000247284L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.0,"discounted_cash":153.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH MAC-LOC 10.2FR 25 CLB HC G09502","code_information":[{"code":"Px0000247356L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.51,"discounted_cash":154.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH GUIDE AVE L 6FR EBU375 LA6EBU375","code_information":[{"code":"Px0000248184L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":106.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH DAWSON-MUELLER 12FR 25CM G10435","code_information":[{"code":"Px0000249209L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":191.0,"discounted_cash":143.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CLIP CORMARK 14GA MAM3014","code_information":[{"code":"Px0000249297L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":140.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL KOPAN HOOK 20GA 7CM G02601","code_information":[{"code":"Px0000250024L","type":"CDM"},{"code":"C1819","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":58.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH SKATER DRAIN 16FR 25CM 756516025","code_information":[{"code":"Px0000250301L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.56,"discounted_cash":202.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BIOP SYS COAXIAL ACHIEVE 20X20","code_information":[{"code":"Px0000250306L","type":"CDM"}],"standard_charges":[{"gross_charge":154.0,"discounted_cash":115.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GUIDEWIRE BENTSON .035 260CM G01063","code_information":[{"code":"Px0000251863L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":38.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL CATH YUEH 5FR 19GA 15CM G09492","code_information":[{"code":"Px0000252702L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":36.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH MAHURKAR 12FR X 20CM 8888101003HP","code_information":[{"code":"Px0000252960L","type":"CDM"},{"code":"C1752","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":281.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MARKER FIDUCIAL TISS SFT GOLD","code_information":[{"code":"Px0000253607L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.3,"discounted_cash":99.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH HEMOSTAR ST 14.5FR 23CM","code_information":[{"code":"Px0000254003L","type":"CDM"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":679.0,"discounted_cash":509.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH MHRKR W/CRV TL 12FR 13CM","code_information":[{"code":"Px0000255265L","type":"CDM"},{"code":"C1752","type":"HCPCS"}],"standard_charges":[{"gross_charge":265.04,"discounted_cash":198.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL HANDPIECE SUROS 12G X 12CM US","code_information":[{"code":"Px0000255503L","type":"CDM"}],"standard_charges":[{"gross_charge":502.08,"discounted_cash":376.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MARKER TRIMARK 13 TRIMARKTD13MR","code_information":[{"code":"Px0000255507L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.0,"discounted_cash":120.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GWIRE VASC AMPL SUPSTI 035X75 M001465631","code_information":[{"code":"Px0000255599L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.6,"discounted_cash":56.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GWIRE LQST STR XSTIF 260X11 G31453","code_information":[{"code":"Px0000256378L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.0,"discounted_cash":226.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SHEATH PEELAWAY 12F G06492","code_information":[{"code":"Px0000257213L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":90.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SHEATH PEELAWAY 14F G06496 G06496","code_information":[{"code":"Px0000257214L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":90.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH DRAIN NITINOL LCK PIG 8FR NNU8LPT","code_information":[{"code":"Px0000257915L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":277.3,"discounted_cash":207.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL COAXIAL ADJ 18GX15CM ACT1815","code_information":[{"code":"Px0000257920L","type":"CDM"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":111.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL COAXIAL ADJ 20GX11CM ACT2011","code_information":[{"code":"Px0000257921L","type":"CDM"}],"standard_charges":[{"gross_charge":827.78,"discounted_cash":620.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH BLN CSV 6FR 80CM BVCS6180","code_information":[{"code":"Px0000258744L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":224.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SPHINCTEROTOME HYDRA RX44 20MM M00583040","code_information":[{"code":"Px0000259413L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1131.36,"discounted_cash":848.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GUIDEWIRE ST BENTSON .35X80CM","code_information":[{"code":"Px0000259518L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.58,"discounted_cash":25.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BLN VIATRAC 7 X 40CM 100820140","code_information":[{"code":"Px0000259802L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":340.0,"discounted_cash":255.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GUIDEWIRE STORQ ANGLE .035/180 503456J","code_information":[{"code":"Px0000259857L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":136.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE TRACH XLT CUFF DISTAL 6 60XLTCD","code_information":[{"code":"Px0000259993L","type":"CDM"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":136.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE TRACH XLT CUFF PROXIMAL 6 60XLTCP","code_information":[{"code":"Px0000259994L","type":"CDM"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":136.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE TRACH XLT UNCUFF PROX 6MM 60XLTUP","code_information":[{"code":"Px0000259995L","type":"CDM"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":136.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE TRACH 8 CUFF DIST XL 80XLTCD","code_information":[{"code":"Px0000259996L","type":"CDM"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":136.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE TRACH XLT CUFF PROXIMAL 8 80XLTCP","code_information":[{"code":"Px0000259997L","type":"CDM"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":136.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE TRACH XLT NOCUFF PROXIM 8 80XLTUP","code_information":[{"code":"Px0000259998L","type":"CDM"}],"standard_charges":[{"gross_charge":181.66,"discounted_cash":136.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH MHRKR PRECRV TL 12FR 16CM 8888101002HP","code_information":[{"code":"Px0000260511L","type":"CDM"},{"code":"C1752","type":"HCPCS"}],"standard_charges":[{"gross_charge":354.0,"discounted_cash":265.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC STENT BIL ZLVR 6F 80CM 12-40MM G36229","code_information":[{"code":"Px0000260932L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1324.57,"discounted_cash":993.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC STENT BIL ZLVR 6F 80CM 12-60MM G36230","code_information":[{"code":"Px0000260933L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2030.0,"discounted_cash":1522.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC STENT ZILVER 6F 14 X 30 80CM","code_information":[{"code":"Px0000260934L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2030.0,"discounted_cash":1522.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC STENT BIL ZLVR 6F 80CM 14-40MM G36234","code_information":[{"code":"Px0000260935L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1324.57,"discounted_cash":993.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC STENT BIL ZLVR 6F 80CM 14-60MM G36235","code_information":[{"code":"Px0000260936L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2030.0,"discounted_cash":1522.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH SIZING OMNI FLUSH 4FR 70C H787137090055","code_information":[{"code":"Px0000261447L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.7,"discounted_cash":61.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GDW .035-.038 X 150 ANGLED XR GR3506","code_information":[{"code":"Px0000261742L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.35,"discounted_cash":46.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH PICC PWR DL 5FR 3275108","code_information":[{"code":"Px0000262370L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":322.0,"discounted_cash":241.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE TRACH XLT CUFF PROXIMAL 7 70XLTCP","code_information":[{"code":"Px0000262983L","type":"CDM"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":136.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL KOPAN HOOK 20GA 9CM G02587","code_information":[{"code":"Px0000264635L","type":"CDM"},{"code":"C1819","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":58.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT DRNGE PLEURX 1000ML 507510","code_information":[{"code":"Px0000264749L","type":"CDM"}],"standard_charges":[{"gross_charge":202.17,"discounted_cash":151.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH PICC PWR TLS TL 6FR FULL","code_information":[{"code":"Px0000266036L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":504.0,"discounted_cash":378.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC HANDPIECE MR 20MM 3.7MM X 14CM ATEC091420MR","code_information":[{"code":"Px0000266039L","type":"CDM"}],"standard_charges":[{"gross_charge":695.95,"discounted_cash":521.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC HANDPIECE MR 12MM 3.7MM X 14CM ATEC091412MR","code_information":[{"code":"Px0000266040L","type":"CDM"}],"standard_charges":[{"gross_charge":695.95,"discounted_cash":521.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC INTRODUCER LOC SET HNDPC 20MR ILS091420","code_information":[{"code":"Px0000266041L","type":"CDM"}],"standard_charges":[{"gross_charge":383.95,"discounted_cash":287.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC INTRODUCER LOCAL SET 12MR ILS091412","code_information":[{"code":"Px0000266042L","type":"CDM"}],"standard_charges":[{"gross_charge":383.95,"discounted_cash":287.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH PICC PWR TLS DL 5FR FULL","code_information":[{"code":"Px0000266150L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":460.0,"discounted_cash":345.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC ANGIOSEAL VIP 6F 610130","code_information":[{"code":"Px0000292099L","type":"CDM"},{"code":"C1760","type":"HCPCS"}],"standard_charges":[{"gross_charge":524.0,"discounted_cash":393.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SHEATH PEELAWAY 16FR .038 G02997","code_information":[{"code":"Px0000292416L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.98,"discounted_cash":83.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC STENT VASC ZLVR 6F 80CM 9-40MM G43861","code_information":[{"code":"Px0000292689L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2030.0,"discounted_cash":1522.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC STENT VASC ZLVR 6F 80CM 10-60M G43867","code_information":[{"code":"Px0000292693L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1818.24,"discounted_cash":1363.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MICROPUNCT 5FR NITNL/PLAT SST G43870","code_information":[{"code":"Px0000293604L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.81,"discounted_cash":56.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE TRACH XLT CUFF DISTAL 5","code_information":[{"code":"Px0000293628L","type":"CDM"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":136.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE TRACH XLT CUFF DISTAL 7 70XLTCD","code_information":[{"code":"Px0000293629L","type":"CDM"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":136.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE TRACH XLT CUFF PROXIMAL 5","code_information":[{"code":"Px0000293630L","type":"CDM"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":136.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GUIDEWIRE TFE 035 80CM AUS","code_information":[{"code":"Px0000293980L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL SET EZ-IO AD 40-UP KG 9001VC005","code_information":[{"code":"Px0000295140L","type":"CDM"}],"standard_charges":[{"gross_charge":404.0,"discounted_cash":303.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC ANGIOSEAL VIP 8F 610131","code_information":[{"code":"Px0000295175L","type":"CDM"},{"code":"C1760","type":"HCPCS"}],"standard_charges":[{"gross_charge":555.0,"discounted_cash":416.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL CATH YUEH 5FR 19GA 20CM G09491","code_information":[{"code":"Px0000297528L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":36.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL 5CM LOCALIZATION WIRE 47520","code_information":[{"code":"Px0000298220L","type":"CDM"},{"code":"C1819","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.25,"discounted_cash":48.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL LOCALIZATION WIRE 7CM 47720","code_information":[{"code":"Px0000298221L","type":"CDM"},{"code":"C1819","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.25,"discounted_cash":48.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL BIOP BONE MURPHY 11GAX15CM","code_information":[{"code":"Px0000299046L","type":"CDM"}],"standard_charges":[{"gross_charge":255.0,"discounted_cash":191.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH EP CLOSUREFAST 7F 60CM CF7760","code_information":[{"code":"Px0000299170L","type":"CDM"},{"code":"C1888","type":"HCPCS"}],"standard_charges":[{"gross_charge":2919.0,"discounted_cash":2189.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH CLOSURE FAST 7F 100CM CF77100","code_information":[{"code":"Px0000299175L","type":"CDM"},{"code":"C1888","type":"HCPCS"}],"standard_charges":[{"gross_charge":2919.0,"discounted_cash":2189.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MARKER TISSUE ULTRACLIP2 US 863017","code_information":[{"code":"Px0000299264L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":224.99,"discounted_cash":168.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SHEATH CHECK-FLO 12FR 038 13CM G07601","code_information":[{"code":"Px0000300013L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":120.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH PICC GRSH DL 5FR 55CM TY","code_information":[{"code":"Px0000300044L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":492.68,"discounted_cash":369.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH PICC GRSH DL 5FR 45 TY","code_information":[{"code":"Px0000300045L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":517.32,"discounted_cash":387.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MARKER BIOPSY TRIMARKTD2S13MR","code_information":[{"code":"Px0000302488L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.3,"discounted_cash":67.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH PICC TLS GRSH SL 4FR TY 9617408","code_information":[{"code":"Px0000303298L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":508.82,"discounted_cash":381.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC INTRODUCER SHEATH SET 7FR 7CM","code_information":[{"code":"Px0000304142L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":72.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC ACCUDRAIN W/O ANTI REFLUX VAL INS8400","code_information":[{"code":"Px0000306897L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":527.4,"discounted_cash":395.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MARKER BIOP MRI ULTRACOR 14GSS","code_information":[{"code":"Px0000307078L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.84,"discounted_cash":138.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC INTRODUCER PUNCTURE MICRO STIF G48008","code_information":[{"code":"Px0000307502L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":91.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MARKER TISSUE ULTRACLIP2 COIL 864017","code_information":[{"code":"Px0000307940L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.0,"discounted_cash":173.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BLN ALL TERRN 10X40MMX40CM","code_information":[{"code":"Px0000308101L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":232.32,"discounted_cash":174.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL BIOP BONE MURPHY 11GAX10CM","code_information":[{"code":"Px0000308165L","type":"CDM"}],"standard_charges":[{"gross_charge":337.0,"discounted_cash":252.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH CEREB 5FR 100CM .038 KMP G11457","code_information":[{"code":"Px0000308218L","type":"CDM"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":48.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SET NEFF ACCESS CHIBA 21GA NT G08426","code_information":[{"code":"Px0000308328L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":153.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC STENT URO MACLOC 10.2FR 24CM G48164","code_information":[{"code":"Px0000308331L","type":"CDM"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":273.98,"discounted_cash":205.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC STENT URO MACLOC 8.5FR 26CM G48180","code_information":[{"code":"Px0000308339L","type":"CDM"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":273.99,"discounted_cash":205.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH CHAIT TRAPDOR CECOSTOMY M G36392","code_information":[{"code":"Px0000308373L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":574.28,"discounted_cash":430.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT MICROPUNCTURE TRANS NIT 4F","code_information":[{"code":"Px0000308428L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":90.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MICROPUNCT 5FR SS/PLAT USOUND","code_information":[{"code":"Px0000308436L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":54.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL KOPAN HOOK 21GA 5CM G02900","code_information":[{"code":"Px0000308443L","type":"CDM"},{"code":"C1819","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":58.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL KOPAN HOOK 21GA 9CM","code_information":[{"code":"Px0000308444L","type":"CDM"},{"code":"C1819","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":58.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL BIOP COAX 20GA 9CM 10THROW G27018","code_information":[{"code":"Px0000308457L","type":"CDM"}],"standard_charges":[{"gross_charge":147.29,"discounted_cash":110.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC STENT BILI ZLVR 6FR 14X40MM G36244","code_information":[{"code":"Px0000308479L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2030.0,"discounted_cash":1522.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC STENT VASC ZLVR 6F 125CM 10-60","code_information":[{"code":"Px0000308513L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2060.0,"discounted_cash":1545.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC STENT VASC ZLVR 6F 125CM 6-40M G43821","code_information":[{"code":"Px0000308517L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2030.0,"discounted_cash":1522.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC STENT VASC ZLVR 6F 125CM 8-60M G43832","code_information":[{"code":"Px0000308528L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2030.0,"discounted_cash":1522.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC STENT VASC ZLVR 6F 80CM 9-80MM","code_information":[{"code":"Px0000308551L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2030.0,"discounted_cash":1522.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH PICC SHERLOCK SOLO DL 5FR 9295108","code_information":[{"code":"Px0000308654L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":497.4,"discounted_cash":373.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC DRSG KIT VAC GRANUFOAM THIN","code_information":[{"code":"Px0000309578L","type":"CDM"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":116.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL CORE BIOP DEVICE CELERO12","code_information":[{"code":"Px0000309593L","type":"CDM"}],"standard_charges":[{"gross_charge":430.71,"discounted_cash":323.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CLIP SECURMARK","code_information":[{"code":"Px0000309595L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.48,"discounted_cash":73.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT MICROPUNCTURE TRANS SS 4F","code_information":[{"code":"Px0000310057L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":51.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SET INTRO TRACH BLUE RHINO G12115","code_information":[{"code":"Px0000310154L","type":"CDM"}],"standard_charges":[{"gross_charge":1094.5,"discounted_cash":820.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE TRACH XLT UNCUFF DST 6MM 60XLTUD","code_information":[{"code":"Px0000310908L","type":"CDM"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":136.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC DRSG VAC GRANFM XLG KT M82750655","code_information":[{"code":"Px0000313538L","type":"CDM"}],"standard_charges":[{"gross_charge":273.65,"discounted_cash":205.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC INTRODUCER KIT G48007","code_information":[{"code":"Px0000313768L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.44,"discounted_cash":88.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SHEATH RAABE 6FR .035 45CM RB","code_information":[{"code":"Px0000314102L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":111.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC FEM COMPRESSION WITH MANOMETER C11165","code_information":[{"code":"Px0000314807L","type":"CDM"}],"standard_charges":[{"gross_charge":248.76,"discounted_cash":186.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TISSUE MARKER WING ULTRACLP II 862017D","code_information":[{"code":"Px0000314848L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.84,"discounted_cash":138.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH MICRO PROGRT 2.8FR 110CM MCPE28111YB","code_information":[{"code":"Px0000325115L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1461.0,"discounted_cash":1095.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH DRAIN GP LOC PGTL 8F 20CM","code_information":[{"code":"Px0000329276L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.0,"discounted_cash":132.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH DRAIN GP LOC PGTL 10F 20C","code_information":[{"code":"Px0000329277L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.0,"discounted_cash":132.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT INTRODUCER MICKEY G-18 98433","code_information":[{"code":"Px0000330024L","type":"CDM"}],"standard_charges":[{"gross_charge":596.0,"discounted_cash":447.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC RFA INTRO PROBE KIT M001262220","code_information":[{"code":"Px0000330648L","type":"CDM"}],"standard_charges":[{"gross_charge":4518.0,"discounted_cash":3388.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH PICC PWR TLS SL 4FR FULL","code_information":[{"code":"Px0000331186L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":428.16,"discounted_cash":321.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC ARCTIC SUN COOLING PAD UNIV 3170004","code_information":[{"code":"Px0000334293L","type":"CDM"}],"standard_charges":[{"gross_charge":1063.68,"discounted_cash":797.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC PAD COOLING ARCTIC SUN SMALL 3170502","code_information":[{"code":"Px0000334294L","type":"CDM"}],"standard_charges":[{"gross_charge":3380.48,"discounted_cash":2535.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC ARCTIC SUN COOLING PAD MED 3170702","code_information":[{"code":"Px0000334295L","type":"CDM"}],"standard_charges":[{"gross_charge":2781.0,"discounted_cash":2085.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC ARTIC SUN COOLING PAD LG 3170902","code_information":[{"code":"Px0000334296L","type":"CDM"}],"standard_charges":[{"gross_charge":2781.0,"discounted_cash":2085.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GUIDEWIRE COATED PTFE .035","code_information":[{"code":"Px0000334484L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.22,"discounted_cash":24.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC DRSG VAC GRANUFM SIL SENSA MED M82750965","code_information":[{"code":"Px0000335713L","type":"CDM"}],"standard_charges":[{"gross_charge":171.35,"discounted_cash":128.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT PLATELET CONCENTRATE 51406","code_information":[{"code":"Px0000337899L","type":"CDM"}],"standard_charges":[{"gross_charge":410.2,"discounted_cash":307.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SHEATH SUPER ARROWFLX 6FR 11CM CL07611","code_information":[{"code":"Px0000338060L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.65,"discounted_cash":73.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL SET EZ-IO LD LONG 45MM 9079VC005","code_information":[{"code":"Px0000338790L","type":"CDM"}],"standard_charges":[{"gross_charge":400.0,"discounted_cash":300.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH BILIARY 16F 40CM G09205","code_information":[{"code":"Px0000345388L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":268.3,"discounted_cash":201.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC PK PROCEDURE CLOSUREFAST","code_information":[{"code":"Px0000346213L","type":"CDM"}],"standard_charges":[{"gross_charge":262.0,"discounted_cash":196.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC PKG BATTERY","code_information":[{"code":"Px0000346720L","type":"CDM"},{"code":"Q0506","type":"HCPCS"}],"standard_charges":[{"gross_charge":2100.0,"discounted_cash":1575.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GUIDEWIRE J CURVE 25X100X180 G01602","code_information":[{"code":"Px0000346739L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":25.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CLIP CELEROMARK","code_information":[{"code":"Px0000346746L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.3,"discounted_cash":99.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BRACE LT WRIST COCKUP L3908","code_information":[{"code":"Px0000348988L","type":"CDM"},{"code":"L3908","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.42,"discounted_cash":154.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL BIOPSY EVIVA APERTURE 20MM EVIVA091320","code_information":[{"code":"Px0000349449L","type":"CDM"}],"standard_charges":[{"gross_charge":582.41,"discounted_cash":436.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MARKER BIOPSY SITE 1ST SMARKEVIVA13","code_information":[{"code":"Px0000349450L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.99,"discounted_cash":110.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL BIOPSY EVIVA APERTURE 12MM EVIVA091312","code_information":[{"code":"Px0000349451L","type":"CDM"}],"standard_charges":[{"gross_charge":608.0,"discounted_cash":456.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MARKER BIOP SECURMARK EVIVA 2 SMARKEVIVA2S13","code_information":[{"code":"Px0000349452L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.99,"discounted_cash":110.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL CATH YUEH 4FR 10CM G09646","code_information":[{"code":"Px0000350122L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":36.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC STENT URO MACLOC 8.5FR 24CM G48176","code_information":[{"code":"Px0000350181L","type":"CDM"},{"code":"C2625","type":"HCPCS"}],"standard_charges":[{"gross_charge":273.99,"discounted_cash":205.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GUIDEWIRE TFE 035 180CM 3J AES G03565","code_information":[{"code":"Px0000350347L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":37.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT DILATOR VASCULAR 200120","code_information":[{"code":"Px0000350521L","type":"CDM"}],"standard_charges":[{"gross_charge":750.37,"discounted_cash":562.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT CHEST TUBE CATH PLEURX SYS 507000B","code_information":[{"code":"Px0000351011L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":1988.0,"discounted_cash":1491.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH DRAIN GP LOC PGTL 12F 20C","code_information":[{"code":"Px0000351084L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.0,"discounted_cash":132.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MARKER BX TRIMARK HRGLASS 130MM TRIMARKEVIVA2S13","code_information":[{"code":"Px0000351096L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.3,"discounted_cash":99.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT SMARTJET LIQ APP 51452","code_information":[{"code":"Px0000351310L","type":"CDM"}],"standard_charges":[{"gross_charge":234.4,"discounted_cash":175.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CLIP HYDROMARK BIOPSY MARKER 40100215T1","code_information":[{"code":"Px0000353590L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":207.44,"discounted_cash":155.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT VASCULAR INSERTION 210CM 701063540","code_information":[{"code":"Px0000353953L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":433.34,"discounted_cash":325.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT TUBE FEED JEJU 12FR 0200-12LV 020012LV","code_information":[{"code":"Px0000355888L","type":"CDM"}],"standard_charges":[{"gross_charge":381.0,"discounted_cash":285.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GLIDEWIRE ANG ADV .035 X 180CM GA3501","code_information":[{"code":"Px0000355901L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":486.38,"discounted_cash":364.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT DRAINAGE PLEURX 500ML 507500B","code_information":[{"code":"Px0000356479L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":202.17,"discounted_cash":151.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT BASIC TIP DURAMAX 28CM","code_information":[{"code":"Px0000357200L","type":"CDM"}],"standard_charges":[{"gross_charge":778.0,"discounted_cash":583.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GLIDEWIRE ANG ADV .035 X 260CM GA3502","code_information":[{"code":"Px0000357228L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":347.4,"discounted_cash":260.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH DRAIN 16FR LBL2-1630HB","code_information":[{"code":"Px0000357233L","type":"CDM"},{"code":"C1758","type":"HCPCS"}],"standard_charges":[{"gross_charge":319.0,"discounted_cash":239.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT ANCHR MIC SAF-T-PEXY FSTNR 98701","code_information":[{"code":"Px0000357957L","type":"CDM"}],"standard_charges":[{"gross_charge":331.0,"discounted_cash":248.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC PORT POWER VACCESS 8F","code_information":[{"code":"Px0000359223L","type":"CDM"},{"code":"C1788","type":"HCPCS"}],"standard_charges":[{"gross_charge":571.0,"discounted_cash":428.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL BIOPSY EVIVA 9G 10CMX12MM EVIVA091012T","code_information":[{"code":"Px0000359853L","type":"CDM"}],"standard_charges":[{"gross_charge":376.61,"discounted_cash":282.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MARKER BIOPSY 10CM SITE 2ND TRIMARKEVIVA2S10","code_information":[{"code":"Px0000359854L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.3,"discounted_cash":99.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT PLEURX STARTER 500071","code_information":[{"code":"Px0000363736L","type":"CDM"}],"standard_charges":[{"gross_charge":965.03,"discounted_cash":723.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MARKER HYDROMARK BRST 15GA 3 40100215T3","code_information":[{"code":"Px0000366500L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":207.44,"discounted_cash":155.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC POWDER ABSRB ARISTA 3GM SM0002USA","code_information":[{"code":"Px0000366562L","type":"CDM"}],"standard_charges":[{"gross_charge":446.83,"discounted_cash":335.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GUIDEWIRE HYDRO ANG SS 35/180 LWSTFA35180","code_information":[{"code":"Px0000366598L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.83,"discounted_cash":78.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH BLN HSG SHOLKOFF","code_information":[{"code":"Px0000366600L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.0,"discounted_cash":128.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC DRAINAGE SET FUHRMAN PLEURAL G55723","code_information":[{"code":"Px0000367013L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":308.0,"discounted_cash":231.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH CV PRESS INJ 3L 7FR 20CM CDC45703XP1A","code_information":[{"code":"Px0000368960L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":341.64,"discounted_cash":256.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBING VACUUM ASSIST 1/4 X32","code_information":[{"code":"Px0000369224L","type":"CDM"}],"standard_charges":[{"gross_charge":238.44,"discounted_cash":178.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GUIDEWIRE HYDRO STD ANG 35/150","code_information":[{"code":"Px0000369332L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.28,"discounted_cash":73.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BLN ARMADA .014 2.0X80X150 A2020080","code_information":[{"code":"Px0000369834L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":340.0,"discounted_cash":255.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BATTERY HRTMET 14V LI-ON SET","code_information":[{"code":"Px0000372405L","type":"CDM"},{"code":"Q0506","type":"HCPCS"}],"standard_charges":[{"gross_charge":1890.0,"discounted_cash":1417.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CLIP BATT HRTME LI-ON 14V SET","code_information":[{"code":"Px0000372406L","type":"CDM"},{"code":"Q0497","type":"HCPCS"}],"standard_charges":[{"gross_charge":1669.14,"discounted_cash":1251.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CHARGER HRTMTE BATT UNIV","code_information":[{"code":"Px0000372411L","type":"CDM"},{"code":"Q0495","type":"HCPCS"}],"standard_charges":[{"gross_charge":19296.0,"discounted_cash":14472.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH CENTESIS 5FR 7CM","code_information":[{"code":"Px0000372561L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.58,"discounted_cash":48.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT TUBE FEEDING JEJU 18F 3.0","code_information":[{"code":"Px0000372621L","type":"CDM"}],"standard_charges":[{"gross_charge":487.0,"discounted_cash":365.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT TUBE FEEDING JEJU 18F 3.5 02301835","code_information":[{"code":"Px0000372622L","type":"CDM"}],"standard_charges":[{"gross_charge":321.11,"discounted_cash":240.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BRIDLE NASAL 10FR TEAL 44110","code_information":[{"code":"Px0000372974L","type":"CDM"}],"standard_charges":[{"gross_charge":249.05,"discounted_cash":186.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BRIDLE NASAL 12FR DARK BLUE","code_information":[{"code":"Px0000372975L","type":"CDM"}],"standard_charges":[{"gross_charge":249.05,"discounted_cash":186.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT TUBE FEED JEJU 18FR 4.0","code_information":[{"code":"Px0000373011L","type":"CDM"}],"standard_charges":[{"gross_charge":487.49,"discounted_cash":365.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT BASIC TIP DURAMAX 24CM H787103028035","code_information":[{"code":"Px0000374024L","type":"CDM"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":778.0,"discounted_cash":583.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC STENT URO MACLOC 10.2FR 26CM G48166","code_information":[{"code":"Px0000374035L","type":"CDM"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":273.98,"discounted_cash":205.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CABLE HRTMTE PAT 14V","code_information":[{"code":"Px0000374514L","type":"CDM"},{"code":"Q0508","type":"HCPCS"}],"standard_charges":[{"gross_charge":3463.0,"discounted_cash":2597.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH PICC PWR TCS DL 5FR FULL 1275108","code_information":[{"code":"Px0000375324L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":580.0,"discounted_cash":435.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BLOOD PUMP CENTRIMAG DISP 20190015","code_information":[{"code":"Px0000375741L","type":"CDM"}],"standard_charges":[{"gross_charge":28836.0,"discounted_cash":21627.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC DRSG ABD ABTHERA OPEN SENSA M82750265","code_information":[{"code":"Px0000375884L","type":"CDM"}],"standard_charges":[{"gross_charge":1349.0,"discounted_cash":1011.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MILK HUMAN FORTIFIER PROLACT +4 10ML 9390110","code_information":[{"code":"Px0000375923L","type":"CDM"}],"standard_charges":[{"gross_charge":27.82,"discounted_cash":20.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MILK HUMAN FORTIFIER PROLACT +4 20ML 9390120","code_information":[{"code":"Px0000375924L","type":"CDM"}],"standard_charges":[{"gross_charge":27.81,"discounted_cash":20.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MILK HUMAN FORTIFIER PROLACT +6 30ML 9390130","code_information":[{"code":"Px0000375925L","type":"CDM"}],"standard_charges":[{"gross_charge":27.81,"discounted_cash":20.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MILK HUMAN FORTIFIER PROLACT +8 40ML 9390140","code_information":[{"code":"Px0000375926L","type":"CDM"}],"standard_charges":[{"gross_charge":27.81,"discounted_cash":20.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MILK HUMAN FORTIFIER PROLACT +10 50ML 9390150","code_information":[{"code":"Px0000375927L","type":"CDM"}],"standard_charges":[{"gross_charge":27.81,"discounted_cash":20.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TRAY BIOPSY ONCONTROL 152MM 9411VC006","code_information":[{"code":"Px0000376101L","type":"CDM"},{"code":"C1830","type":"HCPCS"}],"standard_charges":[{"gross_charge":416.55,"discounted_cash":312.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SHEATH PINNACLE 4FR MARKER","code_information":[{"code":"Px0000378320L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":44.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH SKATER BILIARY DRAIN 10FR 755310040","code_information":[{"code":"Px0000378765L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.56,"discounted_cash":202.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SYSTEM INCISION MGMT PREVENA PRE1001US","code_information":[{"code":"Px0000384110L","type":"CDM"}],"standard_charges":[{"gross_charge":1228.0,"discounted_cash":921.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BLN ARMDA .035 5X20MMX80CM B1050020","code_information":[{"code":"Px0000385271L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":138.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BLN ARMDA .035 5X40MMX80CM B1050040","code_information":[{"code":"Px0000385272L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":138.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BLN ARMDA .035 5X60MMX80CM B1050060","code_information":[{"code":"Px0000385273L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":138.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BLN ARMDA .035 6X20MMX80CM B1060020","code_information":[{"code":"Px0000385277L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.0,"discounted_cash":132.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BLN ARMDA .035 6X40MMX80CM B1060040","code_information":[{"code":"Px0000385278L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":138.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BLN ARMDA .035 6X60MMX80CM","code_information":[{"code":"Px0000385279L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":138.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BLN ARMDA .035 7X20MMX80CM B1070020","code_information":[{"code":"Px0000385283L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.8,"discounted_cash":131.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BLN ARMDA .035 7X40MMX80CM B1070040","code_information":[{"code":"Px0000385284L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":138.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BLN ARMDA .035 7X60MMX80CM","code_information":[{"code":"Px0000385285L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":138.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BLN ARMDA .035 8X20MMX80CM B1080020","code_information":[{"code":"Px0000385289L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.0,"discounted_cash":132.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BLN ARMDA .035 8X40MMX80CM B1080040","code_information":[{"code":"Px0000385290L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":138.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BLN ARMDA .035 8X60MMX80CM","code_information":[{"code":"Px0000385291L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":138.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BLN ARMDA .035 8X80MMX80CM B1080080","code_information":[{"code":"Px0000385292L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":138.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BLN ARMDA .035 9X20MMX80CM B1090020","code_information":[{"code":"Px0000385293L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.0,"discounted_cash":132.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BLN ARMDA .035 9X40MMX80CM B1090040","code_information":[{"code":"Px0000385294L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":138.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BLN ARMDA .035 10X20MMX80CM B1100020","code_information":[{"code":"Px0000385297L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":138.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BLN ARMDA .035 10X40MMX80CM B1100040","code_information":[{"code":"Px0000385298L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":138.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BLN ARMDA .035 12X40MMX80CM B1120040","code_information":[{"code":"Px0000385302L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":138.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BLN ARMDA .035 6X20MMX135CM B2060020","code_information":[{"code":"Px0000385323L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":138.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BLN ARMDA .035 7X40MMX135CM B2070040","code_information":[{"code":"Px0000385330L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":138.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BLN ARMDA .035 8X40MMX135CM B2080040","code_information":[{"code":"Px0000385336L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":138.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BLN ARMDA .035 10X40MMX135CM B2100040","code_information":[{"code":"Px0000385344L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":138.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BLN ARMDA .035 14X40MMX135CM B2140040","code_information":[{"code":"Px0000385352L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":138.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH PICC PWR TL 5FR HF TY 3385108Q","code_information":[{"code":"Px0000386113L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":504.0,"discounted_cash":378.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH PICC PWR TCS TL 5FR HF TY","code_information":[{"code":"Px0000386721L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":657.0,"discounted_cash":492.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC HANDPIECE EVIVA 9G X 13CM 12MM EVIVA091312T","code_information":[{"code":"Px0000387036L","type":"CDM"}],"standard_charges":[{"gross_charge":582.41,"discounted_cash":436.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH SKATER BILIARY DRAIN 12FR 755312040","code_information":[{"code":"Px0000387497L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.56,"discounted_cash":202.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH SKATER NEPHRO DRAIN 10F 755610035","code_information":[{"code":"Px0000387498L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.56,"discounted_cash":202.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH FOLEY SILICONE 30FR X 30CC","code_information":[{"code":"Px0000387503L","type":"CDM"},{"code":"A4344","type":"HCPCS"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":4.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC DRAIN CHEST EXPR SGL 4000100N","code_information":[{"code":"Px0000388429L","type":"CDM"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":114.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SYS BOWEL MGMT DIGNICARE ADV SMS002","code_information":[{"code":"Px0000388838L","type":"CDM"}],"standard_charges":[{"gross_charge":319.37,"discounted_cash":239.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CLIP SECURMARK FOR ATEC 36-12","code_information":[{"code":"Px0000390361L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.99,"discounted_cash":110.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CLIP SECURMARK FOR CELERO 2S","code_information":[{"code":"Px0000390362L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.99,"discounted_cash":110.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CLIP SECURMARK FOR ATEC MRI SS2","code_information":[{"code":"Px0000390363L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.99,"discounted_cash":110.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BLN BAKRI POSTPARTUM RAPID G24237 CDM","code_information":[{"code":"Px0000392702L","type":"CDM"},{"code":"C2628","type":"HCPCS"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH PICC PWR 3CG SL 4FR MAX 1194108D","code_information":[{"code":"Px0000393400L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":629.0,"discounted_cash":471.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH PICC PWR 3CG DL 5FR MAX 1295108D","code_information":[{"code":"Px0000393401L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":662.0,"discounted_cash":496.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC DRSG VAC VERAFLO MED ULTVFL05MD","code_information":[{"code":"Px0000397886L","type":"CDM"},{"code":"A6550","type":"HCPCS"}],"standard_charges":[{"gross_charge":317.03,"discounted_cash":237.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CASSETTE VAC VERALINK ULTLNK0500","code_information":[{"code":"Px0000397888L","type":"CDM"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":114.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL LOC GHAT 20GAX14CM WR-35CM 47020","code_information":[{"code":"Px0000402273L","type":"CDM"},{"code":"C1819","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.04,"discounted_cash":51.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL LOC GHAT 20GAX3CM WR-15CM 47320","code_information":[{"code":"Px0000402275L","type":"CDM"},{"code":"C1819","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.25,"discounted_cash":48.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL LOC GHAT 20GAX9CM WR-20CM 47920","code_information":[{"code":"Px0000402276L","type":"CDM"},{"code":"C1819","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.25,"discounted_cash":48.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT PASV 4FR XCELA PICC 55CM","code_information":[{"code":"Px0000410965L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":829.19,"discounted_cash":621.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC INTRODUCER VASC 8FR 30CM G07878","code_information":[{"code":"Px0000415671L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":116.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC BOOT HEEL ROOKE FLOAT","code_information":[{"code":"Px0000416701L","type":"CDM"}],"standard_charges":[{"gross_charge":282.75,"discounted_cash":212.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MARKER BX SECURMARK EVIVA INFINITY SMARKE13SS2","code_information":[{"code":"Px0000421809L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SHEATH VASC SAFE2 PEEL 9F 13CM SS9","code_information":[{"code":"Px0000424288L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.46,"discounted_cash":67.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CTRLR BACK UP PKT HRTMTE II","code_information":[{"code":"Px0000432200L","type":"CDM"},{"code":"Q0506","type":"HCPCS"}],"standard_charges":[{"gross_charge":1405.0,"discounted_cash":1053.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BAG PC CONSOL HRTMTE II LT","code_information":[{"code":"Px0000432201L","type":"CDM"},{"code":"Q0499","type":"HCPCS"}],"standard_charges":[{"gross_charge":920.0,"discounted_cash":690.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BAG PC CONSOL HRTMTE II RT","code_information":[{"code":"Px0000432202L","type":"CDM"},{"code":"Q0499","type":"HCPCS"}],"standard_charges":[{"gross_charge":989.82,"discounted_cash":742.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC HOLTER VEST, SMALL POCKET CONTROLLER","code_information":[{"code":"Px0000432203L","type":"CDM"},{"code":"Q0498","type":"HCPCS"}],"standard_charges":[{"gross_charge":357.67,"discounted_cash":268.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC HOLTER VEST, MEDIUM POCKET CONTROLLER","code_information":[{"code":"Px0000432204L","type":"CDM"},{"code":"Q0498","type":"HCPCS"}],"standard_charges":[{"gross_charge":409.0,"discounted_cash":306.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC HOLTER VEST, LARGE POCKET CONTROLLER","code_information":[{"code":"Px0000432205L","type":"CDM"},{"code":"Q0498","type":"HCPCS"}],"standard_charges":[{"gross_charge":1114.0,"discounted_cash":835.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SHOWER BAG POCKET CONTROLLER","code_information":[{"code":"Px0000432207L","type":"CDM"},{"code":"Q0501","type":"HCPCS"}],"standard_charges":[{"gross_charge":1269.0,"discounted_cash":951.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC WEARABLE ACCESS KIT","code_information":[{"code":"Px0000432208L","type":"CDM"},{"code":"Q0508","type":"HCPCS"}],"standard_charges":[{"gross_charge":498.0,"discounted_cash":373.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BATTERY RECHG HM II","code_information":[{"code":"Px0000433907L","type":"CDM"},{"code":"Q0495","type":"HCPCS"}],"standard_charges":[{"gross_charge":264.0,"discounted_cash":198.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE LARY PRVX 9/55","code_information":[{"code":"Px0000434309L","type":"CDM"}],"standard_charges":[{"gross_charge":480.81,"discounted_cash":360.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE LARY PRVX 10/55","code_information":[{"code":"Px0000434310L","type":"CDM"}],"standard_charges":[{"gross_charge":480.81,"discounted_cash":360.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GWIRE PICC SS .018X80CM","code_information":[{"code":"Px0000437520L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.0,"discounted_cash":61.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GUIDEWIRE HYDRO STR SS 35/180 LWSTDS35180","code_information":[{"code":"Px0000439748L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.09,"discounted_cash":70.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH BLN CODA 9FR 32MMX120CM G03831","code_information":[{"code":"Px0000441101L","type":"CDM"},{"code":"C2628","type":"HCPCS"}],"standard_charges":[{"gross_charge":1249.0,"discounted_cash":936.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC PACK PROC TENOTMY TX1 5541003001","code_information":[{"code":"Px0000447803L","type":"CDM"}],"standard_charges":[{"gross_charge":1377.0,"discounted_cash":1032.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC STNT BILI SUPERA 4.5MMX80MMX120CM 6FR S45080120P6","code_information":[{"code":"Px0000449402L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3445.0,"discounted_cash":2583.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH CVC POWER KIT 8.5 FR CDC42854XP1A","code_information":[{"code":"Px0000449434L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":391.0,"discounted_cash":293.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC STNT BILI SUPERA 5.5MMX40MMX120CM 6FR S55040120P6","code_information":[{"code":"Px0000449683L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3336.0,"discounted_cash":2502.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH CVC DL 7 FR 20 CM","code_information":[{"code":"Px0000454589L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":318.0,"discounted_cash":238.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SET HLS ADVANCED 701052794","code_information":[{"code":"Px0000456393L","type":"CDM"}],"standard_charges":[{"gross_charge":30705.0,"discounted_cash":23028.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC ALGRFT TISS EPIFIX DISC 14MM GS5140","code_information":[{"code":"Px0000457174L","type":"CDM"},{"code":"Q4186","type":"HCPCS"}],"standard_charges":[{"gross_charge":500.55,"discounted_cash":375.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC ALGRFT TISS EPIFIX 2X3CM GS5230","code_information":[{"code":"Px0000457175L","type":"CDM"},{"code":"Q4186","type":"HCPCS"}],"standard_charges":[{"gross_charge":598.0,"discounted_cash":448.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC STENT VIABAHN A HEP 7X5X120CM VBHR070502A","code_information":[{"code":"Px0000458372L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":7582.0,"discounted_cash":5686.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC STENT VIABAHN A HEP 7X10X120CM VBHR071002A","code_information":[{"code":"Px0000458374L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":7812.0,"discounted_cash":5859.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC STENT VIABAHN A HEP 7X15X120CM VBHR071502A","code_information":[{"code":"Px0000458376L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":9884.0,"discounted_cash":7413.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC STENT VIABAHN A HEP 8X5X120CM VBHR080502A","code_information":[{"code":"Px0000458381L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":7582.0,"discounted_cash":5686.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE FEED TG M-KEY 22FX3.5X45 0270223545","code_information":[{"code":"Px0000458956L","type":"CDM"}],"standard_charges":[{"gross_charge":932.77,"discounted_cash":699.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GLIDEWIRE ANG ADV .018X180CM","code_information":[{"code":"Px0000462937L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":571.0,"discounted_cash":428.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GLIDEWIRE ANG ADV .014X180CM EA 1 EA","code_information":[{"code":"Px0000462939L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GLIDEWIRE ANG ADV .014X300CM GA1430","code_information":[{"code":"Px0000462940L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":637.0,"discounted_cash":477.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MILK HUMAN PROLACTA CREAM 10ML CALORIC FORTIFIER","code_information":[{"code":"Px0000463588L","type":"CDM"}],"standard_charges":[{"gross_charge":17.8,"discounted_cash":13.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC INST BIOP CORE MISSION 18G 10CM 1810MSK","code_information":[{"code":"Px0000463600L","type":"CDM"}],"standard_charges":[{"gross_charge":120.31,"discounted_cash":90.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC INST BIOP CORE MISSION 18G 16CM 1816MSK","code_information":[{"code":"Px0000463601L","type":"CDM"}],"standard_charges":[{"gross_charge":120.31,"discounted_cash":90.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC INST BIOP CORE MISSION 18G 20CM 1820MSK","code_information":[{"code":"Px0000463602L","type":"CDM"}],"standard_charges":[{"gross_charge":120.31,"discounted_cash":90.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC INST BIOP CORE MISSION 20G 20CM 2020MSK","code_information":[{"code":"Px0000463603L","type":"CDM"}],"standard_charges":[{"gross_charge":120.31,"discounted_cash":90.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC INST BIOP CORE MISSION 20G 16CM 2016MSK","code_information":[{"code":"Px0000463604L","type":"CDM"}],"standard_charges":[{"gross_charge":120.31,"discounted_cash":90.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC INST BIOP CORE MISSION 20G 10CM 2010MSK","code_information":[{"code":"Px0000463605L","type":"CDM"}],"standard_charges":[{"gross_charge":120.31,"discounted_cash":90.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL CRYOABLATION ICEROD 1.5 CX FPRPR3533","code_information":[{"code":"Px0000465530L","type":"CDM"},{"code":"C2618","type":"HCPCS"}],"standard_charges":[{"gross_charge":4950.0,"discounted_cash":3712.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MARKER TISSUE BRST VI 14G SMUC10V","code_information":[{"code":"Px0000511176L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.84,"discounted_cash":138.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MARKER TISSUE BRST PNK 14G","code_information":[{"code":"Px0000511177L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.48,"discounted_cash":166.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH CV PRES MNTR SL 2.5F 15CM G02838","code_information":[{"code":"Px0000514243L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.85,"discounted_cash":92.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC PACK CUST ECMO CP PRIM","code_information":[{"code":"Px0000516095L","type":"CDM"}],"standard_charges":[{"gross_charge":693.35,"discounted_cash":520.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE FEED J MIC-KEY LP 14F 3.5","code_information":[{"code":"Px0000536362L","type":"CDM"}],"standard_charges":[{"gross_charge":499.0,"discounted_cash":374.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TRAY BIOP COAX ONCTRL 15X19CM","code_information":[{"code":"Px0000536441L","type":"CDM"}],"standard_charges":[{"gross_charge":1318.35,"discounted_cash":988.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TRAY BIOP COAX ONCTRL 10X14CM 9464VC006","code_information":[{"code":"Px0000536442L","type":"CDM"},{"code":"C1830","type":"HCPCS"}],"standard_charges":[{"gross_charge":1318.35,"discounted_cash":988.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC ALGRFT TISS EPIFIX 18MM DISK GS5180","code_information":[{"code":"Px0000546501L","type":"CDM"},{"code":"Q4186","type":"HCPCS"}],"standard_charges":[{"gross_charge":694.4,"discounted_cash":520.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC ALGRFT TISS EPIFIX 2X2CM GS5220","code_information":[{"code":"Px0000546502L","type":"CDM"},{"code":"Q4186","type":"HCPCS"}],"standard_charges":[{"gross_charge":640.31,"discounted_cash":480.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC ALGRFT TISS EPIFIX 2X4CM GS5240","code_information":[{"code":"Px0000546503L","type":"CDM"},{"code":"Q4186","type":"HCPCS"}],"standard_charges":[{"gross_charge":504.0,"discounted_cash":378.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GRAFT AMNIOTIC EPIFIX 3.5X3.5CM ES3300","code_information":[{"code":"Px0000546506L","type":"CDM"},{"code":"Q4186","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":229.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MESH EPFIX 4X 4.5 CM ES4400","code_information":[{"code":"Px0000546507L","type":"CDM"},{"code":"Q4186","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.13,"discounted_cash":38.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC PNEUMOTHORAX TRAY 14FR 29CMN G56537","code_information":[{"code":"Px0000547367L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":648.07,"discounted_cash":486.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BLN OTW ARMDA .18 4.0X40X90CM EA 1 EA","code_information":[{"code":"Px0000590690L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":284.0,"discounted_cash":213.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BLN OTW ARMDA .18 5.0X40X90CM EA 1 EA","code_information":[{"code":"Px0000590699L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":284.0,"discounted_cash":213.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SET BOWL CELL SAVER 225","code_information":[{"code":"Px0000591212L","type":"CDM"}],"standard_charges":[{"gross_charge":312.72,"discounted_cash":234.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CANNULA BEQ-HLS AS 17F X 15CM 701053087","code_information":[{"code":"Px0000593999L","type":"CDM"}],"standard_charges":[{"gross_charge":1049.32,"discounted_cash":786.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CANNULA BEQ-HLS AS 19F","code_information":[{"code":"Px0000594000L","type":"CDM"}],"standard_charges":[{"gross_charge":1049.32,"discounted_cash":786.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CANNULA BEQ-HLS AS 21F X 15CM 701053089","code_information":[{"code":"Px0000594001L","type":"CDM"}],"standard_charges":[{"gross_charge":1049.32,"discounted_cash":786.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CANNULA BEQ-HLS VL 23F 701053092","code_information":[{"code":"Px0000594003L","type":"CDM"}],"standard_charges":[{"gross_charge":1490.0,"discounted_cash":1117.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL W/ 0.28X20MM GOLD ANCHOR MRKR 0.5X150M","code_information":[{"code":"Px0000594212L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":380.9,"discounted_cash":285.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MARKER BRST 14GA 10CM SMUC10H","code_information":[{"code":"Px0000596103L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.84,"discounted_cash":138.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TRAY CATH MHRKR SE 12FR 20CM 8888221420","code_information":[{"code":"Px0000596634L","type":"CDM"},{"code":"C1752","type":"HCPCS"}],"standard_charges":[{"gross_charge":344.0,"discounted_cash":258.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TRAY CATH MHRKR CE 12FR 20CM","code_information":[{"code":"Px0000596635L","type":"CDM"},{"code":"C1752","type":"HCPCS"}],"standard_charges":[{"gross_charge":344.0,"discounted_cash":258.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TRAY CATH MHRKR CE 12FR 16CM","code_information":[{"code":"Px0000596638L","type":"CDM"},{"code":"C1752","type":"HCPCS"}],"standard_charges":[{"gross_charge":344.0,"discounted_cash":258.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TRAY CATH MHRKR SE 12FR 24CM","code_information":[{"code":"Px0000596639L","type":"CDM"},{"code":"C1752","type":"HCPCS"}],"standard_charges":[{"gross_charge":344.0,"discounted_cash":258.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC STENT ZILVER S PTX 8X60MM G38516","code_information":[{"code":"Px0000604364L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":4141.0,"discounted_cash":3105.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC INST BIOPSY CORE NDL 12GX10CM MQK1210","code_information":[{"code":"Px0000607519L","type":"CDM"}],"standard_charges":[{"gross_charge":253.66,"discounted_cash":190.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TRAY IC MHRKR CRV DL 12FRX20CM","code_information":[{"code":"Px0000607671L","type":"CDM"},{"code":"C1752","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.08,"discounted_cash":233.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH BIOFL DURAMAX 15.5FR 24CM H965103028031","code_information":[{"code":"Px0000607693L","type":"CDM"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":576.45,"discounted_cash":432.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CLIP APPLR SURGICLIP SM-9.0 133650","code_information":[{"code":"Px0000607779L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.92,"discounted_cash":35.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC DEVICE CRE SERTERA SPR LD 12G SERTERA12","code_information":[{"code":"Px0000608261L","type":"CDM"}],"standard_charges":[{"gross_charge":184.6,"discounted_cash":138.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC DEVICE CRE SERTERA SPR LD 14G SERTERA14","code_information":[{"code":"Px0000608262L","type":"CDM"}],"standard_charges":[{"gross_charge":184.59,"discounted_cash":138.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TRAY THRACNTSIS SFTY PLS C","code_information":[{"code":"Px0000608892L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.64,"discounted_cash":58.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BIOSENTRY SEALANT SYS 768022019S","code_information":[{"code":"Px0000610418L","type":"CDM"},{"code":"C2613","type":"HCPCS"}],"standard_charges":[{"gross_charge":987.0,"discounted_cash":740.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC ELCTRD RESUS 1 STEP ADLT 8EA 8900021401","code_information":[{"code":"Px0000610652L","type":"CDM"}],"standard_charges":[{"gross_charge":224.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH BLN CODA 10FR 140CM G23773","code_information":[{"code":"Px0000610709L","type":"CDM"},{"code":"C2628","type":"HCPCS"}],"standard_charges":[{"gross_charge":1249.0,"discounted_cash":936.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC ALGRFT GRAFIX PRIME 1.5X2CM PS11015 3SQCM","code_information":[{"code":"Px0000610775L","type":"CDM"},{"code":"Q4133","type":"HCPCS"}],"standard_charges":[{"gross_charge":739.0,"discounted_cash":554.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC DRSG ALGRFT GRAFIX PRIME 2X3 CM EA PS11023 6SQCM","code_information":[{"code":"Px0000610776L","type":"CDM"},{"code":"Q4133","type":"HCPCS"}],"standard_charges":[{"gross_charge":463.0,"discounted_cash":347.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC DRSG ALGRFT GRAFIX PRIME 3X4 CM EA PS11034 12SQCM","code_information":[{"code":"Px0000610777L","type":"CDM"},{"code":"Q4133","type":"HCPCS"}],"standard_charges":[{"gross_charge":281.0,"discounted_cash":210.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC DRSG ALGRFT GRAFIX PRIME 5X5 CM EA PS11055 25SQCM","code_information":[{"code":"Px0000610778L","type":"CDM"},{"code":"Q4133","type":"HCPCS"}],"standard_charges":[{"gross_charge":294.0,"discounted_cash":220.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC DRSG ALGRFT GRAFIX CRE 1.5X2CM PS12015 3SQCM","code_information":[{"code":"Px0000610781L","type":"CDM"},{"code":"Q4132","type":"HCPCS"}],"standard_charges":[{"gross_charge":739.0,"discounted_cash":554.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC DRSG ALGRFT GRAFIX CRE 2X3CM PS12023","code_information":[{"code":"Px0000610782L","type":"CDM"},{"code":"Q4132","type":"HCPCS"}],"standard_charges":[{"gross_charge":462.68,"discounted_cash":347.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SET BIOPSY LIVER ACCESS G50779","code_information":[{"code":"Px0000612523L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1179.0,"discounted_cash":884.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT WND PREVENA PEEL/PLC 13CM PRE1101US","code_information":[{"code":"Px0000613314L","type":"CDM"}],"standard_charges":[{"gross_charge":1228.0,"discounted_cash":921.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MILK HUMAN PROLACT RTF 26 100ML 95026100","code_information":[{"code":"Px0000616189L","type":"CDM"}],"standard_charges":[{"gross_charge":8.9,"discounted_cash":6.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MILK HUMAN PROLACT RTF 28 100ML 95028100","code_information":[{"code":"Px0000616190L","type":"CDM"}],"standard_charges":[{"gross_charge":11.57,"discounted_cash":8.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MARKER TISS BRST ULTCOR 17G UCTW17","code_information":[{"code":"Px0000622671L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":235.54,"discounted_cash":176.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH CV POWER POLY MDL SL 4FR P4154108D","code_information":[{"code":"Px0000623259L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":390.0,"discounted_cash":292.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SYS INCIS MGMT PREVENA PLUS PRE4001US","code_information":[{"code":"Px0000624882L","type":"CDM"},{"code":"A6550","type":"HCPCS"}],"standard_charges":[{"gross_charge":1607.0,"discounted_cash":1205.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC INST CORE BIOP MARQUEE DSP 16G","code_information":[{"code":"Px0000625021L","type":"CDM"}],"standard_charges":[{"gross_charge":161.15,"discounted_cash":120.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BRACE KNEE ADV CIR LSS 26I","code_information":[{"code":"Px0000637119L","type":"CDM"},{"code":"L1832","type":"HCPCS"}],"standard_charges":[{"gross_charge":310.0,"discounted_cash":232.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SHEATH VASC FLXSHTH 12F 33CM DSF1233","code_information":[{"code":"Px0000637127L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":716.0,"discounted_cash":537.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH ICY INTVASC HME IC-38","code_information":[{"code":"Px0000638029L","type":"CDM"}],"standard_charges":[{"gross_charge":2291.0,"discounted_cash":1718.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT MARQUEE W/COAX 14GAX10CM","code_information":[{"code":"Px0000638781L","type":"CDM"}],"standard_charges":[{"gross_charge":158.0,"discounted_cash":118.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC LIGASURE IMPACT 36MM-18CM LF4418","code_information":[{"code":"Px0000638812L","type":"CDM"}],"standard_charges":[{"gross_charge":1601.7,"discounted_cash":1201.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GRAFT HUM TISS EPICORD 2X3 CM EC5230 6SQCM","code_information":[{"code":"Px0000640227L","type":"CDM"},{"code":"Q4187","type":"HCPCS"}],"standard_charges":[{"gross_charge":593.7,"discounted_cash":445.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GRAFT TISS EPICORD 3X5CM EC5350 15SQCM","code_information":[{"code":"Px0000640228L","type":"CDM"},{"code":"Q4187","type":"HCPCS"}],"standard_charges":[{"gross_charge":580.66,"discounted_cash":435.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BLN SPCMKR PRO SBT OVAL LF LAP 5MM SMBTTOVLX","code_information":[{"code":"Px0000643196L","type":"CDM"}],"standard_charges":[{"gross_charge":788.06,"discounted_cash":591.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MOBILE POWER UNIT HEARTMATE","code_information":[{"code":"Px0000644031L","type":"CDM"},{"code":"Q0479","type":"HCPCS"}],"standard_charges":[{"gross_charge":21360.0,"discounted_cash":16020.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TRAY BIOP ARW ONCTRL 6X10CM","code_information":[{"code":"Px0000659084L","type":"CDM"}],"standard_charges":[{"gross_charge":1307.0,"discounted_cash":980.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NEUROPROTECTION SYS ENROUTE SR200NPS","code_information":[{"code":"Px0000659578L","type":"CDM"},{"code":"C1884","type":"HCPCS"}],"standard_charges":[{"gross_charge":8808.0,"discounted_cash":6606.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC STENT SYS ENROUTE TRNSCAR 10X40 SR1040CS","code_information":[{"code":"Px0000659596L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":6689.0,"discounted_cash":5016.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MICRO INTRODUCER KIT 21G SR4F21G7DMP","code_information":[{"code":"Px0000659598L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":440.0,"discounted_cash":330.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GUIDEWIRE ENROUTE 0.014 SR014GW","code_information":[{"code":"Px0000659599L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":425.0,"discounted_cash":318.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE JEJU G-JET 16F X 2.0CM X 22CM","code_information":[{"code":"Px0000659848L","type":"CDM"}],"standard_charges":[{"gross_charge":1234.0,"discounted_cash":925.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE JEJU G-JET 16FR 3.5X45CM","code_information":[{"code":"Px0000659858L","type":"CDM"}],"standard_charges":[{"gross_charge":1421.86,"discounted_cash":1066.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC THERAPY UNIT PREVENA PLS 125","code_information":[{"code":"Px0000659986L","type":"CDM"}],"standard_charges":[{"gross_charge":298.17,"discounted_cash":223.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC DRSG VAC VFLO CLEANSE CHCE MED ULTVCC05MDS","code_information":[{"code":"Px0000659988L","type":"CDM"}],"standard_charges":[{"gross_charge":375.16,"discounted_cash":281.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUMARK PROF Q SHP 12CM 351222","code_information":[{"code":"Px0000660351L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.36,"discounted_cash":131.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUMARK VISION 10CM","code_information":[{"code":"Px0000660352L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":233.81,"discounted_cash":175.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL BREVERA 9GA 13CM","code_information":[{"code":"Px0000660356L","type":"CDM"}],"standard_charges":[{"gross_charge":623.0,"discounted_cash":467.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC STENT LIFESTREAM 6 X 16 X 80 LSMU0800616","code_information":[{"code":"Px0000661029L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":5775.0,"discounted_cash":4331.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC STENT LIFESTREAM 8X26X80 EA LSMU0800826","code_information":[{"code":"Px0000661038L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":5754.0,"discounted_cash":4315.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC STENT LIFESTREAM 8 X 37 X 80 LSMU0800837","code_information":[{"code":"Px0000661039L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":5754.0,"discounted_cash":4315.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC STENT LIFESTREAM 10X58X80 LSMU0801058","code_information":[{"code":"Px0000661044L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":5754.0,"discounted_cash":4315.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC PACK PROC TX 2","code_information":[{"code":"Px0000661074L","type":"CDM"}],"standard_charges":[{"gross_charge":2142.0,"discounted_cash":1606.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH DRNG UNIV 12FR EA 1 EA","code_information":[{"code":"Px0000663541L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":189.0,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH DRNGE MULT 18FR 25CM G07774","code_information":[{"code":"Px0000663689L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":268.3,"discounted_cash":201.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUMARK PROF X SHP 10CM","code_information":[{"code":"Px0000663883L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.36,"discounted_cash":131.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUMARK PROF Q SHP 10CM 351220","code_information":[{"code":"Px0000663884L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.36,"discounted_cash":131.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC REFLECTOR MARKER SAVI SCOUT 5CM SSR0501","code_information":[{"code":"Px0000664459L","type":"CDM"},{"code":"C1739","type":"HCPCS"}],"standard_charges":[{"gross_charge":1297.2,"discounted_cash":972.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC REFLECTOR MARKER SAVI SCOUT 7.5CM SSR7501","code_information":[{"code":"Px0000664460L","type":"CDM"},{"code":"C1739","type":"HCPCS"}],"standard_charges":[{"gross_charge":1297.2,"discounted_cash":972.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC REFLECTOR MARKER SAVI SCOUT 10CM SSR1001","code_information":[{"code":"Px0000664461L","type":"CDM"},{"code":"C1739","type":"HCPCS"}],"standard_charges":[{"gross_charge":1297.2,"discounted_cash":972.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC ANTENNA MWA PERC EMPRINT 15CM CA15L2","code_information":[{"code":"Px0000664532L","type":"CDM"}],"standard_charges":[{"gross_charge":8226.0,"discounted_cash":6169.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC ANTENNA MWA PERC EMPRINT 20CM CA20L2","code_information":[{"code":"Px0000664533L","type":"CDM"}],"standard_charges":[{"gross_charge":8226.0,"discounted_cash":6169.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SYSTEM NSL TB BRDLE PRO 8-","code_information":[{"code":"Px0000665568L","type":"CDM"}],"standard_charges":[{"gross_charge":249.05,"discounted_cash":186.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL LOC GHIATAS BEAD 20GAX9CM 479201","code_information":[{"code":"Px0000665604L","type":"CDM"},{"code":"C1819","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.4,"discounted_cash":110.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CANNULA BEQ-HLS VL 25F 701053093","code_information":[{"code":"Px0000667915L","type":"CDM"}],"standard_charges":[{"gross_charge":1490.0,"discounted_cash":1117.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CANNULA BEQ-HLS VL 29F 701053094","code_information":[{"code":"Px0000667916L","type":"CDM"}],"standard_charges":[{"gross_charge":1490.0,"discounted_cash":1117.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CRT-D MOMENTUM IS 1 DF1 PM18","code_information":[{"code":"Px0000668173L","type":"CDM"},{"code":"C1882","type":"HCPCS"}],"standard_charges":[{"gross_charge":23752.32,"discounted_cash":17814.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CTRLR PCKT LVAD HEARTMATE 3","code_information":[{"code":"Px0000668661L","type":"CDM"},{"code":"Q0481","type":"HCPCS"}],"standard_charges":[{"gross_charge":14740.0,"discounted_cash":11055.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CABLE MOD LVAD HEARTMATE 3","code_information":[{"code":"Px0000668742L","type":"CDM"},{"code":"Q0508","type":"HCPCS"}],"standard_charges":[{"gross_charge":12783.0,"discounted_cash":9587.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC PROBE MWA CERTUS PREC PR15","code_information":[{"code":"Px0000669365L","type":"CDM"},{"code":"C1886","type":"HCPCS"}],"standard_charges":[{"gross_charge":4950.0,"discounted_cash":3712.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC PROBE MWA CERTUS MAX LK15XT","code_information":[{"code":"Px0000669367L","type":"CDM"}],"standard_charges":[{"gross_charge":5247.0,"discounted_cash":3935.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC PROBE MWA CERTUS MAX LK20XT","code_information":[{"code":"Px0000669368L","type":"CDM"}],"standard_charges":[{"gross_charge":4950.0,"discounted_cash":3712.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC PROBE MWA CERTUS PREC PR15XT","code_information":[{"code":"Px0000669369L","type":"CDM"},{"code":"C1886","type":"HCPCS"}],"standard_charges":[{"gross_charge":4950.0,"discounted_cash":3712.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC PROBE MWA CERTUS PREC PR20XT","code_information":[{"code":"Px0000669370L","type":"CDM"}],"standard_charges":[{"gross_charge":4950.0,"discounted_cash":3712.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC PROBE MWA CERTUS SR25","code_information":[{"code":"Px0000669371L","type":"CDM"}],"standard_charges":[{"gross_charge":4950.0,"discounted_cash":3712.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE FEED IRIS 10FR 43IN 461043E","code_information":[{"code":"Px0000670713L","type":"CDM"}],"standard_charges":[{"gross_charge":570.47,"discounted_cash":427.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE FEED IRIS 12 FR 43IN 461243E","code_information":[{"code":"Px0000670717L","type":"CDM"}],"standard_charges":[{"gross_charge":570.47,"discounted_cash":427.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CLIP NSL TB FEED BRDLE 18FR 44218","code_information":[{"code":"Px0000678103L","type":"CDM"}],"standard_charges":[{"gross_charge":249.0,"discounted_cash":186.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BLN LTNX AV .035 5X80X75 LX3575580V","code_information":[{"code":"Px0000678653L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":3670.0,"discounted_cash":2752.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC BLN CONQUESTT 9MM 4CM 75CM LX3575660V","code_information":[{"code":"Px0000678659L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":3463.0,"discounted_cash":2597.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KT CATH IV ANTIMIC 5ML 10CM20G","code_information":[{"code":"Px0000679403L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":319.08,"discounted_cash":239.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TRAY PICC LUMEN 5FR S1395108D4","code_information":[{"code":"Px0000679421L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":849.57,"discounted_cash":637.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TRAY PICC SL 4FR 1194108D4","code_information":[{"code":"Px0000679422L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.99,"discounted_cash":523.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TRAY PICC DL SOLO 5FR","code_information":[{"code":"Px0000679423L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":472.98,"discounted_cash":354.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SCOPE ASCOPE4 SLIM 3.8/1.2","code_information":[{"code":"Px0000680338L","type":"CDM"}],"standard_charges":[{"gross_charge":693.35,"discounted_cash":520.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH IV REINF PWRGLD 10CMX18GA F118107T","code_information":[{"code":"Px0000680427L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.06,"discounted_cash":149.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC PICC SOLO SL W/GUARDIVA 4FR","code_information":[{"code":"Px0000681230L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":720.86,"discounted_cash":540.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC ALGRFT GRAFIX PRIME PLS 16MM 2SQCM PS13016","code_information":[{"code":"Px0000682559L","type":"CDM"},{"code":"Q4133","type":"HCPCS"}],"standard_charges":[{"gross_charge":628.16,"discounted_cash":471.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC ALGRFT GRAFIX PRIME PLS 1.5X2CM 3SQCM","code_information":[{"code":"Px0000682560L","type":"CDM"},{"code":"Q4133","type":"HCPCS"}],"standard_charges":[{"gross_charge":739.2,"discounted_cash":554.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC ALGRFT GRAFIX PRIME PLS 3X3CM PS13033 9SQCM","code_information":[{"code":"Px0000682562L","type":"CDM"},{"code":"Q4133","type":"HCPCS"}],"standard_charges":[{"gross_charge":347.5,"discounted_cash":260.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC IMP REFLCT W/DEL NDL 7.5CM SGL SSR75S01","code_information":[{"code":"Px0000688187L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":1297.2,"discounted_cash":972.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CANNULA BEQ-PVS 25F X 38CM 701053098","code_information":[{"code":"Px0000702257L","type":"CDM"}],"standard_charges":[{"gross_charge":1490.0,"discounted_cash":1117.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CANNULA BEQ-PVS 23F X 38CM 701053097","code_information":[{"code":"Px0000702258L","type":"CDM"}],"standard_charges":[{"gross_charge":1490.0,"discounted_cash":1117.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT 2DRSG PICO7 NPWT 10X20CM 66022002","code_information":[{"code":"Px0000702383L","type":"CDM"}],"standard_charges":[{"gross_charge":752.78,"discounted_cash":564.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT DRSG PICO7 NPWT 10X40CM 66022014","code_information":[{"code":"Px0000702395L","type":"CDM"}],"standard_charges":[{"gross_charge":458.0,"discounted_cash":343.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BLN DC LUTONIX PTA 4X40X130 LX181304404F","code_information":[{"code":"Px0000710641L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":3336.0,"discounted_cash":2502.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC COIL EMBOLIZATION MICRO NESTER G47337 0.018INX2MMX7CM","code_information":[{"code":"Px0000710800L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.39,"discounted_cash":188.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MARKER MAGSEED 18GA 7CM","code_information":[{"code":"Px0000711359L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":1471.32,"discounted_cash":1103.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MARKER MAGSEED 18GA 12CM","code_information":[{"code":"Px0000711360L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":1471.32,"discounted_cash":1103.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SET ASPIR SIMPLE PNEUMOTHOR G05297","code_information":[{"code":"Px0000716939L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":255.2,"discounted_cash":191.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC INST CORE BIOP MSN 18GX6CM 1806MS","code_information":[{"code":"Px0000717314L","type":"CDM"}],"standard_charges":[{"gross_charge":109.08,"discounted_cash":81.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MR NDL LOC GHAT 20GAX5CM 475201","code_information":[{"code":"Px0000717343L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.61,"discounted_cash":75.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL LOC GHAT 20GAX7CM 477201","code_information":[{"code":"Px0000717344L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.4,"discounted_cash":110.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC INST CORE BIOP MARQ 18GX10CM","code_information":[{"code":"Px0000717472L","type":"CDM"},{"code":"A4215","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.2,"discounted_cash":117.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MARKER TISS SENOMARK COIL 12G","code_information":[{"code":"Px0000717490L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":228.51,"discounted_cash":171.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TISSUE MARKER RIBBON","code_information":[{"code":"Px0000717505L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.48,"discounted_cash":166.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MARKER BRST TISS COIL 14GX13CM","code_information":[{"code":"Px0000717506L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.48,"discounted_cash":166.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MARKER BRST TISS RIB 14GX13CM","code_information":[{"code":"Px0000717508L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.48,"discounted_cash":166.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MARKER BRST TISS VENUS14G X13CM","code_information":[{"code":"Px0000717509L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.48,"discounted_cash":166.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MILK HUMAN FORTIFIER PROLACT +6 15ML 9390115","code_information":[{"code":"Px0000717862L","type":"CDM"}],"standard_charges":[{"gross_charge":27.81,"discounted_cash":20.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CANNULA BEQ-HLS AL 15FR X 23CM 701053081","code_information":[{"code":"Px0000722657L","type":"CDM"}],"standard_charges":[{"gross_charge":1049.32,"discounted_cash":786.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CANNULA BEQ-HLS AL 19FR X 23CM 701053083","code_information":[{"code":"Px0000722659L","type":"CDM"}],"standard_charges":[{"gross_charge":1049.32,"discounted_cash":786.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CANNULA BEQ-HLS AL 21FR 701053084","code_information":[{"code":"Px0000722660L","type":"CDM"}],"standard_charges":[{"gross_charge":1049.32,"discounted_cash":786.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CANNULA BEQ-HLS AS 23FR X 15CM 701053090","code_information":[{"code":"Px0000722662L","type":"CDM"}],"standard_charges":[{"gross_charge":1049.32,"discounted_cash":786.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CANNULA BEQ-HLS VS 21FR X 38CM 701053096","code_information":[{"code":"Px0000722663L","type":"CDM"}],"standard_charges":[{"gross_charge":1490.0,"discounted_cash":1117.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC APPLIC HMOST FLOSEAL FAST 5ML ADS201844","code_information":[{"code":"Px0000723899L","type":"CDM"}],"standard_charges":[{"gross_charge":368.0,"discounted_cash":276.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC APPLIC HMOST FLOSEAL FAST 10ML ADS201845","code_information":[{"code":"Px0000723900L","type":"CDM"}],"standard_charges":[{"gross_charge":651.0,"discounted_cash":488.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC OXGNTR BIOLINE QUADROX-ID 701067859","code_information":[{"code":"Px0000724369L","type":"CDM"}],"standard_charges":[{"gross_charge":2653.73,"discounted_cash":1990.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC DEVICE RHINOLARYNGOSCOPE FLEXIBLE COMPACT 510001000","code_information":[{"code":"Px0000725375L","type":"CDM"}],"standard_charges":[{"gross_charge":410.0,"discounted_cash":307.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC STENT NEPHURET 8FR 20CM","code_information":[{"code":"Px0000761726L","type":"CDM"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":4111.0,"discounted_cash":3083.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC STENT NEPHURET 8FR 22CM","code_information":[{"code":"Px0000761727L","type":"CDM"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":4111.0,"discounted_cash":3083.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC STENT NEPHURET 8FR 24CM","code_information":[{"code":"Px0000761728L","type":"CDM"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":4111.0,"discounted_cash":3083.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC STENT NEPHURET 8FR 26CM","code_information":[{"code":"Px0000761729L","type":"CDM"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":4111.0,"discounted_cash":3083.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC PROBE ELEV BRST BIOPSY SYS EV12","code_information":[{"code":"Px0000761774L","type":"CDM"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TRAY CATH PICC MAX DL 4 FR S1294108D4","code_information":[{"code":"Px0000762776L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":797.35,"discounted_cash":598.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT XLUNG","code_information":[{"code":"Px0000766419L","type":"CDM"}],"standard_charges":[{"gross_charge":21783.0,"discounted_cash":16337.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC ALGRFT DERM PRE-THIN 19X22CM 418SQCM PP1500","code_information":[{"code":"Px0000772292L","type":"CDM"},{"code":"Q4128","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.48,"discounted_cash":60.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC ALGRFT DERM PRE-THIN 21X24CM 504SQCM PP0002","code_information":[{"code":"Px0000772293L","type":"CDM"},{"code":"Q4128","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.31,"discounted_cash":54.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC ALGRFT DERM PRE-THCK 17.5X20 350SQCM PP2001","code_information":[{"code":"Px0000772295L","type":"CDM"},{"code":"Q4128","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.27,"discounted_cash":62.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC ALGRFT DERM PRE-THCK 19X22CM 418SQCM PP1502","code_information":[{"code":"Px0000772296L","type":"CDM"},{"code":"Q4128","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.48,"discounted_cash":60.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC ALGRFT DERM PRE-THCK 21X24CM 504SQCM PP2002","code_information":[{"code":"Px0000772297L","type":"CDM"},{"code":"Q4128","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.31,"discounted_cash":54.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE FEEDING NASAL 12-14FR 4-421214","code_information":[{"code":"Px0000774605L","type":"CDM"}],"standard_charges":[{"gross_charge":249.05,"discounted_cash":186.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SET EXT MIC-KY ENFIT 14FR 1.5C 8140141.5","code_information":[{"code":"Px0000774907L","type":"CDM"}],"standard_charges":[{"gross_charge":263.0,"discounted_cash":197.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SET EXT MIC-KY ENFIT 18FR 2.0C 8140182","code_information":[{"code":"Px0000774932L","type":"CDM"}],"standard_charges":[{"gross_charge":263.32,"discounted_cash":197.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SET EXT MIC-KEY ENFIT 24FR 4.0C 814024400","code_information":[{"code":"Px0000774955L","type":"CDM"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":127.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT MIC SFTY PEG 20FR 818020","code_information":[{"code":"Px0000774962L","type":"CDM"}],"standard_charges":[{"gross_charge":263.47,"discounted_cash":197.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE FEED JEJU 18FR 45CM","code_information":[{"code":"Px0000774991L","type":"CDM"}],"standard_charges":[{"gross_charge":589.83,"discounted_cash":442.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SET EXT JEJU 16FR 2.5CM","code_information":[{"code":"Px0000775015L","type":"CDM"}],"standard_charges":[{"gross_charge":905.6,"discounted_cash":679.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SET EXT JEJU 22FR 3.0CM","code_information":[{"code":"Px0000775038L","type":"CDM"}],"standard_charges":[{"gross_charge":933.0,"discounted_cash":699.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC STENT VBAHN HEP 10MMX10CM 8F VBHR101002A","code_information":[{"code":"Px0000776668L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":8859.0,"discounted_cash":6644.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL BREVERA 9G 20MM 13CM BREVDISP09","code_information":[{"code":"Px0000776934L","type":"CDM"}],"standard_charges":[{"gross_charge":653.73,"discounted_cash":490.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SET APPLIC LOCALIZER 20 10CM 090007","code_information":[{"code":"Px0000776937L","type":"CDM"},{"code":"C1819","type":"HCPCS"}],"standard_charges":[{"gross_charge":775.42,"discounted_cash":581.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SET APPLIC LOCALIZER 7 10CM 090028","code_information":[{"code":"Px0000776938L","type":"CDM"},{"code":"C1819","type":"HCPCS"}],"standard_charges":[{"gross_charge":775.42,"discounted_cash":581.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SET APPLIC LOCALIZER 20 090029","code_information":[{"code":"Px0000776939L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":775.42,"discounted_cash":581.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SET APPLIC LOCALIZER-S 20 10CM","code_information":[{"code":"Px0000777003L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":501.42,"discounted_cash":376.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC HEMOFILTER CRRT TREAT OXIRIS 955503","code_information":[{"code":"Px0000780757L","type":"CDM"}],"standard_charges":[{"gross_charge":812.72,"discounted_cash":609.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC PROSTHESIS URO RECTAL SPACER KIT SPACEOAR VUE SYNTHETIC 10ML SV2101","code_information":[{"code":"Px0000781428L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":9720.0,"discounted_cash":7290.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH PICC PWR PROVENA TL 5FR S9385108D","code_information":[{"code":"Px0000781616L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":588.78,"discounted_cash":441.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT CATH 10CM 18GA STRL LF DIS F318108PT","code_information":[{"code":"Px0000800457L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":330.8,"discounted_cash":248.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CANN VEN 27FR WITHINTROUDUCER 96670127","code_information":[{"code":"Px0000804321L","type":"CDM"}],"standard_charges":[{"gross_charge":1005.05,"discounted_cash":753.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL CRYOABLAT FORCE 2.1 CX 90D FPRPR3602","code_information":[{"code":"Px0000805635L","type":"CDM"},{"code":"C2618","type":"HCPCS"}],"standard_charges":[{"gross_charge":4950.0,"discounted_cash":3712.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC  NDL CRYOABLAT PEARL 2.1 CX 90D FPRPR3601","code_information":[{"code":"Px0000805636L","type":"CDM"},{"code":"C2618","type":"HCPCS"}],"standard_charges":[{"gross_charge":4950.0,"discounted_cash":3712.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL CRYOABLAT SPHR 1.5 CX 90D  FPRPR3573","code_information":[{"code":"Px0000805637L","type":"CDM"},{"code":"C2618","type":"HCPCS"}],"standard_charges":[{"gross_charge":4950.0,"discounted_cash":3712.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MEMBRANE 2CMX4CM AMNIOBAND WC3024 8SQCM","code_information":[{"code":"Px0000824003L","type":"CDM"},{"code":"Q4157","type":"HCPCS"}],"standard_charges":[{"gross_charge":314.96,"discounted_cash":236.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MEMBRANE 4CMX4CM AMNIOBAND WC3044","code_information":[{"code":"Px0000824056L","type":"CDM"},{"code":"Q4159","type":"HCPCS"}],"standard_charges":[{"gross_charge":444.0,"discounted_cash":333.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MEMBRANE 4CMX6CM AMNIOBAND WC3046","code_information":[{"code":"Px0000824081L","type":"CDM"},{"code":"Q4161","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":243.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MEMBRANE 2CMX2CM AMNIOBAND WC3022 4SQCM","code_information":[{"code":"Px0000825916L","type":"CDM"},{"code":"Q4151","type":"HCPCS"}],"standard_charges":[{"gross_charge":539.58,"discounted_cash":404.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC ELCTRD HEADBAND EEG CERIBELL DISP NTAP","code_information":[{"code":"Px0000827254L","type":"CDM"}],"standard_charges":[{"gross_charge":1587.65,"discounted_cash":1190.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MEMBRANE 3CMX4CM AMNIOBAND WC3034 12SQCM","code_information":[{"code":"Px0000827391L","type":"CDM"},{"code":"Q4158","type":"HCPCS"}],"standard_charges":[{"gross_charge":235.25,"discounted_cash":176.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TRAY PICC 4FR DUAL LUMEN MAX B S1294108D2","code_information":[{"code":"Px0000829379L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":792.0,"discounted_cash":594.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC ALGRFT STRAVIX 2X4CM 8SQCM PS61024","code_information":[{"code":"Px0000833064L","type":"CDM"},{"code":"Q4133","type":"HCPCS"}],"standard_charges":[{"gross_charge":589.95,"discounted_cash":442.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH KIT PERIVAC PIGTAIL US M004PERIVAC1P0","code_information":[{"code":"Px0000834572L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":352.0,"discounted_cash":264.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC STENT PROSTATIC TEMP IMP WA2ITA00","code_information":[{"code":"Px0000842858L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":6811.35,"discounted_cash":5108.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC PERCLOSE PROSTYLE 1277303","code_information":[{"code":"Px0000842866L","type":"CDM"},{"code":"C1760","type":"HCPCS"}],"standard_charges":[{"gross_charge":542.0,"discounted_cash":406.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT ACC CRAN VENT W/O LIDO 46154","code_information":[{"code":"Px0000843369L","type":"CDM"},{"code":"843369L","type":"HCPCS"}],"standard_charges":[{"gross_charge":410.0,"discounted_cash":307.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC ALGRFT EPICORD 1X2CM EC-5120 2SQCM","code_information":[{"code":"Px0000847490L","type":"CDM"},{"code":"Q4187","type":"HCPCS"}],"standard_charges":[{"gross_charge":1245.74,"discounted_cash":934.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SET BEQ-HLS ADV 7050 7.0 701069078","code_information":[{"code":"Px0000868333L","type":"CDM"}],"standard_charges":[{"gross_charge":33514.0,"discounted_cash":25135.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH HEMO 13FR 15CM CRV DUAL","code_information":[{"code":"Px0000868422L","type":"CDM"},{"code":"C1752","type":"HCPCS"}],"standard_charges":[{"gross_charge":403.93,"discounted_cash":302.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC DEV BIOP BIOPINCE ULTRA FULL 18X10 360108002","code_information":[{"code":"Px0000870772L","type":"CDM"}],"standard_charges":[{"gross_charge":174.63,"discounted_cash":130.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MARKER BIOP SECURMARK TOP HAT","code_information":[{"code":"Px0000873668L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.99,"discounted_cash":110.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MARKER BIOP MRI SS SHP 1 SMARKMSS1","code_information":[{"code":"Px0000873673L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":111.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MARKER BX SECURMARK INFINITY SMARKUSS2","code_information":[{"code":"Px0000873674L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.48,"discounted_cash":73.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MARKER BIOP EVIVA 13GA TRIMARKEVIVA13","code_information":[{"code":"Px0000873679L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.3,"discounted_cash":99.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH DLYS 13FR 12.5CM CRV DUAL 5626120","code_information":[{"code":"Px0000874618L","type":"CDM"},{"code":"C1752","type":"HCPCS"}],"standard_charges":[{"gross_charge":404.0,"discounted_cash":303.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC ALGRFT MATRIX HD 5MM 4X6CM 24SQCM TDT546","code_information":[{"code":"Px0000879547L","type":"CDM"},{"code":"Q4128","type":"HCPCS"}],"standard_charges":[{"gross_charge":369.66,"discounted_cash":277.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MATRIX HEMOSTATIC WITH RECOTHROM FLOSEAL 5ML ADS202105","code_information":[{"code":"Px0001001561L","type":"CDM"}],"standard_charges":[{"gross_charge":414.56,"discounted_cash":310.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATHETER INTRA AORTIC BALLOON 0.025IN REDIGUARD 8FRX40CC IABS840C","code_information":[{"code":"Px0001001717L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":835.0,"discounted_cash":626.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUMARK CONIC 18G X 10CM 351260","code_information":[{"code":"Px0001002149L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":233.81,"discounted_cash":175.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUMARK CONIC 18G X 12CM 351262","code_information":[{"code":"Px0001002194L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":233.81,"discounted_cash":175.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATHETER BALLOON PERIPHERAL RX ENROUTE ENFLATE SR5525BC 5.5X25MM","code_information":[{"code":"Px0001003795L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":956.0,"discounted_cash":717.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KERECIS OMEGA3 3X3.5CM FATTY ACIDS GRAFT WOUND DRSG 50200S01B2D 11SQCM","code_information":[{"code":"Px0001005408L","type":"CDM"},{"code":"Q4158","type":"HCPCS"}],"standard_charges":[{"gross_charge":169.0,"discounted_cash":126.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KERECIS OMEGA3 5X7CM FATTY ACIDS GRAFT WOUND DRSG 50200S05B2D 35SQCM","code_information":[{"code":"Px0001005430L","type":"CDM"},{"code":"Q4158","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":74.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KERECIS OMEGA3 3X7CM FATTY ACIDS GRAFT WOUND DRSG 50200S0 21SQCM","code_information":[{"code":"Px0001005431L","type":"CDM"},{"code":"Q4158","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":117.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KERECIS OMEGA3 16MM FATTY ACIDS GRAFT WOUND DRSG 50200S16B2D 2SQCM","code_information":[{"code":"Px0001005432L","type":"CDM"},{"code":"Q4158","type":"HCPCS"}],"standard_charges":[{"gross_charge":1074.6,"discounted_cash":805.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KERECIS OMEGA3 1.75X1.75CM FATTY ACIDS GRAFT WOUND DRESSING 50200S00B2D","code_information":[{"code":"Px0001005438L","type":"CDM"},{"code":"Q4158","type":"HCPCS"}],"standard_charges":[{"gross_charge":391.0,"discounted_cash":293.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT DEV INTRAUTERINE HEMORRHAGE JADA 1047196 CDM","code_information":[{"code":"Px0001007757L","type":"CDM"},{"code":"C2628","type":"HCPCS"}],"standard_charges":[{"gross_charge":3587.15,"discounted_cash":2690.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC REFLECTOR DELIVERY SYSTEM MARKER SCOUT BX 15GAX12.3CM SSR13B-01","code_information":[{"code":"Px0001012349L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":1302.84,"discounted_cash":977.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NEEDLE PROC LOC SINGLE HAND MINI SCOUT SSR75SM01 7.5CM","code_information":[{"code":"Px0001012500L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":1297.2,"discounted_cash":972.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MILK HUMAN PROLACT RTF 24 100ML 95024100","code_information":[{"code":"Px0001012655L","type":"CDM"}],"standard_charges":[{"gross_charge":6.23,"discounted_cash":4.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SEALANT HEMOSTATIC NON ANTIMICROBIAL FLOSEAL COLLGN 10ML ADS202110","code_information":[{"code":"Px0001016602L","type":"CDM"}],"standard_charges":[{"gross_charge":711.24,"discounted_cash":533.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC HEMOSTAT SURGICEL OXIDIZED REG CELLULOSE ABSORB ORIGINAL 2X14IN","code_information":[{"code":"Px0001017434L","type":"CDM"}],"standard_charges":[{"gross_charge":377.99,"discounted_cash":283.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT BIOPSY BONE MARROW NDL TREK TKM1115 11GAX15CM","code_information":[{"code":"Px0001061586L","type":"CDM"},{"code":"C1830","type":"HCPCS"}],"standard_charges":[{"gross_charge":445.36,"discounted_cash":334.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT BIOPSY BONE MARROW NDL TREK TKM1110 11GAX10CM","code_information":[{"code":"Px0001061593L","type":"CDM"},{"code":"C1830","type":"HCPCS"}],"standard_charges":[{"gross_charge":445.36,"discounted_cash":334.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GUIDEWIRE VASCULAR STRAIGHT TIP SPLASHWIRE MSWSTDS35180 0.035INX180CM","code_information":[{"code":"Px0001062994L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.84,"discounted_cash":78.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GUIDEWIRE VASCULAR ANGLED TIP SPLASHWIRE MSWSTDA35150 0.035INX150CM","code_information":[{"code":"Px0001063008L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.28,"discounted_cash":73.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT BIOPSY BONE LESION 13GAX6CM NEEDLE TREK TKL1106 11GAX 6CM","code_information":[{"code":"Px0001073674L","type":"CDM"},{"code":"C1830","type":"HCPCS"}],"standard_charges":[{"gross_charge":948.0,"discounted_cash":711.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT BIOPSY BONE LESION 11GAX10CM NEEDLE TREK TKL110 11GAX10CM","code_information":[{"code":"Px0001073679L","type":"CDM"},{"code":"C1830","type":"HCPCS"}],"standard_charges":[{"gross_charge":948.0,"discounted_cash":711.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT BIOPSY BONE LESION 12GX10.8CM NEEDLE TREK TKL1006 10GAX6CM","code_information":[{"code":"Px0001073680L","type":"CDM"},{"code":"C1830","type":"HCPCS"}],"standard_charges":[{"gross_charge":948.05,"discounted_cash":711.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT BIOPSY BONE LESION 12GX19.8CM NEEDLE TREK TKL1015 10GAX15CM","code_information":[{"code":"Px0001073697L","type":"CDM"},{"code":"C1830","type":"HCPCS"}],"standard_charges":[{"gross_charge":948.05,"discounted_cash":711.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT BIOPSY BONE LESION 11GAX15CM NEEDLE TREK TKL1115 11GA X 15CM","code_information":[{"code":"Px0001073698L","type":"CDM"},{"code":"C1830","type":"HCPCS"}],"standard_charges":[{"gross_charge":948.05,"discounted_cash":711.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT BIOPSY BONE LESION LOW HIGH SPEED TREK TKL1010 10GAX10CM","code_information":[{"code":"Px0001073713L","type":"CDM"},{"code":"C1830","type":"HCPCS"}],"standard_charges":[{"gross_charge":948.05,"discounted_cash":711.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH VENOUS ARTERIAL BIO MEDICUS 27FRX61CM LS LS96360027","code_information":[{"code":"Px0001074172L","type":"CDM"}],"standard_charges":[{"gross_charge":1573.6,"discounted_cash":1180.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH VENOUS/ARTERIAL BIO MEDICUS LIFE SUPPORT LS96555021 21FRX55CM","code_information":[{"code":"Px0001074178L","type":"CDM"}],"standard_charges":[{"gross_charge":1475.25,"discounted_cash":1106.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH VENOUS ARTERIAL BIO MEDICUS 25FRX55CM LS LS96555025","code_information":[{"code":"Px0001074179L","type":"CDM"}],"standard_charges":[{"gross_charge":1475.25,"discounted_cash":1106.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GRAFT BIO SOFT TISSUE RECTANGLE SURGICLOSE 50205N20D0D 4X6CM 24SQCM","code_information":[{"code":"Px0001079669L","type":"CDM"},{"code":"Q4158","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.91,"discounted_cash":140.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SMARTCLIP SOFT TISSUE MARKER AND DELIVERY SYSTEM PINK 5CM","code_information":[{"code":"Px0001079738L","type":"CDM"},{"code":"C1739","type":"HCPCS"}],"standard_charges":[{"gross_charge":905.6,"discounted_cash":679.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SMARTCLIP SOFT TISSUE MARKER AND DELIVERY SYSTEM PINK 7.5CM","code_information":[{"code":"Px0001079739L","type":"CDM"},{"code":"C1739","type":"HCPCS"}],"standard_charges":[{"gross_charge":905.6,"discounted_cash":679.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SMARTCLIP SOFT TISSUE MARKER AND DELIVERY SYSTEM PINK 10CM","code_information":[{"code":"Px0001079740L","type":"CDM"},{"code":"C1739","type":"HCPCS"}],"standard_charges":[{"gross_charge":905.6,"discounted_cash":679.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SMARTCLIP SOFT TISSUE MARKER AND DELIVERY SYSTEM GREEN 5CM","code_information":[{"code":"Px0001079741L","type":"CDM"},{"code":"C1739","type":"HCPCS"}],"standard_charges":[{"gross_charge":905.6,"discounted_cash":679.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SMARTCLIP SOFT TISSUE MARKER AND DELIVERY SYSTEM GREEN 7.5CM","code_information":[{"code":"Px0001079742L","type":"CDM"},{"code":"C1739","type":"HCPCS"}],"standard_charges":[{"gross_charge":905.6,"discounted_cash":679.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SMARTCLIP SOFT TISSUE MARKER AND DELIVERY SYSTEM GREEN 10CM","code_information":[{"code":"Px0001079743L","type":"CDM"},{"code":"C1739","type":"HCPCS"}],"standard_charges":[{"gross_charge":905.6,"discounted_cash":679.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SMARTCLIP SOFT TISSUE MARKER AND DELIVERY SYSTEM PURPLE 5CM","code_information":[{"code":"Px0001079744L","type":"CDM"},{"code":"C1739","type":"HCPCS"}],"standard_charges":[{"gross_charge":1058.0,"discounted_cash":793.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SMARTCLIP SOFT TISSUE MARKER AND DELIVERY SYSTEM PURPLE 7.5CM","code_information":[{"code":"Px0001079745L","type":"CDM"},{"code":"C1739","type":"HCPCS"}],"standard_charges":[{"gross_charge":1058.0,"discounted_cash":793.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SMARTCLIP SOFT TISSUE MARKER AND DELIVERY SYSTEM PURPLE 10CM","code_information":[{"code":"Px0001079746L","type":"CDM"},{"code":"C1739","type":"HCPCS"}],"standard_charges":[{"gross_charge":1058.0,"discounted_cash":793.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MEMBRANE 3CMX8CM AMNIOBAND WC3038","code_information":[{"code":"Px0001080193L","type":"CDM"},{"code":"Q4160","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":211.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MEMBRANE 7CMX7CM AMNIOBAND WC3077","code_information":[{"code":"Px0001080197L","type":"CDM"},{"code":"Q4163","type":"HCPCS"}],"standard_charges":[{"gross_charge":427.0,"discounted_cash":320.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MEMBRANE 14MM AMNIOBAND 1.5SQCM WC3014","code_information":[{"code":"Px0001080204L","type":"CDM"},{"code":"Q4152","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":46.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MEMBRANE 10MM AMNIOBAND 1SQCM WC3010","code_information":[{"code":"Px0001080208L","type":"CDM"},{"code":"Q4151","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":39.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MEMBRANE 18MM AMNIOBAND WC3018 3SQCM","code_information":[{"code":"Px0001080217L","type":"CDM"},{"code":"Q4154","type":"HCPCS"}],"standard_charges":[{"gross_charge":443.06,"discounted_cash":332.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MEMBRANE 2CMX3CM AMNIOBAND WC3023 12SQCM","code_information":[{"code":"Px0001080223L","type":"CDM"},{"code":"Q4156","type":"HCPCS"}],"standard_charges":[{"gross_charge":196.99,"discounted_cash":147.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MEMBRANE 16MM AMNIOBAND WC3016 2SQCM","code_information":[{"code":"Px0001080226L","type":"CDM"},{"code":"Q4153","type":"HCPCS"}],"standard_charges":[{"gross_charge":606.3,"discounted_cash":454.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MEMBRANE 5CMX6CM AMNIOBAND WC3056","code_information":[{"code":"Px0001080228L","type":"CDM"},{"code":"Q4162","type":"HCPCS"}],"standard_charges":[{"gross_charge":431.0,"discounted_cash":323.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MARKER BREAST BIOPSY LOCALIZATION THRD W TUFLEX NIT 18GAX5CM 271640","code_information":[{"code":"Px0001081572L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":746.41,"discounted_cash":559.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MARKER BREAST BIOPSY LOCALIZATION THRD W TUFLEX NIT 18GAX7.5CM 271641","code_information":[{"code":"Px0001081580L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":746.41,"discounted_cash":559.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC PROSTHESIS URO PROSTATE SCULPTABLE SPACER CUSTOM KIT BARRIGEL 10263069","code_information":[{"code":"Px0001081619L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":7888.0,"discounted_cash":5916.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GRAFT BIOLOGICAL SOFT TISSUE RECTANGLE ULTRA OASIS 8213100037 3X7 CM","code_information":[{"code":"Px0001093171L","type":"CDM"},{"code":"Q4102","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.73,"discounted_cash":22.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GRAFT BIOLGCL SOFT TISS RECTANGLE ULTRAOASIS 8213100033 3X3.5CM 10.5SQCM","code_information":[{"code":"Px0001093172L","type":"CDM"},{"code":"Q4102","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.41,"discounted_cash":22.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT THERAPY DRESSING PEEL AND PLACE LG SEVEN VAC EZ5LRG.S 26X35.6CM","code_information":[{"code":"Px0001100843L","type":"CDM"}],"standard_charges":[{"gross_charge":447.82,"discounted_cash":335.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT THERAPY DRESSING PEEL AND PLACE MED VAC EZ5MED.S 23.7X29.2CM","code_information":[{"code":"Px0001100848L","type":"CDM"}],"standard_charges":[{"gross_charge":294.29,"discounted_cash":220.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT THERAPY DRESSING PEEL AND PLACE SM SEVEN VAC EZ5SML.S 16.9X20.6CM","code_information":[{"code":"Px0001100852L","type":"CDM"}],"standard_charges":[{"gross_charge":364.61,"discounted_cash":273.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATHETER CENTRAL VENOUS POWERPICC PROVENA SOLO S1294108D6 4FRX55CM","code_information":[{"code":"Px0001111767L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":884.41,"discounted_cash":663.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATHETER CENTRAL VENOUS POWERPICC PROVENA SOLO S1193108D6 3FRX55CM","code_information":[{"code":"Px0001111772L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":861.34,"discounted_cash":646.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC R&B-SEMI-PRIVATE","code_information":[{"code":"Px00012010001","type":"CDM"}],"standard_charges":[{"gross_charge":5143.0,"discounted_cash":3857.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC R&B-SEMI-PRIVATE OVERFLOW","code_information":[{"code":"Px00012010003","type":"CDM"}],"standard_charges":[{"gross_charge":5143.0,"discounted_cash":3857.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC R&B-SEMI-PRIVATE MED SURG W/ TELE","code_information":[{"code":"Px00012010009","type":"CDM"}],"standard_charges":[{"gross_charge":5143.0,"discounted_cash":3857.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC R&B-SEMI-PRIVATE ISOLATION","code_information":[{"code":"Px00012010011","type":"CDM"}],"standard_charges":[{"gross_charge":7929.0,"discounted_cash":5946.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC R&B-SEMI-PRIVATE MED SURG TELEMETRY ISOLATION","code_information":[{"code":"Px00012010024","type":"CDM"}],"standard_charges":[{"gross_charge":4373.0,"discounted_cash":3279.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC R&B-SEMI-PRIVATE MED/SURG GYN","code_information":[{"code":"Px00012110001","type":"CDM"}],"standard_charges":[{"gross_charge":5143.0,"discounted_cash":3857.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC R&B- SEMI-PRIVATE ED BOARDER","code_information":[{"code":"Px00012110005","type":"CDM"}],"standard_charges":[{"gross_charge":5143.0,"discounted_cash":3857.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC R&B-SEMI-PRIVATE OB","code_information":[{"code":"Px00012210001","type":"CDM"}],"standard_charges":[{"gross_charge":6939.0,"discounted_cash":5204.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC R&B-SEMI-PRIVATE PEDIATRIC ISOLATION","code_information":[{"code":"Px00012310002","type":"CDM"}],"standard_charges":[{"gross_charge":8593.0,"discounted_cash":6444.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC R&B-SEMI-PRIVATE REHAB ISOLATION CDM","code_information":[{"code":"Px00012800001","type":"CDM"}],"standard_charges":[{"gross_charge":8214.0,"discounted_cash":6160.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC R&B-SEMI-PRIVATE REHAB","code_information":[{"code":"Px00012810001","type":"CDM"}],"standard_charges":[{"gross_charge":7505.0,"discounted_cash":5628.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC R&B-SEMI-PRIVATE OTHER W/TELEMETRY","code_information":[{"code":"Px00012910002","type":"CDM"}],"standard_charges":[{"gross_charge":5143.0,"discounted_cash":3857.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC R&B- SEMI-PRIVATE MED SURG GYN PACU DC WARD","code_information":[{"code":"Px00013110002","type":"CDM"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC R&B ADMINISTRATIVE DAYS CMS/CA SNF LVL/WA IPF/WA LTAC CDM","code_information":[{"code":"Px00016910001","type":"CDM"}],"standard_charges":[{"gross_charge":1079.0,"discounted_cash":809.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC R&B NURSERY ROUTINE CARE","code_information":[{"code":"Px00017010001","type":"CDM"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC R&B NURSERY SPECIAL CARE","code_information":[{"code":"Px00017010003","type":"CDM"}],"standard_charges":[{"gross_charge":7207.0,"discounted_cash":5405.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC R&B NURSERY BOARDER","code_information":[{"code":"Px00017910002","type":"CDM"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC LEAVE OF ABSENCE NO CHRG","code_information":[{"code":"Px00018010001","type":"CDM"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC R&B ADMINISTRATIVE DAYS WA CDM","code_information":[{"code":"Px00019110002","type":"CDM"}],"standard_charges":[{"gross_charge":1079.0,"discounted_cash":809.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC INTENSIVE CARE","code_information":[{"code":"Px00020010001","type":"CDM"}],"standard_charges":[{"gross_charge":11891.0,"discounted_cash":8918.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC R&B-ICU ISOLATION","code_information":[{"code":"Px00020010011","type":"CDM"}],"standard_charges":[{"gross_charge":11891.0,"discounted_cash":8918.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC INTENSIVE CARE INTERMEDIATE","code_information":[{"code":"Px00020610001","type":"CDM"}],"standard_charges":[{"gross_charge":5143.0,"discounted_cash":3857.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC R&B-INTERMEDIATE/TELEMETRY ISOLATION","code_information":[{"code":"Px00020610003","type":"CDM"}],"standard_charges":[{"gross_charge":4488.0,"discounted_cash":3366.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC COLLECT BLOOD FROM IMPLANT VENOUS ACCESS DEVICE CDM","code_information":[{"code":"Px00026010005","type":"CDM"},{"code":"36591","type":"HCPCS"}],"standard_charges":[{"gross_charge":278.0,"discounted_cash":208.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BLOOD DRAW PICC OR NONIMPLANTED CENTRAL LINE CDM","code_information":[{"code":"Px00026010006","type":"CDM"},{"code":"36592","type":"HCPCS"}],"standard_charges":[{"gross_charge":674.0,"discounted_cash":505.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IV HYDRATION INITIAL HR CDM","code_information":[{"code":"Px00026010007","type":"CDM"},{"code":"96360","type":"HCPCS"}],"standard_charges":[{"gross_charge":1381.0,"discounted_cash":1035.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IV HYDRATION EACH ADDL HR CDM","code_information":[{"code":"Px00026010008","type":"CDM"},{"code":"96361","type":"HCPCS"}],"standard_charges":[{"gross_charge":452.0,"discounted_cash":339.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IV INFUSION INITIAL HR CDM","code_information":[{"code":"Px00026010009","type":"CDM"},{"code":"96365","type":"HCPCS"}],"standard_charges":[{"gross_charge":1626.0,"discounted_cash":1219.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IV INFUSION EA ADDL HR CDM","code_information":[{"code":"Px00026010010","type":"CDM"},{"code":"96366","type":"HCPCS"}],"standard_charges":[{"gross_charge":585.0,"discounted_cash":438.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IV INFUSION SEQUENTIAL DRUG 1ST HR","code_information":[{"code":"Px00026010011","type":"CDM"},{"code":"96367","type":"HCPCS"}],"standard_charges":[{"gross_charge":1306.0,"discounted_cash":979.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IV INFUSION CONCURRENT DRUG CDM","code_information":[{"code":"Px00026010012","type":"CDM"},{"code":"96368","type":"HCPCS"}],"standard_charges":[{"gross_charge":427.0,"discounted_cash":320.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ATTEMPT MIDLINE 5 YR/>","code_information":[{"code":"Px00026010031","type":"CDM"},{"code":"36410","type":"HCPCS"}],"standard_charges":[{"gross_charge":5711.0,"discounted_cash":4283.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC INSERT MIDLINE GTE 3 YR CDM","code_information":[{"code":"Px00026010033","type":"CDM"},{"code":"36410","type":"HCPCS"}],"standard_charges":[{"gross_charge":5711.0,"discounted_cash":4283.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC FOLEY CATH TRAY W/BAG","code_information":[{"code":"Px00027210301","type":"CDM"},{"code":"A4314","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":54.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD RADIATION ONCOLOGY"}]},{"description":"HC WRIST SPLINT/VELCRO","code_information":[{"code":"Px00027410120","type":"CDM"},{"code":"L3807","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":90.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC EO  NO JOINTS  CUSTOM","code_information":[{"code":"Px00027410236","type":"CDM"},{"code":"L3702","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.0,"discounted_cash":201.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC EWHO RIGID NO JOINTS  CUSTOM","code_information":[{"code":"Px00027410237","type":"CDM"},{"code":"L3763","type":"HCPCS"}],"standard_charges":[{"gross_charge":554.0,"discounted_cash":415.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC WHFO W/JOINTS W/BANDS CSTM","code_information":[{"code":"Px00027410240","type":"CDM"},{"code":"L3806","type":"HCPCS"}],"standard_charges":[{"gross_charge":564.0,"discounted_cash":423.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC WHFO RIGID  NO JOINTS CUSTOM","code_information":[{"code":"Px00027410241","type":"CDM"},{"code":"L3808","type":"HCPCS"}],"standard_charges":[{"gross_charge":307.0,"discounted_cash":230.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC WHO W/JOINTS W/BANDS CSTM","code_information":[{"code":"Px00027410242","type":"CDM"},{"code":"L3905","type":"HCPCS"}],"standard_charges":[{"gross_charge":544.0,"discounted_cash":408.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HFO NO JOINTS CUSTOM","code_information":[{"code":"Px00027410243","type":"CDM"},{"code":"L3913","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.0,"discounted_cash":201.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HAND ORTHOTIC -  NO JOINTS CUSTOM","code_information":[{"code":"Px00027410244","type":"CDM"},{"code":"L3919","type":"HCPCS"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":240.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC FO NO JOINTS CUSTOM","code_information":[{"code":"Px00027410246","type":"CDM"},{"code":"L3933","type":"HCPCS"}],"standard_charges":[{"gross_charge":167.0,"discounted_cash":125.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC WHO NO JOINTS CUSTOM","code_information":[{"code":"Px00027410269","type":"CDM"},{"code":"L3906","type":"HCPCS"}],"standard_charges":[{"gross_charge":332.0,"discounted_cash":249.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BRACHYTHERAPY NEEDLE","code_information":[{"code":"Px00027810436","type":"CDM"},{"code":"C1715","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":27.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD RADIATION ONCOLOGY"}]},{"description":"HC BRACHYTX SOURCE NS HDR IR-192","code_information":[{"code":"Px00027810509","type":"CDM"},{"code":"C1717","type":"HCPCS"}],"standard_charges":[{"gross_charge":1000.0,"discounted_cash":750.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD RADIATION ONCOLOGY"}]},{"description":"HC PROBE CRYOABLATION URO","code_information":[{"code":"Px00027910149","type":"CDM"},{"code":"C2618","type":"HCPCS"}],"standard_charges":[{"gross_charge":4961.0,"discounted_cash":3720.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CELL COUNT MISCELLANEOUS BODY FLUIDS LAB","code_information":[{"code":"Px00030000003","type":"CDM"},{"code":"89050","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.0,"discounted_cash":39.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CELL COUNT MISC BODY FLUIDS W/DIFFERENTIAL COUNT LAB","code_information":[{"code":"Px00030000004","type":"CDM"},{"code":"89051","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.0,"discounted_cash":61.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CRYSTAL ID LIGHT MICROSCOPY ALYS TISS/ANY FLUID LAB","code_information":[{"code":"Px00030000006","type":"CDM"},{"code":"89060","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":36.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CELL COUNT MISCELLANEOUS BODY FLUIDS LAB","code_information":[{"code":"Px00030000007","type":"CDM"},{"code":"89050","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.0,"discounted_cash":39.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CELL COUNT MISC BODY FLUIDS W/DIFFERENTIAL COUNT LAB","code_information":[{"code":"Px00030000008","type":"CDM"},{"code":"89051","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.0,"discounted_cash":61.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BLOOD DRAW VENIPUNCTURE CDM","code_information":[{"code":"Px00030010004","type":"CDM"},{"code":"36415","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":19.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ROUTINE VENIPUNCTURE - COLLECTION VENOUS BLD CDM","code_information":[{"code":"Px00030010009","type":"CDM"},{"code":"36415","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":19.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ROUTINE VENIPUNCTURE - IVT VENIP LAB DRAW","code_information":[{"code":"Px00030010010","type":"CDM"},{"code":"36415","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":19.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC COLLECTION CAPILLARY BLOOD SPECIMEN","code_information":[{"code":"Px00030010011","type":"CDM"},{"code":"36416","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":20.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ARTERIAL PUNCTURE WITHDRAWAL BLOOD DX CDM","code_information":[{"code":"Px00030010013","type":"CDM"},{"code":"36600","type":"HCPCS"}],"standard_charges":[{"gross_charge":440.0,"discounted_cash":330.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF VITAMIN NOT OTHERWISE SPECIFIED CDM","code_information":[{"code":"Px00030010029","type":"CDM"},{"code":"84591","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":78.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC KRAS GENE ANALYSIS VARIANTS IN EXON 2 LAB","code_information":[{"code":"Px00030010045","type":"CDM"},{"code":"81275","type":"HCPCS"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":240.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BRAF GENE ANALYSIS V600 VARIANT(S) LAB","code_information":[{"code":"Px00030010050","type":"CDM"},{"code":"81210","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC FLU A FLU B AND RSV BY PCR","code_information":[{"code":"Px00030010068","type":"CDM"},{"code":"87631","type":"HCPCS"}],"standard_charges":[{"gross_charge":295.0,"discounted_cash":221.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY IDENTIFICATION PLATELET IMMUNOGL ASSAY CDM","code_information":[{"code":"Px00030010188","type":"CDM"},{"code":"86023","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC EGFR GENE ANALYSIS COMMON VARIANTS LAB","code_information":[{"code":"Px00030010228","type":"CDM"},{"code":"81235","type":"HCPCS"}],"standard_charges":[{"gross_charge":416.0,"discounted_cash":312.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY HLA CLASS I HIGH DEFINITION PANEL QUAL","code_information":[{"code":"Px00030010256","type":"CDM"},{"code":"86832","type":"HCPCS"}],"standard_charges":[{"gross_charge":456.0,"discounted_cash":342.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY HLA CLASS II HIGH DEFINITION PANEL QUAL","code_information":[{"code":"Px00030010257","type":"CDM"},{"code":"86833","type":"HCPCS"}],"standard_charges":[{"gross_charge":459.0,"discounted_cash":344.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IADNA RESPIRATRY PROBE & REV TRNSCR 3-5 TARGETS CDM","code_information":[{"code":"Px00030010260","type":"CDM"},{"code":"87631","type":"HCPCS"}],"standard_charges":[{"gross_charge":295.0,"discounted_cash":221.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IADNA RESPIRATRY PROBE & REV TRNSCR 12-25 TARGET CDM","code_information":[{"code":"Px00030010262","type":"CDM"},{"code":"87633","type":"HCPCS"}],"standard_charges":[{"gross_charge":688.0,"discounted_cash":516.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC LEUKOCYTE ASSMT FECAL QUAL/SEMIQUANTITATIVE CDM","code_information":[{"code":"Px00030010281","type":"CDM"},{"code":"89055","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":41.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANA TITER IGG REFLEX (ARUP)","code_information":[{"code":"Px00030010416","type":"CDM"},{"code":"86039","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":34.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HEPARIN ASSOC AB - HIT (ARUP)","code_information":[{"code":"Px00030010418","type":"CDM"},{"code":"86022","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":50.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC C-REACTIVE PROTEIN HIGH SENSITIVITY CDM","code_information":[{"code":"Px00030010421","type":"CDM"},{"code":"86141","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":48.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BETA2 GLYCOPROT AB IGG (OF PNL)","code_information":[{"code":"Px00030010424","type":"CDM"},{"code":"86146","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY IDENTIFICATION PLATELET IMMUNOGL ASSAY CDM","code_information":[{"code":"Px00030010428","type":"CDM"},{"code":"86023","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC C-1-ESTERASE INHIB FUNC(ARUP)","code_information":[{"code":"Px00030010431","type":"CDM"},{"code":"86161","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":42.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC COMPLEMENT FUNCTIONAL ACTIVITY EACH COMPONENT CDM","code_information":[{"code":"Px00030010433","type":"CDM"},{"code":"86161","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":42.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC COMPLEMENT CH50 TOTAL(ARUP)","code_information":[{"code":"Px00030010434","type":"CDM"},{"code":"86162","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CCP AB IGG","code_information":[{"code":"Px00030010443","type":"CDM"},{"code":"86200","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":66.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC EBV AB VIRAL CAPSID AG IGM","code_information":[{"code":"Px00030010455","type":"CDM"},{"code":"86665","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":93.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS BE ANTIBODY (ARUP)","code_information":[{"code":"Px00030010459","type":"CDM"},{"code":"86707","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":27.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC EBV AB VIRAL CAPSID AG IGG","code_information":[{"code":"Px00030010462","type":"CDM"},{"code":"86665","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":93.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC GLOM BASEMENT MEMB AB IGG(ARUP)","code_information":[{"code":"Px00030010470","type":"CDM"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":77.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CDM","code_information":[{"code":"Px00030010472","type":"CDM"},{"code":"86316","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":33.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC THYROGLOBULIN AB","code_information":[{"code":"Px00030010478","type":"CDM"},{"code":"86800","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.0,"discounted_cash":83.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC FLUORESCENT ANTIBODY SCREEN - NONINFEC AGENT","code_information":[{"code":"Px00030010485","type":"CDM"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":77.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY TUMOR CA 19-9","code_information":[{"code":"Px00030010558","type":"CDM"},{"code":"86301","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":64.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CHROMOGRANIN A (ARUP)","code_information":[{"code":"Px00030010568","type":"CDM"},{"code":"86316","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":33.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HYPERSENS PNEUMO I (PANEL)","code_information":[{"code":"Px00030010582","type":"CDM"},{"code":"86331","type":"HCPCS"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":4.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC INHIBIN A (ARUP)","code_information":[{"code":"Px00030010615","type":"CDM"},{"code":"86336","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":54.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC INSULIN ANTIBODIES CDM","code_information":[{"code":"Px00030010617","type":"CDM"},{"code":"86337","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":57.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC EBV AB NUCLEAR AG IGG","code_information":[{"code":"Px00030010619","type":"CDM"},{"code":"86664","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":79.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ISLET CELL ANTIBODY IGG(ARUP)","code_information":[{"code":"Px00030010621","type":"CDM"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":33.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ISLET CELL ANTIBODY CDM","code_information":[{"code":"Px00030010623","type":"CDM"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":33.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC NATURAL KILLER CELLS TOTAL COUNT CDM","code_information":[{"code":"Px00030010630","type":"CDM"},{"code":"86357","type":"HCPCS"}],"standard_charges":[{"gross_charge":258.0,"discounted_cash":193.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CELL FUNCTION ASSAY W/STIM","code_information":[{"code":"Px00030010631","type":"CDM"},{"code":"86352","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":90.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC T CELLS ABSOLUTE C4 C8 COUNT","code_information":[{"code":"Px00030010632","type":"CDM"},{"code":"86360","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.0,"discounted_cash":226.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC THYROID PEROXIDASE AB (ANTI-TPO)","code_information":[{"code":"Px00030010634","type":"CDM"},{"code":"86376","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":68.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MICROSOMAL ANTIBODIES EACH CDM","code_information":[{"code":"Px00030010661","type":"CDM"},{"code":"86376","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":68.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BARTONELLA HENSELAE IGM (PANL)","code_information":[{"code":"Px00030010700","type":"CDM"},{"code":"86611","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BARTONELLA HENSELAE IGG (PANL)","code_information":[{"code":"Px00030010708","type":"CDM"},{"code":"86611","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC LYME IGM W BLOT(PANL)","code_information":[{"code":"Px00030010720","type":"CDM"},{"code":"86617","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":18.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY BORRELIA BURGDORFERI CONFIRMATORY TST CDM","code_information":[{"code":"Px00030010722","type":"CDM"},{"code":"86617","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":18.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC LYME IGG W BLOT(PANL)","code_information":[{"code":"Px00030010723","type":"CDM"},{"code":"86617","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":18.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC B BURGDORFERI AB TOTAL (ARUP)","code_information":[{"code":"Px00030010730","type":"CDM"},{"code":"86618","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":28.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY CANDIDA CDM","code_information":[{"code":"Px00030010736","type":"CDM"},{"code":"86628","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":27.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CMV IGM","code_information":[{"code":"Px00030010762","type":"CDM"},{"code":"86645","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":57.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HELMINTH ANTIBODY - STRONGYLOIDES","code_information":[{"code":"Px00030010859","type":"CDM"},{"code":"86682","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":42.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY HEP DELTA AGENT CDM","code_information":[{"code":"Px00030010872","type":"CDM"},{"code":"86692","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":56.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HISTOPLASMA YEAST AB (OF PANEL)","code_information":[{"code":"Px00030010891","type":"CDM"},{"code":"86698","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":34.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HEP B CORE IGM ANTIBODY","code_information":[{"code":"Px00030010892","type":"CDM"},{"code":"86705","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":63.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY PARVOVIRUS CDM","code_information":[{"code":"Px00030010894","type":"CDM"},{"code":"86747","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":45.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HISTOPLAS MYCELIA AB (OF PANEL)","code_information":[{"code":"Px00030010913","type":"CDM"},{"code":"86698","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":34.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HIV- 2","code_information":[{"code":"Px00030010922","type":"CDM"},{"code":"86702","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":69.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS BE ANTIBODY HBEAB CDM","code_information":[{"code":"Px00030010928","type":"CDM"},{"code":"86707","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":27.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS ANTIBODY HAAB IGM ANTIBODY CDM","code_information":[{"code":"Px00030010931","type":"CDM"},{"code":"86709","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":62.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MYCOPLASMA IGM (PANL)","code_information":[{"code":"Px00030010944","type":"CDM"},{"code":"86738","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":32.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PARVOVIRUS IGM (PANL)","code_information":[{"code":"Px00030010954","type":"CDM"},{"code":"86747","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":45.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PARVOVIRUS IGG (PANL)","code_information":[{"code":"Px00030010955","type":"CDM"},{"code":"86747","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":45.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MEASLES (RUBEOLA) AB IGM (ARUP)","code_information":[{"code":"Px00030010968","type":"CDM"},{"code":"86765","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC TOXO GONDII AB IGG(ARUP)","code_information":[{"code":"Px00030010983","type":"CDM"},{"code":"86777","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":30.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC TOXO GONDII AB IGM (PANL)","code_information":[{"code":"Px00030010993","type":"CDM"},{"code":"86778","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":21.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MHA-TP CONFIRMATION REFLX (ARUP)","code_information":[{"code":"Px00030010997","type":"CDM"},{"code":"86780","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":30.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC FTA-ABS (ARUP)","code_information":[{"code":"Px00030010998","type":"CDM"},{"code":"86780","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":30.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC TREPONEMA PALLIDUM - AB","code_information":[{"code":"Px00030010999","type":"CDM"},{"code":"86780","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":30.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC VARICELLA-ZOSTER ANTIBODY - IGG","code_information":[{"code":"Px00030011003","type":"CDM"},{"code":"86787","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY VARICELLA-ZOSTER CDM","code_information":[{"code":"Px00030011004","type":"CDM"},{"code":"86787","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC VARICELLA ZOSTER ANTIBODY","code_information":[{"code":"Px00030011005","type":"CDM"},{"code":"86787","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTINUCLEAR ANTIBODIES","code_information":[{"code":"Px00030011023","type":"CDM"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY SCREEN RBC EACH SERUM TECHNIQUE LAB","code_information":[{"code":"Px00030011040","type":"CDM"},{"code":"86850","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC THYROGLOBULIN ANTIBODY CDM","code_information":[{"code":"Px00030011045","type":"CDM"},{"code":"86800","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.0,"discounted_cash":83.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY ID RBC ANTIBODIES EA PANEL EA SERUM TQ LAB","code_information":[{"code":"Px00030011046","type":"CDM"},{"code":"86870","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":120.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY ID RBC ANTIBODIES EA PANEL EA SERUM TQ LAB","code_information":[{"code":"Px00030011050","type":"CDM"},{"code":"86870","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":120.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DIRECT COOMBS","code_information":[{"code":"Px00030011070","type":"CDM"},{"code":"86880","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":74.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTIHUMAN GLOBULIN INDIRECT EACH ANTIBODY TITER LAB","code_information":[{"code":"Px00030011079","type":"CDM"},{"code":"86886","type":"HCPCS"}],"standard_charges":[{"gross_charge":324.0,"discounted_cash":243.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BLOOD TYPING SEROLOGIC ABO LAB","code_information":[{"code":"Px00030011083","type":"CDM"},{"code":"86900","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":33.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BLOOD TYPE ANTIGEN DONOR EA","code_information":[{"code":"Px00030011098","type":"CDM"},{"code":"86902","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":54.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BLOOD TYPING RBC ANTIGENS","code_information":[{"code":"Px00030011114","type":"CDM"},{"code":"86905","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC COMPATIBILITY EACH UNIT ANTIGLOBULIN LAB","code_information":[{"code":"Px00030011123","type":"CDM"},{"code":"86922","type":"HCPCS"}],"standard_charges":[{"gross_charge":334.0,"discounted_cash":250.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC COMPATIBILITY EACH UNIT ELECTRONIC LAB","code_information":[{"code":"Px00030011125","type":"CDM"},{"code":"86923","type":"HCPCS"}],"standard_charges":[{"gross_charge":334.0,"discounted_cash":250.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC RBC PRETREATMENT SERUM - EACH CELL","code_information":[{"code":"Px00030011136","type":"CDM"},{"code":"86978","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.0,"discounted_cash":82.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MYCOPLASMA - UREA","code_information":[{"code":"Px00030011165","type":"CDM"},{"code":"87109","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":34.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MYCOBACTERIC IDENTIFICATION","code_information":[{"code":"Px00030011172","type":"CDM"},{"code":"87118","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":68.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC OVA AND PARASITES SMEARS","code_information":[{"code":"Px00030011200","type":"CDM"},{"code":"87177","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ACID FAST STAIN","code_information":[{"code":"Px00030011241","type":"CDM"},{"code":"87206","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.0,"discounted_cash":82.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC SMEAR COMPLEX STAIN-TRICHROME/OVA/PARA","code_information":[{"code":"Px00030011257","type":"CDM"},{"code":"87209","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":78.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC SMR PRIM SRC WET MOUNT NFCT AGT LAB","code_information":[{"code":"Px00030011261","type":"CDM"},{"code":"87210","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":45.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC VIRUS INOCULATION TISSUE","code_information":[{"code":"Px00030011280","type":"CDM"},{"code":"87252","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":56.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CRYPTOCOCCUS NEOFORM AG EIA","code_information":[{"code":"Px00030011352","type":"CDM"},{"code":"87327","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":48.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANA IGG REFLEX (ARUP)","code_information":[{"code":"Px00030011373","type":"CDM"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS BE ANTIGEN (ARUP)","code_information":[{"code":"Px00030011394","type":"CDM"},{"code":"87350","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":28.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IAAD IA HEPATITIS BE ANTIGEN CDM","code_information":[{"code":"Px00030011397","type":"CDM"},{"code":"87350","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":28.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASPERGILLUS AB BY ID (ARUP)","code_information":[{"code":"Px00030011417","type":"CDM"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":11.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC B BURGDORFERI PCR (ARUP)","code_information":[{"code":"Px00030011418","type":"CDM"},{"code":"87476","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":55.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC B CELLS","code_information":[{"code":"Px00030011419","type":"CDM"},{"code":"86355","type":"HCPCS"}],"standard_charges":[{"gross_charge":258.0,"discounted_cash":193.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BILIRUBIN TOTAL TRANSCUTANEOUS CDM","code_information":[{"code":"Px00030011424","type":"CDM"},{"code":"88720","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":16.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IADNA BK VIRUS QUANTIFICATION EACH ORGANISM CDM","code_information":[{"code":"Px00030011426","type":"CDM"},{"code":"87799","type":"HCPCS"}],"standard_charges":[{"gross_charge":283.0,"discounted_cash":212.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BK VIRUS QUANT PCR (ARUP)","code_information":[{"code":"Px00030011427","type":"CDM"},{"code":"87799","type":"HCPCS"}],"standard_charges":[{"gross_charge":283.0,"discounted_cash":212.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC SINGLE ALLERGEN(ARUP)","code_information":[{"code":"Px00030011431","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN FOOD HAZELNUT (ARUP)","code_information":[{"code":"Px00030011435","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN FOOD CASHEW (ARUP)","code_information":[{"code":"Px00030011438","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN WALNUT (ARUP)","code_information":[{"code":"Px00030011444","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN ALMOND (ARUP)","code_information":[{"code":"Px00030011445","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN EGG WHOLE (ARUP)","code_information":[{"code":"Px00030011449","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN PECAN (ARUP)","code_information":[{"code":"Px00030011451","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN PISTACHIO (ARUP)","code_information":[{"code":"Px00030011457","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN LATEX (ARUP)","code_information":[{"code":"Px00030011460","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC C-1-ESTERASE INHIBITOR(ARUP)","code_information":[{"code":"Px00030011484","type":"CDM"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY INFECTIOUS AGENT ANTIBODY QUAN DIPTHERIA CDM","code_information":[{"code":"Px00030011501","type":"CDM"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":53.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL","code_information":[{"code":"Px00030011502","type":"CDM"},{"code":"86592","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":25.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC COCCI AB  IGG (EIA) (PANL)","code_information":[{"code":"Px00030011506","type":"CDM"},{"code":"86635","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":12.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC COCCI AB (ID) (PANL)","code_information":[{"code":"Px00030011507","type":"CDM"},{"code":"86635","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":12.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS C ANTIBODY CDM","code_information":[{"code":"Px00030011511","type":"CDM"},{"code":"86803","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":105.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC POOLING PLATELETS/OTHER BLOOD PRODUCTS LAB","code_information":[{"code":"Px00030011514","type":"CDM"},{"code":"86965","type":"HCPCS"}],"standard_charges":[{"gross_charge":169.0,"discounted_cash":126.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CANDIDA SPECIES DNA PROBE(PANL)","code_information":[{"code":"Px00030011541","type":"CDM"},{"code":"87480","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":32.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IADNA CYTOMEGALOVIRUS QUANTIFICATION CDM","code_information":[{"code":"Px00030011582","type":"CDM"},{"code":"87497","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":93.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CYTP C/V AUTO THIN LYR PREPJ SCR MNL RESCR PHYS","code_information":[{"code":"Px00030011594","type":"CDM"},{"code":"88175","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":91.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC NASAL SMEAR EOSINOPHILS CDM","code_information":[{"code":"Px00030011610","type":"CDM"},{"code":"89190","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":48.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC EPSTEIN BARR VIRUS BY PCR","code_information":[{"code":"Px00030011612","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IADNA EPSTEIN BARR QUANTIFICATION EA ORG CDM","code_information":[{"code":"Px00030011613","type":"CDM"},{"code":"87799","type":"HCPCS"}],"standard_charges":[{"gross_charge":283.0,"discounted_cash":212.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY EA ADDTL LAB","code_information":[{"code":"Px00030011621","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":51.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY 1ST LAB","code_information":[{"code":"Px00030011626","type":"CDM"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":349.0,"discounted_cash":261.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC GARDNERELLA VAG DNA PROBE(PANL)","code_information":[{"code":"Px00030011638","type":"CDM"},{"code":"87510","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":32.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IADNA HEPATITIS C QUANT & REVERSE TRANSCRIPTION CDM","code_information":[{"code":"Px00030011653","type":"CDM"},{"code":"87522","type":"HCPCS"}],"standard_charges":[{"gross_charge":432.0,"discounted_cash":324.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC INFECTIOUS AGENT DETECTION AMPLIFIED PROBE","code_information":[{"code":"Px00030011693","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC INFECTIOUS AGENT DETECTION PCR","code_information":[{"code":"Px00030011694","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC INHIBIN A CDM","code_information":[{"code":"Px00030011698","type":"CDM"},{"code":"86336","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":54.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IAADIADOO NOT OTHERWISE SPECIFIED CDM","code_information":[{"code":"Px00030011703","type":"CDM"},{"code":"87899","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":100.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IADNA BORRELIA BURGDORFERI AMPLIFIED PROBE TQ CDM","code_information":[{"code":"Px00030011709","type":"CDM"},{"code":"87476","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":55.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IADNA MYCOPLSM PNEUMONIAE AMPLIFIED PROBE TQ CDM","code_information":[{"code":"Px00030011710","type":"CDM"},{"code":"87581","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":97.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IAADIADOO STREPTOCOCCUS GROUP A LAB","code_information":[{"code":"Px00030011741","type":"CDM"},{"code":"87880","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":54.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY ELUTION RBC EACH ELUTION LAB","code_information":[{"code":"Px00030011742","type":"CDM"},{"code":"86860","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":153.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ROM (AMNISURE)","code_information":[{"code":"Px00030011747","type":"CDM"},{"code":"84112","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC SEMEN ANALYSIS SPERM PRESENCE&/MOTILITY SPRM CDM","code_information":[{"code":"Px00030011752","type":"CDM"},{"code":"89321","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":22.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC STREP PNEUMO ANTIGEN","code_information":[{"code":"Px00030011761","type":"CDM"},{"code":"87899","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":100.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IADNA TRICHOMONAS VAGINALIS DIRECT PROBE TQ CDM","code_information":[{"code":"Px00030011799","type":"CDM"},{"code":"87660","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":32.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HLA-B27","code_information":[{"code":"Px00030011856","type":"CDM"},{"code":"86812","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.0,"discounted_cash":134.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HYPERSENS PNEUMO II (PANEL)","code_information":[{"code":"Px00030011866","type":"CDM"},{"code":"86331","type":"HCPCS"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":4.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IMMUNOFIX E-PHORESIS SERUM - REF LAB","code_information":[{"code":"Px00030011867","type":"CDM"},{"code":"86334","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":114.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC T CELLS TOTAL COUNT","code_information":[{"code":"Px00030011868","type":"CDM"},{"code":"86359","type":"HCPCS"}],"standard_charges":[{"gross_charge":243.0,"discounted_cash":182.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CMV IGG","code_information":[{"code":"Px00030011874","type":"CDM"},{"code":"86644","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":50.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC EBV AB TO EARLY (D) AG IGG","code_information":[{"code":"Px00030011882","type":"CDM"},{"code":"86663","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":65.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY RUBEOLA CDM","code_information":[{"code":"Px00030011886","type":"CDM"},{"code":"86765","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC SCL-70 AB IGG(ARUP)","code_information":[{"code":"Px00030011905","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":105.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC COCCI AB  IGM (EIA) (PANL)","code_information":[{"code":"Px00030011913","type":"CDM"},{"code":"86635","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":12.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC LACOSAMIND SERUM OR PLASMA","code_information":[{"code":"Px00030011992","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":62.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC AQUAPORIN-4 RECEPTOR ANTIBODY","code_information":[{"code":"Px00030011993","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HCIMMUNOASSAY ANALYTE QUANTITATIVE","code_information":[{"code":"Px00030011994","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CRYOGLOBULIN QUALITATIVE/SEMI-QUANTITATIVE CDM","code_information":[{"code":"Px00030012035","type":"CDM"},{"code":"82595","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":24.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ESTRONE CDM","code_information":[{"code":"Px00030012037","type":"CDM"},{"code":"82679","type":"HCPCS"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":15.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY BORRELIA BURGDORFERI CONFIRMATORY TST CDM","code_information":[{"code":"Px00030012170","type":"CDM"},{"code":"86617","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":18.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC LYME IGM BY WESTERN BLOT","code_information":[{"code":"Px00030012171","type":"CDM"},{"code":"86617","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":18.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PRO BNP","code_information":[{"code":"Px00030012211","type":"CDM"},{"code":"83880","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"discounted_cash":150.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CPK ISOENZYMES","code_information":[{"code":"Px00030012275","type":"CDM"},{"code":"82552","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":11.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC TB AG RESPONSE T-CELL SUSP","code_information":[{"code":"Px00030012379","type":"CDM"},{"code":"86481","type":"HCPCS"}],"standard_charges":[{"gross_charge":344.0,"discounted_cash":258.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC URINE PREGNANCY TEST","code_information":[{"code":"Px00030013001","type":"CDM"},{"code":"81025","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":43.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CERULOPLASMIN CDM","code_information":[{"code":"Px00030013004","type":"CDM"},{"code":"82390","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":47.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DEHYDROEPIANDROSTERONE","code_information":[{"code":"Px00030013005","type":"CDM"},{"code":"82627","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.0,"discounted_cash":104.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC OCCULT BLOOD OTHER SOURCES","code_information":[{"code":"Px00030013006","type":"CDM"},{"code":"82271","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":23.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF MYOGLOBIN","code_information":[{"code":"Px00030013007","type":"CDM"},{"code":"83874","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1-3 SPEC CDM","code_information":[{"code":"Px00030013008","type":"CDM"},{"code":"82272","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":12.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED CDM","code_information":[{"code":"Px00030013010","type":"CDM"},{"code":"82306","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":77.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF C-PEPTIDE","code_information":[{"code":"Px00030013013","type":"CDM"},{"code":"84681","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":98.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC URINALYSIS VOLUME MEASURE","code_information":[{"code":"Px00030013017","type":"CDM"},{"code":"81050","type":"HCPCS"}],"standard_charges":[{"gross_charge":19.0,"discounted_cash":14.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ADRENOCORTICOTROPIC HORMONE ACTH CDM","code_information":[{"code":"Px00030013018","type":"CDM"},{"code":"82024","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":22.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ALDOLASE CDM","code_information":[{"code":"Px00030013019","type":"CDM"},{"code":"82085","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":20.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF IGE","code_information":[{"code":"Px00030013033","type":"CDM"},{"code":"82785","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.0,"discounted_cash":69.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY CARBOXYHB QUANT CDM","code_information":[{"code":"Px00030013039","type":"CDM"},{"code":"82375","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":59.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PORPHOBILINOGEN URINE QUANTITATIVE","code_information":[{"code":"Px00030013045","type":"CDM"},{"code":"84110","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":43.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF HISTAMINE","code_information":[{"code":"Px00030013047","type":"CDM"},{"code":"83088","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF SELENIUM CDM","code_information":[{"code":"Px00030013049","type":"CDM"},{"code":"84255","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":27.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY LIPOPROTEIN PLA2","code_information":[{"code":"Px00030013061","type":"CDM"},{"code":"83698","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":39.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC APOLIPOPROTEIN EACH CDM","code_information":[{"code":"Px00030013075","type":"CDM"},{"code":"82172","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":35.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PROCALCITONIN (PCT) CDM","code_information":[{"code":"Px00030013086","type":"CDM"},{"code":"84145","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":58.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PROTEIN TOTAL OTHER SOURCE","code_information":[{"code":"Px00030013090","type":"CDM"},{"code":"84157","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":40.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PREGNENOLONE CDM","code_information":[{"code":"Px00030013109","type":"CDM"},{"code":"84140","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":33.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MYELIN BASIC PROTEIN CEREBROSPINAL FLUID CDM","code_information":[{"code":"Px00030013127","type":"CDM"},{"code":"83873","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUAL/SEMIQUAN MULTIPLE STEP CDM","code_information":[{"code":"Px00030013138","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC TREPONEMAL AB","code_information":[{"code":"Px00030013140","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ACETYLCHOL REC MOD AB RLFX(ARUP)","code_information":[{"code":"Px00030013143","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":47.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ACTH (ARUP)","code_information":[{"code":"Px00030013145","type":"CDM"},{"code":"82024","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":22.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC AFP (ARUP)","code_information":[{"code":"Px00030013146","type":"CDM"},{"code":"82105","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":72.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ALDOLASE (ARUP)","code_information":[{"code":"Px00030013147","type":"CDM"},{"code":"82085","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":20.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ALDOSTERONE URINE(ARUP)","code_information":[{"code":"Px00030013148","type":"CDM"},{"code":"82088","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ALDOSTERONE(ARUP)","code_information":[{"code":"Px00030013149","type":"CDM"},{"code":"82088","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ALUMINUM SERUM (ARUP)","code_information":[{"code":"Px00030013150","type":"CDM"},{"code":"82108","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":29.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ANDROSTENEDIONE","code_information":[{"code":"Px00030013155","type":"CDM"},{"code":"82157","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANGIOTENSIN CONVERT ENZYME(ARUP)","code_information":[{"code":"Px00030013156","type":"CDM"},{"code":"82164","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":22.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC APC RESISTANCE PROFILE (ARUP)","code_information":[{"code":"Px00030013157","type":"CDM"},{"code":"85307","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":45.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ARSENIC FRACT URINE RFLX ARUP","code_information":[{"code":"Px00030013159","type":"CDM"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":12.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ARSENIC URINE(ARUP)","code_information":[{"code":"Px00030013160","type":"CDM"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":12.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BETA-2 MICROGLOBULIN SERUM (ARUP)","code_information":[{"code":"Px00030013165","type":"CDM"},{"code":"82232","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":28.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BILE ACIDS FRACTIONATED (ARUP)","code_information":[{"code":"Px00030013166","type":"CDM"},{"code":"83789","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":41.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CADMIUM BLOOD (ARUP)","code_information":[{"code":"Px00030013167","type":"CDM"},{"code":"82300","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":28.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CADMIUM URINE (ARUP)","code_information":[{"code":"Px00030013168","type":"CDM"},{"code":"82300","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":28.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CALCITONIN (ARUP)","code_information":[{"code":"Px00030013169","type":"CDM"},{"code":"82308","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":35.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CARNITINE FREE AND TOTAL(ARUP)","code_information":[{"code":"Px00030013171","type":"CDM"},{"code":"82379","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":33.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CATECHOLAMINE FRACT PLASMA (ARUP)","code_information":[{"code":"Px00030013172","type":"CDM"},{"code":"82384","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":32.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CATECHOLAMINES URINE FREE (ARUP)","code_information":[{"code":"Px00030013173","type":"CDM"},{"code":"82384","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":32.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CITRIC ACID URINE(ARUP)","code_information":[{"code":"Px00030013174","type":"CDM"},{"code":"82507","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":28.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC COPPER URINE (ARUP)","code_information":[{"code":"Px00030013175","type":"CDM"},{"code":"82525","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":23.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC COPPER(ARUP)","code_information":[{"code":"Px00030013176","type":"CDM"},{"code":"82525","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":23.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CORTISOL URINE FREE (ARUP)","code_information":[{"code":"Px00030013177","type":"CDM"},{"code":"82530","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":32.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CRYOGLOBULIN QUALITATIVE(ARUP)","code_information":[{"code":"Px00030013178","type":"CDM"},{"code":"82595","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":24.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DHEA (ARUP)","code_information":[{"code":"Px00030013179","type":"CDM"},{"code":"82626","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":27.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ESTROGENS FRACTIONATED TMS(ARUP)","code_information":[{"code":"Px00030013180","type":"CDM"},{"code":"82671","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":45.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ESTRONE TMS(ARUP)","code_information":[{"code":"Px00030013181","type":"CDM"},{"code":"82679","type":"HCPCS"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":15.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC FRUCTOSAMINE(ARUP)","code_information":[{"code":"Px00030013185","type":"CDM"},{"code":"82985","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":27.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC GASTRIN(ARUP)","code_information":[{"code":"Px00030013187","type":"CDM"},{"code":"82941","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC GLIADIN AB IGA","code_information":[{"code":"Px00030013188","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC GLUCOSE-6-PHOSPHATE DEHYD(ARUP)","code_information":[{"code":"Px00030013190","type":"CDM"},{"code":"82955","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":33.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC GROWTH HORMONE (ARUP)","code_information":[{"code":"Px00030013192","type":"CDM"},{"code":"83003","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":30.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HEMOGLOBIN A1C (CONFIRM)(ARUP)","code_information":[{"code":"Px00030013193","type":"CDM"},{"code":"83036","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HGB A2 AND F BY COLUMN (ARUP)","code_information":[{"code":"Px00030013194","type":"CDM"},{"code":"83021","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":27.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC LEAD WHOLE BLOOD","code_information":[{"code":"Px00030013199","type":"CDM"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MAGNESIUM URINE (ARUP)","code_information":[{"code":"Px00030013202","type":"CDM"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":34.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MERCURY BLOOD(ARUP)","code_information":[{"code":"Px00030013203","type":"CDM"},{"code":"83825","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":12.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MERCURY URINE (ARUP)","code_information":[{"code":"Px00030013204","type":"CDM"},{"code":"83825","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":12.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC METANEPHRINES PLASMA (ARUP)","code_information":[{"code":"Px00030013205","type":"CDM"},{"code":"83835","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC METANEPHRINES URINE(ARUP)","code_information":[{"code":"Px00030013206","type":"CDM"},{"code":"83835","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MYELIN BASIC PROTEIN (ARUP)","code_information":[{"code":"Px00030013210","type":"CDM"},{"code":"83873","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC OXALATE URINE (ARUP)","code_information":[{"code":"Px00030013215","type":"CDM"},{"code":"83945","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":34.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PORPHYRINS FRACT QUANT UR (ARUP)","code_information":[{"code":"Px00030013218","type":"CDM"},{"code":"84120","type":"HCPCS"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":15.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC RENIN ACTIVITY(ARUP)","code_information":[{"code":"Px00030013221","type":"CDM"},{"code":"84244","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":21.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC SEROTONIN (ARUP)","code_information":[{"code":"Px00030013222","type":"CDM"},{"code":"84260","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":30.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC SIROLIMUS(ARUP)","code_information":[{"code":"Px00030013224","type":"CDM"},{"code":"80195","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":48.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC STONE (CALCULI) ANALYSIS (ARUP)","code_information":[{"code":"Px00030013226","type":"CDM"},{"code":"82365","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC THYROID STIM IMMUNOGLOB(ARUP)","code_information":[{"code":"Px00030013229","type":"CDM"},{"code":"84445","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":42.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC TOPIRAMATE(ARUP)","code_information":[{"code":"Px00030013231","type":"CDM"},{"code":"80201","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":41.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC TRIIODTHYRONINE REVERSE (ARUP)","code_information":[{"code":"Px00030013232","type":"CDM"},{"code":"84482","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":25.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC TRYPTASE (ARUP)","code_information":[{"code":"Px00030013233","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC VITAMIN A (RETINOL) (ARUP)","code_information":[{"code":"Px00030013235","type":"CDM"},{"code":"84590","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":25.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC VITAMIN B6 (PYRIDOX 5 PHOS)(ARUP)","code_information":[{"code":"Px00030013236","type":"CDM"},{"code":"84207","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":25.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC VITAMIN D 1 25-DIHYDROXY","code_information":[{"code":"Px00030013237","type":"CDM"},{"code":"82652","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":45.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC VITAMIN E (ARUP)","code_information":[{"code":"Px00030013239","type":"CDM"},{"code":"84446","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":25.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC VMA URINE (ARUP)","code_information":[{"code":"Px00030013240","type":"CDM"},{"code":"84585","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":11.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC VRY LNG CHN-BRNCHD FTY ACD (ARUP)","code_information":[{"code":"Px00030013241","type":"CDM"},{"code":"82726","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.0,"discounted_cash":161.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ZACETYLCHOLINE BIND AB(PANL)","code_information":[{"code":"Px00030013584","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":47.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ZACETYLCHOLINE BLOCK AB(PANL)","code_information":[{"code":"Px00030013585","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":47.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ZALBUMIN CSF (PANL)","code_information":[{"code":"Px00030013594","type":"CDM"},{"code":"82042","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":51.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ZALBUMIN SERUM (PANL)","code_information":[{"code":"Px00030013595","type":"CDM"},{"code":"82040","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":21.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ZALKP ISOENZYMES (PANL)","code_information":[{"code":"Px00030013597","type":"CDM"},{"code":"84080","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":12.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ZALKP TOTAL (PANL)","code_information":[{"code":"Px00030013598","type":"CDM"},{"code":"84075","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":24.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ZALPHA-1-ANTITRYPSIN (PANL)","code_information":[{"code":"Px00030013599","type":"CDM"},{"code":"82103","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":60.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ZALPHA-1-ANTITRYPSIN PHENO(PANL)","code_information":[{"code":"Px00030013600","type":"CDM"},{"code":"82104","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":16.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ZARSENIC BLOOD (PANL)","code_information":[{"code":"Px00030013612","type":"CDM"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":12.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ZARSENIC URINE (PANL)","code_information":[{"code":"Px00030013614","type":"CDM"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":12.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ZCK ISOENZYMES (PANL)","code_information":[{"code":"Px00030013631","type":"CDM"},{"code":"82552","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":11.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ZCK TOTAL (PANL)","code_information":[{"code":"Px00030013632","type":"CDM"},{"code":"82550","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":45.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ZDRVVT (PANL)","code_information":[{"code":"Px00030013642","type":"CDM"},{"code":"85613","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":25.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ZF8 (PANL)","code_information":[{"code":"Px00030013652","type":"CDM"},{"code":"85240","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":29.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ZFACTOR VIII ACTIVITY (ARUP)","code_information":[{"code":"Px00030013653","type":"CDM"},{"code":"85240","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":29.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ZFOLATE RBC (ARUP)","code_information":[{"code":"Px00030013657","type":"CDM"},{"code":"82747","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":15.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ZGM1 AB IGG (PANL)","code_information":[{"code":"Px00030013665","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ZGM1 AB IGM (PANL)","code_information":[{"code":"Px00030013666","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ZIGG SUBCLASS 1 (PANL)","code_information":[{"code":"Px00030013682","type":"CDM"},{"code":"82787","type":"HCPCS"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":9.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ZIGG SUBCLASS 2 (PANL)","code_information":[{"code":"Px00030013683","type":"CDM"},{"code":"82787","type":"HCPCS"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":9.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ZIGG SUBCLASS 3 (PANL)","code_information":[{"code":"Px00030013684","type":"CDM"},{"code":"82787","type":"HCPCS"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":9.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ZIGG SUBCLASS 4 (PANL)","code_information":[{"code":"Px00030013685","type":"CDM"},{"code":"82787","type":"HCPCS"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":9.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ZIMMUNOGLOBULINS (PANL)","code_information":[{"code":"Px00030013692","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":48.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ZINC SERUM(ARUP)","code_information":[{"code":"Px00030013694","type":"CDM"},{"code":"84630","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":21.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ZLEAD BLOOD (PANL)","code_information":[{"code":"Px00030013710","type":"CDM"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ZLEAD BLOOD(PANL)","code_information":[{"code":"Px00030013711","type":"CDM"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ZLEAD URINE (PANL)","code_information":[{"code":"Px00030013712","type":"CDM"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ZMERCURY BLOOD (PANL)","code_information":[{"code":"Px00030013715","type":"CDM"},{"code":"83825","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":12.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ZMERCURY URINE (PANL)","code_information":[{"code":"Px00030013716","type":"CDM"},{"code":"83825","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":12.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ZMYELOPEROXIDASE AB(MPO)(ARUP)","code_information":[{"code":"Px00030013722","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ZPHENOBARBITAL (ARUP)","code_information":[{"code":"Px00030013730","type":"CDM"},{"code":"80184","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.0,"discounted_cash":104.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ZPRIMIDONE (ARUP)","code_information":[{"code":"Px00030013733","type":"CDM"},{"code":"80188","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":18.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ZPT-D (PANL)","code_information":[{"code":"Px00030013737","type":"CDM"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ZPTT-D (PANL)","code_information":[{"code":"Px00030013740","type":"CDM"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":45.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ZSERINE PROTEASE 3 AB(PR3)(ARUP)","code_information":[{"code":"Px00030013746","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ZT3 UPTAKE (PANL)","code_information":[{"code":"Px00030013748","type":"CDM"},{"code":"84479","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":13.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ZT4 (PANL)","code_information":[{"code":"Px00030013750","type":"CDM"},{"code":"84436","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ZT4 FREE BY EQUIL DIALYSIS(ARUP)","code_information":[{"code":"Px00030013751","type":"CDM"},{"code":"84439","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":40.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ZVWF AG (PANL)","code_information":[{"code":"Px00030013767","type":"CDM"},{"code":"85246","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":29.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ZZPP QUANT(PANL)","code_information":[{"code":"Px00030013768","type":"CDM"},{"code":"84202","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":17.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ZVWF (PANL)","code_information":[{"code":"Px00030013771","type":"CDM"},{"code":"85245","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":29.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF MANGANESE CDM","code_information":[{"code":"Px00030013773","type":"CDM"},{"code":"83785","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":33.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF CALPROTECTIN FECAL CDM","code_information":[{"code":"Px00030013774","type":"CDM"},{"code":"83993","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":57.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC EVAL C/V AMNIOTIC FLUID PROTEIN QUAL EA SPECIMEN CDM","code_information":[{"code":"Px00030013783","type":"CDM"},{"code":"84112","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF HYDROXYPROGESTERONE 17-D CDM","code_information":[{"code":"Px00030013811","type":"CDM"},{"code":"83498","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":25.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CREATININE OTHER SOURCE CDM","code_information":[{"code":"Px00030013840","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":39.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF FERRITIN CDM","code_information":[{"code":"Px00030013881","type":"CDM"},{"code":"82728","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":50.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MASS SPECT&TANDEM MASS SPECT NONDRG ANAL NES EA CDM","code_information":[{"code":"Px00030013905","type":"CDM"},{"code":"83789","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":41.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF LIPASE CDM","code_information":[{"code":"Px00030013912","type":"CDM"},{"code":"83690","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PROTHROMBIN TIME 85610","code_information":[{"code":"Px00030013952","type":"CDM"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BLOOD COUNT RETICULOCYTES AUTO 1/> CELL MEAS CDM","code_information":[{"code":"Px00030013969","type":"CDM"},{"code":"85046","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":13.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC SODIUM","code_information":[{"code":"Px00030013978","type":"CDM"},{"code":"84295","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":40.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DRVVT","code_information":[{"code":"Px00030014048","type":"CDM"},{"code":"85613","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":25.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ALPHA-1-ANTITRYPSIN TOTAL CDM","code_information":[{"code":"Px00030014052","type":"CDM"},{"code":"82103","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":60.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ALPHA-1-ANTITRYPSIN PHENOTYPE CDM","code_information":[{"code":"Px00030014053","type":"CDM"},{"code":"82104","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":16.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC KETONE BODIES SERUM QUANTITATIVE CDM","code_information":[{"code":"Px00030014072","type":"CDM"},{"code":"82010","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":48.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ALPHA-FETOPROTEIN SERUM CDM","code_information":[{"code":"Px00030014112","type":"CDM"},{"code":"82105","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":72.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ALDOSTERONE BLD","code_information":[{"code":"Px00030014129","type":"CDM"},{"code":"82088","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ALDOSTERONE CDM","code_information":[{"code":"Px00030014132","type":"CDM"},{"code":"82088","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ALKALINE PHOS","code_information":[{"code":"Px00030014138","type":"CDM"},{"code":"84075","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":24.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ALT (SGPT) 84460","code_information":[{"code":"Px00030014158","type":"CDM"},{"code":"84460","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":23.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ALUMINUM CDM","code_information":[{"code":"Px00030014159","type":"CDM"},{"code":"82108","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":29.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC AMINO ACIDS 6/> AMINO ACIDS QUANTITATIVE EA SPE CDM","code_information":[{"code":"Px00030014168","type":"CDM"},{"code":"82139","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.0,"discounted_cash":82.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANGIOTENSIN I-CONVERTING ENZYME CDM","code_information":[{"code":"Px00030014236","type":"CDM"},{"code":"82164","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":22.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ARSENIC CDM","code_information":[{"code":"Px00030014290","type":"CDM"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":12.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BILE ACIDS TOTAL CDM","code_information":[{"code":"Px00030014414","type":"CDM"},{"code":"82239","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":22.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BUN","code_information":[{"code":"Px00030014459","type":"CDM"},{"code":"84520","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":18.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CADMIUM CDM","code_information":[{"code":"Px00030014472","type":"CDM"},{"code":"82300","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":28.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CALCITONIN CDM","code_information":[{"code":"Px00030014480","type":"CDM"},{"code":"82308","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":35.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CALCIUM IONIZED","code_information":[{"code":"Px00030014481","type":"CDM"},{"code":"82330","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":123.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CARNITINE FREE AND TOTAL","code_information":[{"code":"Px00030014497","type":"CDM"},{"code":"82379","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":33.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CAROTENE CDM","code_information":[{"code":"Px00030014498","type":"CDM"},{"code":"82380","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":30.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CATECHOLAMINES FRACTIONATED CDM","code_information":[{"code":"Px00030014500","type":"CDM"},{"code":"82384","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":32.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CARCINOEMBRYONIC ANTIGEN CEA CDM","code_information":[{"code":"Px00030014520","type":"CDM"},{"code":"82378","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":54.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CHEMILUMINESCENT ASSAY","code_information":[{"code":"Px00030014538","type":"CDM"},{"code":"82397","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":41.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CHLORIDE URINE","code_information":[{"code":"Px00030014544","type":"CDM"},{"code":"82436","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":16.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF CHROMIUM CDM","code_information":[{"code":"Px00030014558","type":"CDM"},{"code":"82495","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":49.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF CITRATE CDM","code_information":[{"code":"Px00030014564","type":"CDM"},{"code":"82507","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":28.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CK TOTAL","code_information":[{"code":"Px00030014566","type":"CDM"},{"code":"82550","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":45.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC COLUMN CHROMOTOGRAPHY QUANT","code_information":[{"code":"Px00030014590","type":"CDM"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":93.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF COPPER CDM","code_information":[{"code":"Px00030014603","type":"CDM"},{"code":"82525","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":23.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CORTISOL","code_information":[{"code":"Px00030014605","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":135.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CREATINE KINASE TOTAL CDM","code_information":[{"code":"Px00030014625","type":"CDM"},{"code":"82550","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":45.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CRYOGLOBULIN SERUM","code_information":[{"code":"Px00030014642","type":"CDM"},{"code":"82595","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":24.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DDIMER QUANT","code_information":[{"code":"Px00030014674","type":"CDM"},{"code":"85379","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":144.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DEHYDROEPIANDROSTERONE CDM","code_information":[{"code":"Px00030014683","type":"CDM"},{"code":"82626","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":27.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC RUSSELL VIPER VENOM TIME DILUTED CDM","code_information":[{"code":"Px00030014690","type":"CDM"},{"code":"85613","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":25.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ESTRADIOL","code_information":[{"code":"Px00030014796","type":"CDM"},{"code":"82670","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":97.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ESTRIOL LEVEL","code_information":[{"code":"Px00030014801","type":"CDM"},{"code":"82677","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ETHYLENE GLYCOL LEVEL","code_information":[{"code":"Px00030014810","type":"CDM"},{"code":"82693","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC FACTOR 8","code_information":[{"code":"Px00030014823","type":"CDM"},{"code":"85240","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":29.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER CDM","code_information":[{"code":"Px00030014877","type":"CDM"},{"code":"82270","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC FTL FIBRONECTIN CERVICOVAG SECRETIONS SEMI-QUAN CDM","code_information":[{"code":"Px00030014881","type":"CDM"},{"code":"82731","type":"HCPCS"}],"standard_charges":[{"gross_charge":406.0,"discounted_cash":304.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF FOLIC ACID RBC CDM","code_information":[{"code":"Px00030014899","type":"CDM"},{"code":"82747","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":15.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF FREE THYROXINE CDM","code_information":[{"code":"Px00030014933","type":"CDM"},{"code":"84439","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":40.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GLYCATED PROTEIN CDM","code_information":[{"code":"Px00030014936","type":"CDM"},{"code":"82985","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":27.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC GLUC-6-PHOSPHATE DEHYDROGENASE QUANTITATIVE CDM","code_information":[{"code":"Px00030014945","type":"CDM"},{"code":"82955","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":33.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GASTRIN CDM","code_information":[{"code":"Px00030014962","type":"CDM"},{"code":"82941","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC GGT GLUTAMYTRANSFERASE GAMMA","code_information":[{"code":"Px00030014969","type":"CDM"},{"code":"82977","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":57.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC GLUCOSE QUANTITATIVE BLOOD (EXCEPT REAGENT STRIP)","code_information":[{"code":"Px00030014986","type":"CDM"},{"code":"82947","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":19.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GROWTH HORMONE HUMAN CDM","code_information":[{"code":"Px00030015029","type":"CDM"},{"code":"83003","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":30.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC GONADOTROPIN CHORIONIC QUALITATIVE CDM","code_information":[{"code":"Px00030015043","type":"CDM"},{"code":"84703","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC LIPOPROTEIN DIR MEAS HIGH DENSITY CHOLESTEROL CDM","code_information":[{"code":"Px00030015059","type":"CDM"},{"code":"83718","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HEMATOCRIT (HCT)","code_information":[{"code":"Px00030015067","type":"CDM"},{"code":"85014","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":17.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HEMATOCRIT SPUN-MISC FLUID","code_information":[{"code":"Px00030015068","type":"CDM"},{"code":"85013","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":17.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HEMOGLOBIN METHEMOGLOBIN QUANTITATIVE CDM","code_information":[{"code":"Px00030015078","type":"CDM"},{"code":"83050","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":35.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HEMOGLOBIN (HGB)","code_information":[{"code":"Px00030015080","type":"CDM"},{"code":"85018","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":17.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HGB/RBCS FETAL FETOMATERNAL HEMRRG ROSETTE LAB","code_information":[{"code":"Px00030015085","type":"CDM"},{"code":"85461","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":78.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANT HUMAN ANTI MOUSE AB CDM","code_information":[{"code":"Px00030015187","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HVY MET BLD - ARSENIC","code_information":[{"code":"Px00030015188","type":"CDM"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":12.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HVY MET BLD - LEAD","code_information":[{"code":"Px00030015190","type":"CDM"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HVY MET BLD - MERCURY","code_information":[{"code":"Px00030015191","type":"CDM"},{"code":"83825","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":12.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HVY MET UR - ARSENIC","code_information":[{"code":"Px00030015192","type":"CDM"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":12.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HVY MET UR - LEAD","code_information":[{"code":"Px00030015194","type":"CDM"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HVY MET UR - MERCURY","code_information":[{"code":"Px00030015195","type":"CDM"},{"code":"83825","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":12.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANT IGF BP3 CDM","code_information":[{"code":"Px00030015217","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC GAMMAGLOBULIN IMMUNOGLOBULIN SUBCLASSES LAB","code_information":[{"code":"Px00030015229","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":48.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC GAMMAGLOBULIN IMMUNOGLOBULIN SUBCLASSES LAB","code_information":[{"code":"Px00030015258","type":"CDM"},{"code":"82787","type":"HCPCS"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":9.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IRON BINDING CAPACITY CDM","code_information":[{"code":"Px00030015300","type":"CDM"},{"code":"83550","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HGB/RBCS FETAL FETOMATERNAL HEMRRG DIFRNTL LYSIS CDM","code_information":[{"code":"Px00030015351","type":"CDM"},{"code":"85460","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":93.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF LACTATE","code_information":[{"code":"Px00030015357","type":"CDM"},{"code":"83605","type":"HCPCS"}],"standard_charges":[{"gross_charge":228.0,"discounted_cash":171.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC LACTATE DEHYDROGENASE ISOENZYMES SEP&QUAN CDM","code_information":[{"code":"Px00030015370","type":"CDM"},{"code":"83625","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":12.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC LACTATE DEHYDROGENASE LDH CDM","code_information":[{"code":"Px00030015371","type":"CDM"},{"code":"83615","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":56.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC LDH SERUM","code_information":[{"code":"Px00030015373","type":"CDM"},{"code":"83615","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":56.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC VERY LONG CHAIN FATTY ACIDS CDM","code_information":[{"code":"Px00030015404","type":"CDM"},{"code":"82726","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.0,"discounted_cash":161.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MAGNESIUM QUANT URINE","code_information":[{"code":"Px00030015421","type":"CDM"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":34.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MERCURY QUANT BLOOD","code_information":[{"code":"Px00030015440","type":"CDM"},{"code":"83825","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":12.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC METANEPHRINES CDM","code_information":[{"code":"Px00030015448","type":"CDM"},{"code":"83835","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MYOGLOBIN CDM","code_information":[{"code":"Px00030015558","type":"CDM"},{"code":"83874","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC NI METABOLIC SCREEN CDM","code_information":[{"code":"Px00030015575","type":"CDM"},{"code":"84030","type":"HCPCS"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":7.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC NMR-LIPOPROTEIN PAR QNT & SUBCLASSES","code_information":[{"code":"Px00030015580","type":"CDM"},{"code":"83704","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.0,"discounted_cash":60.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BLOOD OCCULT PEROXIDASE ACTV QUAL OTHER SOURCES CDM","code_information":[{"code":"Px00030015613","type":"CDM"},{"code":"82271","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":23.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PH GASTRIC CDM","code_information":[{"code":"Px00030015674","type":"CDM"},{"code":"83986","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":36.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CREATININE BLOOD","code_information":[{"code":"Px00030015717","type":"CDM"},{"code":"82565","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":18.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ALPHA-FETOPROTEIN SERUM CDM","code_information":[{"code":"Px00030015745","type":"CDM"},{"code":"82105","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":72.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PRENATAL-ESTRIOL","code_information":[{"code":"Px00030015746","type":"CDM"},{"code":"82677","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC GONADOTROPIN CHORIONIC QUANTITATIVE CDM","code_information":[{"code":"Px00030015747","type":"CDM"},{"code":"84702","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":50.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL CDM","code_information":[{"code":"Px00030015761","type":"CDM"},{"code":"84153","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":62.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PROTEIN TOTAL URINE PAMC","code_information":[{"code":"Px00030015783","type":"CDM"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":18.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PROTEINASE-3 ANTIBODY EIA","code_information":[{"code":"Px00030015793","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CHEMILUMINESCENT ASSAY CDM","code_information":[{"code":"Px00030015823","type":"CDM"},{"code":"82397","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":41.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC THROMBOPLASTIN TIME PRTL SUBSTIT PLASMA FRCTJ EA CDM","code_information":[{"code":"Px00030015834","type":"CDM"},{"code":"85732","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF MAGNESIUM LAB","code_information":[{"code":"Px00030015863","type":"CDM"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":34.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF RENIN CDM","code_information":[{"code":"Px00030015879","type":"CDM"},{"code":"84244","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":21.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC SELENIUM SERUM","code_information":[{"code":"Px00030015900","type":"CDM"},{"code":"84255","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":27.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF SEROTONIN","code_information":[{"code":"Px00030015924","type":"CDM"},{"code":"84260","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":30.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC SEX HORMONE BINDING GLOBULIN","code_information":[{"code":"Px00030015928","type":"CDM"},{"code":"84270","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":39.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC SGOT / AST","code_information":[{"code":"Px00030015929","type":"CDM"},{"code":"84450","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":28.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC SGPT (ALT)","code_information":[{"code":"Px00030015931","type":"CDM"},{"code":"84460","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":23.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC SGPT / ALT","code_information":[{"code":"Px00030015932","type":"CDM"},{"code":"84460","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":23.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC TRIIODOTHYRONINE T3 REVERSE CDM","code_information":[{"code":"Px00030015998","type":"CDM"},{"code":"84482","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":25.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC THYROGLOBULIN REFLEX TEST","code_information":[{"code":"Px00030016038","type":"CDM"},{"code":"84432","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":40.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC THYROID STIMULATING IMMUNE GLOBULINS TSI CDM","code_information":[{"code":"Px00030016040","type":"CDM"},{"code":"84445","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":42.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC THYRO-THYROGLOBULIN","code_information":[{"code":"Px00030016042","type":"CDM"},{"code":"84432","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":40.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF THYROXINE BINDING GLOBULIN CDM","code_information":[{"code":"Px00030016043","type":"CDM"},{"code":"84442","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":23.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC TRIGLYCERIDES","code_information":[{"code":"Px00030016086","type":"CDM"},{"code":"84478","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":92.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC TROPONIN QUANTITATIVE","code_information":[{"code":"Px00030016091","type":"CDM"},{"code":"84484","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":109.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANTITATIVE TRYPTASE CDM","code_information":[{"code":"Px00030016097","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF URIC ACID OTHER SOURCE LAB","code_information":[{"code":"Px00030016119","type":"CDM"},{"code":"84560","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":43.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF THIAMINE-VITAMIN B-1 CDM","code_information":[{"code":"Px00030016184","type":"CDM"},{"code":"84425","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":25.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF VITAMIN NOT OTHERWISE SPECIFIED CDM","code_information":[{"code":"Px00030016187","type":"CDM"},{"code":"84591","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":78.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PYRIDOXAL PHOSPHATE CDM","code_information":[{"code":"Px00030016188","type":"CDM"},{"code":"84207","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":25.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC 1 25 DIHYDROXY INCLUDES FRACTIONS IF PERFORMED CDM","code_information":[{"code":"Px00030016189","type":"CDM"},{"code":"82652","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":45.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC VOLATILES METHANOL OR ISOPROP","code_information":[{"code":"Px00030016201","type":"CDM"},{"code":"84600","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":18.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CLOTTING FACTOR VIII VW FACTOR ANTIGEN","code_information":[{"code":"Px00030016214","type":"CDM"},{"code":"85246","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":29.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ZINC CDM","code_information":[{"code":"Px00030016230","type":"CDM"},{"code":"84630","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":21.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANTITATIVE CELIAC CDM","code_information":[{"code":"Px00030016245","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CLOSTRIDIUM DIFFICILE TOXINS AMPLIFIED PROBE","code_information":[{"code":"Px00030016255","type":"CDM"},{"code":"87493","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.0,"discounted_cash":165.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC COMPLEMENT ANTIGEN EACH COMPONENT CDM","code_information":[{"code":"Px00030016259","type":"CDM"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC COBALT SERUM","code_information":[{"code":"Px00030016272","type":"CDM"},{"code":"83018","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":36.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC GASES BLOOD PH ONLY CDM","code_information":[{"code":"Px00030016274","type":"CDM"},{"code":"82800","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CREATININE URINE","code_information":[{"code":"Px00030016275","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":39.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF CHROMIUM CDM","code_information":[{"code":"Px00030016279","type":"CDM"},{"code":"82495","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":49.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF CHROMIUM CDM","code_information":[{"code":"Px00030016280","type":"CDM"},{"code":"82495","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":49.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PLATELET ASSOCIATED ANTIBODY","code_information":[{"code":"Px00030016281","type":"CDM"},{"code":"86022","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":50.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH CDM","code_information":[{"code":"Px00030016291","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY RUBEOLA CDM","code_information":[{"code":"Px00030017035","type":"CDM"},{"code":"86765","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC TESTOSTERONE FREE (ADD ON ONLY)","code_information":[{"code":"Px00030017037","type":"CDM"},{"code":"84270","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":39.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF HYDROXYINDOLACETIC ACID 5-HIAA LAB","code_information":[{"code":"Px00030100010","type":"CDM"},{"code":"83497","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":25.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DRUG ASSAY CARBAMAZEPINE -10 11-EPOXIDE LAB","code_information":[{"code":"Px00030100041","type":"CDM"},{"code":"80161","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":45.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DRUG ASSAY SALICYLATE LAB","code_information":[{"code":"Px00030100043","type":"CDM"},{"code":"80179","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":45.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DRUG ASSAY FLECAINIDE LAB","code_information":[{"code":"Px00030100044","type":"CDM"},{"code":"80181","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":39.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ALKALOIDS NOT OTHERWISE SPECIFIED LAB","code_information":[{"code":"Px00030100117","type":"CDM"},{"code":"80323","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":93.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANTITATIVE NOS LAB","code_information":[{"code":"Px00030100121","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ALKALOIDS NOT OTHERWISE SPECIFIED LAB","code_information":[{"code":"Px00030100122","type":"CDM"},{"code":"80323","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":93.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ALPHA-FETOPROTEIN SERUM","code_information":[{"code":"Px00030100127","type":"CDM"},{"code":"82105","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":72.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ESTRIOL","code_information":[{"code":"Px00030100128","type":"CDM"},{"code":"82677","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC GONADOTROPIN CHORIONIC QUANTITATIVE","code_information":[{"code":"Px00030100129","type":"CDM"},{"code":"84702","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":50.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANGIOTENSIN I-CONVERTING ENZYME LAB","code_information":[{"code":"Px00030100132","type":"CDM"},{"code":"82164","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":22.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC GONADOTROPIN CHORIONIC QUANTITATIVE LAB","code_information":[{"code":"Px00030100137","type":"CDM"},{"code":"84702","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":50.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC METANEPHRINES LAB","code_information":[{"code":"Px00030100140","type":"CDM"},{"code":"83835","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC LAB","code_information":[{"code":"Px00030100143","type":"CDM"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":93.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CREATININE OTHER SOURCE LAB","code_information":[{"code":"Px00030100162","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":39.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF COPPER LAB","code_information":[{"code":"Px00030100175","type":"CDM"},{"code":"82525","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":23.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HEMOGLOBIN FRACTJ/QUANTJ ELECTROPHORESIS CDM","code_information":[{"code":"Px00030100178","type":"CDM"},{"code":"83020","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":27.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF MAGNESIUM LAB","code_information":[{"code":"Px00030100197","type":"CDM"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":34.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CHLORIDE URINE LAB","code_information":[{"code":"Px00030100205","type":"CDM"},{"code":"82436","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":16.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC POTASSIUM URINE LAB","code_information":[{"code":"Px00030100206","type":"CDM"},{"code":"84133","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":20.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF URINE SODIUM LAB","code_information":[{"code":"Px00030100207","type":"CDM"},{"code":"84300","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":39.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUAL SEMIQUAL MULTIPLE STEP LAB","code_information":[{"code":"Px00030100236","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF HISTAMINE LAB","code_information":[{"code":"Px00030100239","type":"CDM"},{"code":"83088","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ESTRONE LAB","code_information":[{"code":"Px00030100256","type":"CDM"},{"code":"82679","type":"HCPCS"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":15.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANT ALCOHOLS BIOMARKERS 1 OR 2 LAB","code_information":[{"code":"Px00030100315","type":"CDM"},{"code":"80321","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.0,"discounted_cash":135.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC NORTRIPTYLINE LEVEL SERUM LAB","code_information":[{"code":"Px00030100350","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":62.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC AMITRIPTYLINE AND NORTRIPTYLINE LEVEL LAB","code_information":[{"code":"Px00030100351","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":62.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUAL/SEMIQUAL MULTIPLE STEP","code_information":[{"code":"Px00030100354","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CLOBAZAM LAB","code_information":[{"code":"Px00030100355","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":62.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ELASTASE PANCREATIC FECAL QUANTITATIVE LAB","code_information":[{"code":"Px00030100376","type":"CDM"},{"code":"82653","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":89.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH LAB","code_information":[{"code":"Px00030100378","type":"CDM"},{"code":"83521","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":40.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF INTERLEUKIN-6 (IL-6) LAB","code_information":[{"code":"Px00030100379","type":"CDM"},{"code":"83529","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":34.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH LAB","code_information":[{"code":"Px00030100383","type":"CDM"},{"code":"83521","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":40.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH LAB","code_information":[{"code":"Px00030100408","type":"CDM"},{"code":"83521","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":40.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH LAB","code_information":[{"code":"Px00030100409","type":"CDM"},{"code":"83521","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":40.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC QUANTITATION DRUG NOT ELSEWHERE SPECIFIED LAB","code_information":[{"code":"Px00030100430","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":62.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD LAB","code_information":[{"code":"Px00030100454","type":"CDM"},{"code":"84155","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":18.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM LAB","code_information":[{"code":"Px00030100455","type":"CDM"},{"code":"84165","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":47.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUAL/SEMIQUAN MULTIPLE STEP LAB","code_information":[{"code":"Px00030100499","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC LIPID PANEL LAB","code_information":[{"code":"Px00030100518","type":"CDM"},{"code":"80061","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":58.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC LIPOPROTEIN BLOOD QUAN NUMBERS & SUBCLASSES LAB","code_information":[{"code":"Px00030100519","type":"CDM"},{"code":"83704","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.0,"discounted_cash":60.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY THIOPURINE S-METHYLTRANSFERASE LAB","code_information":[{"code":"Px00030100540","type":"CDM"},{"code":"84433","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":93.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE VANCOMYCIN LAB","code_information":[{"code":"Px00030100544","type":"CDM"},{"code":"80202","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":146.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ALBUMIN SERUM PLASMA/WHOLE BLOOD LAB","code_information":[{"code":"Px00030100562","type":"CDM"},{"code":"82040","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":21.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC OTHER SOURCE ALBUMIN QUANTITATIVE EACH SPECIMEN LAB","code_information":[{"code":"Px00030100563","type":"CDM"},{"code":"82042","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":51.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ALPHA-FETOPROTEIN SERUM LAB","code_information":[{"code":"Px00030100566","type":"CDM"},{"code":"82105","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":72.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BILIRUBIN TOTAL LAB","code_information":[{"code":"Px00030100571","type":"CDM"},{"code":"82247","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":19.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CADMIUM LAB","code_information":[{"code":"Px00030100573","type":"CDM"},{"code":"82300","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":28.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CALCIUM TOTAL LAB","code_information":[{"code":"Px00030100574","type":"CDM"},{"code":"82310","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":18.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CARBOXYHEMOGLOBIN QUANTITATIVE LAB","code_information":[{"code":"Px00030100576","type":"CDM"},{"code":"82375","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":59.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC COLLAGEN CROSS LINKS ANY METHOD LAB","code_information":[{"code":"Px00030100578","type":"CDM"},{"code":"82523","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":56.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CORTISOL TOTAL LAB","code_information":[{"code":"Px00030100582","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":135.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC LAB","code_information":[{"code":"Px00030100583","type":"CDM"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":93.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CREATININE OTHER SOURCE LAB","code_information":[{"code":"Px00030100590","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":39.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CREATININE OTHER SOURCE LAB","code_information":[{"code":"Px00030100591","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":39.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CREATININE OTHER SOURCE LAB","code_information":[{"code":"Px00030100592","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":39.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CREATININE OTHER SOURCE LAB","code_information":[{"code":"Px00030100595","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":39.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ESTRIOL LAB","code_information":[{"code":"Px00030100598","type":"CDM"},{"code":"82677","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH LAB","code_information":[{"code":"Px00030100606","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":48.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF INSULIN TOTAL LAB","code_information":[{"code":"Px00030100622","type":"CDM"},{"code":"83525","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":42.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF INSULIN FREE LAB","code_information":[{"code":"Px00030100623","type":"CDM"},{"code":"83527","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":18.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF LEAD LAB","code_information":[{"code":"Px00030100624","type":"CDM"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF LEAD LAB","code_information":[{"code":"Px00030100625","type":"CDM"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF MERCURY QUANTITATIVE LAB","code_information":[{"code":"Px00030100629","type":"CDM"},{"code":"83825","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":12.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC NATRIURETIC PEPTIDE LAB","code_information":[{"code":"Px00030100630","type":"CDM"},{"code":"83880","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"discounted_cash":150.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC NATRIURETIC PEPTIDE LAB","code_information":[{"code":"Px00030100631","type":"CDM"},{"code":"83880","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"discounted_cash":150.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PHOSPHATASE ALKALINE LAB","code_information":[{"code":"Px00030100632","type":"CDM"},{"code":"84075","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":24.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PHOSPHATASE ALKALINE ISOENZYMES LAB","code_information":[{"code":"Px00030100633","type":"CDM"},{"code":"84080","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":12.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC POTASSIUM URINE LAB","code_information":[{"code":"Px00030100635","type":"CDM"},{"code":"84133","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":20.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PROTEIN TOTAL XCPT REFRACTOMETRY URINE LAB","code_information":[{"code":"Px00030100639","type":"CDM"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":18.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PROTOPORPHYRIN RBC QUANTITATIVE LAB","code_information":[{"code":"Px00030100649","type":"CDM"},{"code":"84202","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":17.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF SEX HORMONE BINDING GLOBULIN LAB","code_information":[{"code":"Px00030100651","type":"CDM"},{"code":"84270","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":39.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF URINE SODIUM LAB","code_information":[{"code":"Px00030100652","type":"CDM"},{"code":"84300","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":39.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TESTOSTERONE TOTAL LAB","code_information":[{"code":"Px00030100657","type":"CDM"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":45.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF THYROXINE TOTAL LAB","code_information":[{"code":"Px00030100658","type":"CDM"},{"code":"84436","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF FREE THYROXINE LAB","code_information":[{"code":"Px00030100659","type":"CDM"},{"code":"84439","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":40.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF THYROID STIMULATING HORMONE TSH LAB","code_information":[{"code":"Px00030100660","type":"CDM"},{"code":"84443","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":40.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC THYROID HORM UPTK/THYROID HORMONE BINDING RATIO LAB","code_information":[{"code":"Px00030100663","type":"CDM"},{"code":"84479","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":13.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC THYROID HORM UPTK/THYROID HORMONE BINDING RATIO LAB","code_information":[{"code":"Px00030100664","type":"CDM"},{"code":"84479","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":13.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC GONADOTROPIN CHORIONIC QUANTITATIVE LAB","code_information":[{"code":"Px00030100672","type":"CDM"},{"code":"84702","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":50.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CYSTATIN C LAB","code_information":[{"code":"Px00030100714","type":"CDM"},{"code":"82610","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":54.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC COLLAGEN CROSS LINKS ANY METHOD LAB","code_information":[{"code":"Px00030100716","type":"CDM"},{"code":"82523","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":56.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING BENZODIAZEPINES 13 OR MORE LAB","code_information":[{"code":"Px00030100726","type":"CDM"},{"code":"80347","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":78.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUAL/SEMIQUAN MULTIPLE STEP","code_information":[{"code":"Px00030100729","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CHEMILUMINESCENT ASSAY LAB","code_information":[{"code":"Px00030100759","type":"CDM"},{"code":"82397","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":41.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DRUG ASSAY INFLIXIMAB LAB","code_information":[{"code":"Px00030100760","type":"CDM"},{"code":"80230","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":78.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CREATINE KINASE MB FRACTION ONLY LAB","code_information":[{"code":"Px00030100762","type":"CDM"},{"code":"82553","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":114.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC GLUCOSE BODY FLUID OTHER THAN BLOOD LAB","code_information":[{"code":"Px00030100765","type":"CDM"},{"code":"82945","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF LEAD LAB","code_information":[{"code":"Px00030100766","type":"CDM"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CREATININE OTHER SOURCE LAB","code_information":[{"code":"Px00030100767","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":39.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC METANEPHRINES LAB","code_information":[{"code":"Px00030100768","type":"CDM"},{"code":"83835","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ORGANIC ACIDS TOTAL QUANTITATIVE EACH SPECIMEN LAB","code_information":[{"code":"Px00030100769","type":"CDM"},{"code":"83918","type":"HCPCS"}],"standard_charges":[{"gross_charge":230.0,"discounted_cash":172.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HEMOGLOBIN FRACTJ/QUANTJ CHROMOTOGRAPHY LAB","code_information":[{"code":"Px00030100782","type":"CDM"},{"code":"83021","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":27.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HEMOGLOBIN FRACTJ/QUANTJ CHROMOTOGRAPHY LAB","code_information":[{"code":"Px00030100783","type":"CDM"},{"code":"83021","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":27.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF THYROGLOBULIN LAB","code_information":[{"code":"Px00030100786","type":"CDM"},{"code":"84432","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":40.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF VITAMIN NOT OTHERWISE SPECIFIED","code_information":[{"code":"Px00030100787","type":"CDM"},{"code":"84591","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":78.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC QUANTITATION DRUG NOT ELSEWHERE SPECIFIED","code_information":[{"code":"Px00030100788","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":62.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF MANGANESE","code_information":[{"code":"Px00030100791","type":"CDM"},{"code":"83785","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":33.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUAL/SEMIQUAL MULTIPLE STEP LAB","code_information":[{"code":"Px00030100812","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUAL/SEMIQUAL MULTIPLE STEP LAB","code_information":[{"code":"Px00030100813","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC APOLIPOPROTEIN EACH LAB","code_information":[{"code":"Px00030100826","type":"CDM"},{"code":"82172","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":35.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BILIRUBIN TOTAL LAB","code_information":[{"code":"Px00030100827","type":"CDM"},{"code":"82247","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":19.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL LAB","code_information":[{"code":"Px00030100828","type":"CDM"},{"code":"82465","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":19.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP LAB","code_information":[{"code":"Px00030100829","type":"CDM"},{"code":"82947","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":19.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GLUTAMYLTRASE GAMMA LAB","code_information":[{"code":"Px00030100830","type":"CDM"},{"code":"82977","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":57.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF HAPTOGLOBIN QUANTITATIVE LAB","code_information":[{"code":"Px00030100831","type":"CDM"},{"code":"83010","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":98.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF NEPHELOMETRY EACH ANALYTE NES LAB","code_information":[{"code":"Px00030100832","type":"CDM"},{"code":"83883","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC TRANSFERASE ASPARTATE AMINO AST SGOT LAB","code_information":[{"code":"Px00030100833","type":"CDM"},{"code":"84450","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":28.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC TRANSFERASE ALANINE AMINO ALT SGPT LAB","code_information":[{"code":"Px00030100834","type":"CDM"},{"code":"84460","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":23.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TRIGLYCERIDES LAB","code_information":[{"code":"Px00030100835","type":"CDM"},{"code":"84478","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":92.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PROTEIN TOTAL XCPT REFRACTOMETRY URINE LAB","code_information":[{"code":"Px00030100862","type":"CDM"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":18.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3 LAB","code_information":[{"code":"Px00030100931","type":"CDM"},{"code":"82803","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.0,"discounted_cash":207.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CALCIUM IONIZED LAB","code_information":[{"code":"Px00030100932","type":"CDM"},{"code":"82330","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":123.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC GASES BLOOD PH ONLY LAB","code_information":[{"code":"Px00030100933","type":"CDM"},{"code":"82800","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ELECTROLYTE PANEL LAB","code_information":[{"code":"Px00030100935","type":"CDM"},{"code":"80051","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3 LAB","code_information":[{"code":"Px00030100936","type":"CDM"},{"code":"82803","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.0,"discounted_cash":207.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3 LAB","code_information":[{"code":"Px00030100937","type":"CDM"},{"code":"82803","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.0,"discounted_cash":207.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CALCIUM IONIZED LAB","code_information":[{"code":"Px00030100938","type":"CDM"},{"code":"82330","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":123.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC GASES BLOOD PH ONLY LAB","code_information":[{"code":"Px00030100939","type":"CDM"},{"code":"82800","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CARBOXYHEMOGLOBIN QUANTITATIVE LAB","code_information":[{"code":"Px00030100940","type":"CDM"},{"code":"82375","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":59.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3 LAB","code_information":[{"code":"Px00030100941","type":"CDM"},{"code":"82803","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.0,"discounted_cash":207.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3 LAB","code_information":[{"code":"Px00030100942","type":"CDM"},{"code":"82803","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.0,"discounted_cash":207.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC GASES BLOOD PH ONLY LAB","code_information":[{"code":"Px00030100943","type":"CDM"},{"code":"82800","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CALCIUM IONIZED LAB","code_information":[{"code":"Px00030100944","type":"CDM"},{"code":"82330","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":123.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PROCALCITONIN (PCT) LAB","code_information":[{"code":"Px00030100967","type":"CDM"},{"code":"84145","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":58.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE LAB","code_information":[{"code":"Px00030100968","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":57.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE","code_information":[{"code":"Px00030100972","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":57.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF AMYLASE LAB","code_information":[{"code":"Px00030100977","type":"CDM"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":37.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CREATININE CLEARANCE LAB","code_information":[{"code":"Px00030101030","type":"CDM"},{"code":"82575","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":42.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3 LAB","code_information":[{"code":"Px00030101037","type":"CDM"},{"code":"82803","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.0,"discounted_cash":207.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3 LAB","code_information":[{"code":"Px00030101038","type":"CDM"},{"code":"82803","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.0,"discounted_cash":207.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL LAB","code_information":[{"code":"Px00030101047","type":"CDM"},{"code":"84153","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":62.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF FOLIC ACID RBC LAB","code_information":[{"code":"Px00030101050","type":"CDM"},{"code":"82747","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":15.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CORTISOL TOTAL LAB","code_information":[{"code":"Px00030101057","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":135.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CORTISOL TOTAL LAB","code_information":[{"code":"Px00030101059","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":135.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CORTISOL TOTAL LAB","code_information":[{"code":"Px00030101060","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":135.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CORTISOL TOTAL LAB","code_information":[{"code":"Px00030101062","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":135.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CORTISOL TOTAL LAB","code_information":[{"code":"Px00030101063","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":135.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC NATRIURETIC PEPTIDE LAB","code_information":[{"code":"Px00030101072","type":"CDM"},{"code":"83880","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"discounted_cash":150.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC NATRIURETIC PEPTIDE LAB","code_information":[{"code":"Px00030101073","type":"CDM"},{"code":"83880","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"discounted_cash":150.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF LACTATE LAB","code_information":[{"code":"Px00030101085","type":"CDM"},{"code":"83605","type":"HCPCS"}],"standard_charges":[{"gross_charge":228.0,"discounted_cash":171.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF LACTATE LAB","code_information":[{"code":"Px00030101086","type":"CDM"},{"code":"83605","type":"HCPCS"}],"standard_charges":[{"gross_charge":228.0,"discounted_cash":171.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CA 15-3","code_information":[{"code":"Px00030110007","type":"CDM"},{"code":"86300","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":112.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CA 27.29","code_information":[{"code":"Px00030110008","type":"CDM"},{"code":"86300","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":112.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CA 19.9","code_information":[{"code":"Px00030110009","type":"CDM"},{"code":"86301","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":64.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HEP B SURFACE AG CONFIRM","code_information":[{"code":"Px00030110011","type":"CDM"},{"code":"87341","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":59.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HISTOPLASMA AG EIA URINE(ARUP)","code_information":[{"code":"Px00030110012","type":"CDM"},{"code":"87385","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HEP C AB REFLEXIVE","code_information":[{"code":"Px00030110014","type":"CDM"},{"code":"86803","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":105.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL CDM","code_information":[{"code":"Px00030110064","type":"CDM"},{"code":"84153","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":62.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE PHENYTOIN TOTAL LAB","code_information":[{"code":"Px00030110073","type":"CDM"},{"code":"80185","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":96.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF BLOOD/URIC ACID CDM","code_information":[{"code":"Px00030110077","type":"CDM"},{"code":"84550","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":19.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PROTEIN ELECTROP FXJ&QUAN OTH FLUS CONCENTRATI LAB","code_information":[{"code":"Px00030110084","type":"CDM"},{"code":"84166","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":131.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC LAB","code_information":[{"code":"Px00030110085","type":"CDM"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":93.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC LIPID PANEL OF NMR","code_information":[{"code":"Px00030110101","type":"CDM"},{"code":"80061","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":58.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BLOOD GASES W/O2 SATURATION CDM","code_information":[{"code":"Px00030110103","type":"CDM"},{"code":"82805","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.0,"discounted_cash":207.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANT CLOZAPINE LAB","code_information":[{"code":"Px00030110128","type":"CDM"},{"code":"80159","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":49.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANT EVEROLIMUS LAB","code_information":[{"code":"Px00030110129","type":"CDM"},{"code":"80169","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":81.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE LAMOTRIGINE LAB","code_information":[{"code":"Px00030110131","type":"CDM"},{"code":"80175","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":59.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DRUG SCRN QUAN LEVETIRACETAM","code_information":[{"code":"Px00030110132","type":"CDM"},{"code":"80177","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":59.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DRUG SCRN QUANT OXCARBAZEPIN LAB","code_information":[{"code":"Px00030110134","type":"CDM"},{"code":"80183","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":77.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE ZONISAMIDE LAB","code_information":[{"code":"Px00030110136","type":"CDM"},{"code":"80203","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":77.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DRUGS OF ABUSE URINE","code_information":[{"code":"Px00030110155","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":57.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC LACTOFERRIN FECAL QUANTITATIVE LAB","code_information":[{"code":"Px00030110181","type":"CDM"},{"code":"83631","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":43.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF FREE THYROXINE LAB","code_information":[{"code":"Px00030110182","type":"CDM"},{"code":"84439","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":40.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TESTOSTERONE FREE","code_information":[{"code":"Px00030110223","type":"CDM"},{"code":"84402","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":16.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TESTOSTERONE TOTAL","code_information":[{"code":"Px00030110224","type":"CDM"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":45.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TESTOSTERONE FREE LAB","code_information":[{"code":"Px00030110254","type":"CDM"},{"code":"84402","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":16.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF CHROMIUM LAB","code_information":[{"code":"Px00030110305","type":"CDM"},{"code":"82495","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":49.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DIHYDROTESTOSTERONE (DHT) LAB","code_information":[{"code":"Px00030110364","type":"CDM"},{"code":"82642","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":41.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF OXALATE LAB","code_information":[{"code":"Px00030110532","type":"CDM"},{"code":"83945","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":34.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF VANILLYLMANDELIC ACID URINE LAB","code_information":[{"code":"Px00030110533","type":"CDM"},{"code":"84585","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":11.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUAL/SEMIQUAN MULTIPLE STEP LAB","code_information":[{"code":"Px00030110583","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ALDOSTERONE PLASMA LAB","code_information":[{"code":"Px00030110584","type":"CDM"},{"code":"82088","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PROTEIN TOTAL XCPT REFRACTOMETRY URINE LAB","code_information":[{"code":"Px00030110600","type":"CDM"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":18.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF VANCOMYCIN","code_information":[{"code":"Px00030110602","type":"CDM"},{"code":"80202","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":146.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CREATININE OTHER SOURCE LAB","code_information":[{"code":"Px00030110605","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":39.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ALKALOIDS NOS","code_information":[{"code":"Px00030110638","type":"CDM"},{"code":"80323","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":93.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN AMPHETAMINES 1 OR 2","code_information":[{"code":"Px00030110639","type":"CDM"},{"code":"80324","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":90.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING BENZODIAZEPINES 1-12 CDM","code_information":[{"code":"Px00030110661","type":"CDM"},{"code":"80346","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":107.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING FENTANYL CDM","code_information":[{"code":"Px00030110669","type":"CDM"},{"code":"80354","type":"HCPCS"}],"standard_charges":[{"gross_charge":257.0,"discounted_cash":192.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING METHYLENEDIOXYAMPHETAMINES LAB","code_information":[{"code":"Px00030110674","type":"CDM"},{"code":"80359","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":90.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC OPIATES 1 OR MORE","code_information":[{"code":"Px00030110676","type":"CDM"},{"code":"80361","type":"HCPCS"}],"standard_charges":[{"gross_charge":257.0,"discounted_cash":192.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING TRAMADOL LAB","code_information":[{"code":"Px00030110688","type":"CDM"},{"code":"80373","type":"HCPCS"}],"standard_charges":[{"gross_charge":257.0,"discounted_cash":192.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BENZODIAZEPINE SERUM-PLSMA(ARUP)","code_information":[{"code":"Px00030110696","type":"CDM"},{"code":"80347","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":78.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC AMYTRIPTYLINE-NOTRIPTYLINE (ARUP)","code_information":[{"code":"Px00030110697","type":"CDM"},{"code":"80335","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":43.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ETHYL GLUCURONIDE URINE","code_information":[{"code":"Px00030110701","type":"CDM"},{"code":"80321","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.0,"discounted_cash":135.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DRUG CONFIRMATION THC","code_information":[{"code":"Px00030110716","type":"CDM"},{"code":"80349","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":136.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ETHANOL","code_information":[{"code":"Px00030110725","type":"CDM"},{"code":"80320","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.0,"discounted_cash":142.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC AMPHETAMINE SERUM-PLASMA(ARUP)","code_information":[{"code":"Px00030110727","type":"CDM"},{"code":"80326","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":46.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ZNORTRIPTYLINE(ARUP)","code_information":[{"code":"Px00030110732","type":"CDM"},{"code":"80335","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":43.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CORTISOL FREE LAB","code_information":[{"code":"Px00030110741","type":"CDM"},{"code":"82530","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":32.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DRUG ASSAY INFLIXIMAB LAB","code_information":[{"code":"Px00030110807","type":"CDM"},{"code":"80230","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":78.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 125 LAB","code_information":[{"code":"Px00030111010","type":"CDM"},{"code":"86304","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":90.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3","code_information":[{"code":"Px00030112002","type":"CDM"},{"code":"82803","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.0,"discounted_cash":207.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF SERUM ALBUMIN","code_information":[{"code":"Px00030112003","type":"CDM"},{"code":"82040","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":21.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC OCCULT BLOOD FECES","code_information":[{"code":"Px00030112004","type":"CDM"},{"code":"82270","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF LACTIC ACID","code_information":[{"code":"Px00030112005","type":"CDM"},{"code":"83605","type":"HCPCS"}],"standard_charges":[{"gross_charge":228.0,"discounted_cash":171.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CREATINE MB FRACTION","code_information":[{"code":"Px00030112006","type":"CDM"},{"code":"82553","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":114.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF UREA NITROGEN","code_information":[{"code":"Px00030112008","type":"CDM"},{"code":"84520","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":18.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF AMYLASE","code_information":[{"code":"Px00030112009","type":"CDM"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":37.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TRANSFERRIN","code_information":[{"code":"Px00030112011","type":"CDM"},{"code":"84466","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":40.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF SOMATOMEDIN LAB","code_information":[{"code":"Px00030112012","type":"CDM"},{"code":"84305","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":90.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF HAPTOGLOBIN QUANT","code_information":[{"code":"Px00030112013","type":"CDM"},{"code":"83010","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":98.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF MAGNESIUM","code_information":[{"code":"Px00030112014","type":"CDM"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":34.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC SODIUM BLOOD","code_information":[{"code":"Px00030112016","type":"CDM"},{"code":"84295","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":40.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC THYROID STIMULATING HORMONE TSH","code_information":[{"code":"Px00030112017","type":"CDM"},{"code":"84443","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":40.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC LIPOPROTEIN DIRECT MEASUREMENT LDL CHOLESTEROL LAB","code_information":[{"code":"Px00030112018","type":"CDM"},{"code":"83721","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":33.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TACROLIMUS","code_information":[{"code":"Px00030112019","type":"CDM"},{"code":"80197","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":69.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MICROALBUMIN QUANTITATIVE","code_information":[{"code":"Px00030112020","type":"CDM"},{"code":"82043","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":25.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ALPHA-1-ANTITRYPSIN TOTAL LAB","code_information":[{"code":"Px00030112022","type":"CDM"},{"code":"82103","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":60.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BILIRUBIN TOTAL","code_information":[{"code":"Px00030112023","type":"CDM"},{"code":"82247","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":19.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC NATRIURETIC PEPTIDE","code_information":[{"code":"Px00030112024","type":"CDM"},{"code":"83880","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"discounted_cash":150.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TROPONIN QUANTITATIVE","code_information":[{"code":"Px00030112026","type":"CDM"},{"code":"84484","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":109.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CALCIUM IONIZED","code_information":[{"code":"Px00030112027","type":"CDM"},{"code":"82330","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":123.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF URINE CREATININE","code_information":[{"code":"Px00030112028","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":39.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS ACUTE PANEL","code_information":[{"code":"Px00030112029","type":"CDM"},{"code":"80074","type":"HCPCS"}],"standard_charges":[{"gross_charge":472.0,"discounted_cash":354.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CHORIONIC GONADOTROPIN QUAL","code_information":[{"code":"Px00030112030","type":"CDM"},{"code":"84703","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ELECTROLYTE PANEL","code_information":[{"code":"Px00030112031","type":"CDM"},{"code":"80051","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ALPHA-FETOPROTEIN SERUM CDM","code_information":[{"code":"Px00030112032","type":"CDM"},{"code":"82105","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":72.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BLOOD METHEMOGLOBIN ASSAY","code_information":[{"code":"Px00030112033","type":"CDM"},{"code":"83050","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":35.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PH BODY FLUID NOT OTHERWISE SPECIFIED","code_information":[{"code":"Px00030112035","type":"CDM"},{"code":"83986","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":36.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF VITAMIN A LAB","code_information":[{"code":"Px00030112039","type":"CDM"},{"code":"84590","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":25.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF NUCLEOTIDASE 5 LAB","code_information":[{"code":"Px00030112041","type":"CDM"},{"code":"83915","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":22.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF CREATININE","code_information":[{"code":"Px00030112042","type":"CDM"},{"code":"82565","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":18.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BILIRUBIN DIRECT","code_information":[{"code":"Px00030112043","type":"CDM"},{"code":"82248","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":19.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC OSMOLALITY URINE","code_information":[{"code":"Px00030112044","type":"CDM"},{"code":"83935","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.0,"discounted_cash":108.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PREALBUMIN CDM","code_information":[{"code":"Px00030112045","type":"CDM"},{"code":"84134","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":114.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF URINE CHLORIDE","code_information":[{"code":"Px00030112047","type":"CDM"},{"code":"82436","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":16.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE PHENOBARBITAL LAB","code_information":[{"code":"Px00030112050","type":"CDM"},{"code":"80184","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.0,"discounted_cash":104.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC RENIN","code_information":[{"code":"Px00030112051","type":"CDM"},{"code":"84244","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":21.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF CAROTENE","code_information":[{"code":"Px00030112052","type":"CDM"},{"code":"82380","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":30.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC POTASSIUM URINE","code_information":[{"code":"Px00030112055","type":"CDM"},{"code":"84133","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":20.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CORTISOL TOTAL LAB","code_information":[{"code":"Px00030112057","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":135.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC OSMOLALITY BLOOD","code_information":[{"code":"Px00030112058","type":"CDM"},{"code":"83930","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":88.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PROSTATE SPECIFIC ANTIGEN TOTAL","code_information":[{"code":"Px00030112059","type":"CDM"},{"code":"84153","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":62.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CALCIUM TOTAL LAB","code_information":[{"code":"Px00030112060","type":"CDM"},{"code":"82310","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":18.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BASIC METABOLIC PANEL","code_information":[{"code":"Px00030112061","type":"CDM"},{"code":"80048","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":36.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC COMPREHEN METABOLIC PANEL","code_information":[{"code":"Px00030112062","type":"CDM"},{"code":"80053","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":42.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC LIPID PANEL","code_information":[{"code":"Px00030112063","type":"CDM"},{"code":"80061","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":58.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC RENAL FUNCTION PANEL CDM","code_information":[{"code":"Px00030112064","type":"CDM"},{"code":"80069","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":38.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC THYROXINE FREE","code_information":[{"code":"Px00030112065","type":"CDM"},{"code":"84439","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":40.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC GLYCOSYLATED HEMOGLOBIN TEST","code_information":[{"code":"Px00030112066","type":"CDM"},{"code":"83036","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PROGESTERONE CDM","code_information":[{"code":"Px00030112067","type":"CDM"},{"code":"84144","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":98.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC GTT-ADDED SAMPLES","code_information":[{"code":"Px00030112068","type":"CDM"},{"code":"82952","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":18.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ESTRADIOL","code_information":[{"code":"Px00030112069","type":"CDM"},{"code":"82670","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":97.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE THEOPHYLLINE CDM","code_information":[{"code":"Px00030112071","type":"CDM"},{"code":"80198","type":"HCPCS"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":167.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PHOSPHORUS URINE","code_information":[{"code":"Px00030112072","type":"CDM"},{"code":"84105","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":45.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PROLACTIN CDM","code_information":[{"code":"Px00030112073","type":"CDM"},{"code":"84146","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":96.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE ETHOSUXIMIDE LAB","code_information":[{"code":"Px00030112083","type":"CDM"},{"code":"80168","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":24.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE PHENYTOIN FREE CDM","code_information":[{"code":"Px00030112088","type":"CDM"},{"code":"80186","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":93.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF VASOPRESSIN ANTI-DIURETIC HORMONE LAB","code_information":[{"code":"Px00030112098","type":"CDM"},{"code":"84588","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":44.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY GLUCOSE BLOOD QUANT","code_information":[{"code":"Px00030112099","type":"CDM"},{"code":"82947","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":19.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF INSULIN TOTAL CDM","code_information":[{"code":"Px00030112100","type":"CDM"},{"code":"83525","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":42.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC LACTATE (LD) (LDH) ENZYME","code_information":[{"code":"Px00030112101","type":"CDM"},{"code":"83615","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":56.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HEPATIC FUNCTION PANEL CDM","code_information":[{"code":"Px00030112103","type":"CDM"},{"code":"80076","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":39.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ALANINE AMINO (ALT) (SGPT)","code_information":[{"code":"Px00030112104","type":"CDM"},{"code":"84460","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":23.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GGT","code_information":[{"code":"Px00030112105","type":"CDM"},{"code":"82977","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":57.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BLOOD FOLIC ACID SERUM","code_information":[{"code":"Px00030112106","type":"CDM"},{"code":"82746","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":67.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY PHOSPHORUS","code_information":[{"code":"Px00030112107","type":"CDM"},{"code":"84100","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":45.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF AMMONIA LAB","code_information":[{"code":"Px00030112108","type":"CDM"},{"code":"82140","type":"HCPCS"}],"standard_charges":[{"gross_charge":189.0,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE DIGOXIN TOTAL CDM","code_information":[{"code":"Px00030112109","type":"CDM"},{"code":"80162","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":58.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ERYTHROPOIETIN","code_information":[{"code":"Px00030112110","type":"CDM"},{"code":"82668","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":79.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF FERRITIN","code_information":[{"code":"Px00030112111","type":"CDM"},{"code":"82728","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":50.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF IRON","code_information":[{"code":"Px00030112112","type":"CDM"},{"code":"83540","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":21.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC FREE ASSAY (FT-3)","code_information":[{"code":"Px00030112114","type":"CDM"},{"code":"84481","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC TESTOSTERONE TOTAL","code_information":[{"code":"Px00030112115","type":"CDM"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":45.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE LITHIUM CDM","code_information":[{"code":"Px00030112116","type":"CDM"},{"code":"80178","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":54.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IRON BINDING CAPACITY LAB","code_information":[{"code":"Px00030112117","type":"CDM"},{"code":"83550","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC THYROXINE TOTAL","code_information":[{"code":"Px00030112118","type":"CDM"},{"code":"84436","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC GONADOTROPIN FOLLICLE STIMULATING HORMONE LAB","code_information":[{"code":"Px00030112119","type":"CDM"},{"code":"83001","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":62.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC GONADOTROPIN LUTEINIZING HORMONE LAB","code_information":[{"code":"Px00030112120","type":"CDM"},{"code":"83002","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":62.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CALCIUM URINE QUANTITATIVE TIMED SPECIMEN CDM","code_information":[{"code":"Px00030112121","type":"CDM"},{"code":"82340","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.0,"discounted_cash":39.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF LDH ENZYMES","code_information":[{"code":"Px00030112122","type":"CDM"},{"code":"83625","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":12.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE PRIMIDONE LAB","code_information":[{"code":"Px00030112124","type":"CDM"},{"code":"80188","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":18.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC GASES BLOOD PH ONLY","code_information":[{"code":"Px00030112126","type":"CDM"},{"code":"82800","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF VASOACTIVE INTESTINAL PEPTIDE LAB","code_information":[{"code":"Px00030112134","type":"CDM"},{"code":"84586","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":47.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CALCULUS SPECTROSCOPY","code_information":[{"code":"Px00030112138","type":"CDM"},{"code":"82365","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TRIGLYCERIDES","code_information":[{"code":"Px00030112157","type":"CDM"},{"code":"84478","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":92.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PHOSPHATASE ALKALINE LAB","code_information":[{"code":"Px00030112158","type":"CDM"},{"code":"84075","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":24.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF LIPASE","code_information":[{"code":"Px00030112159","type":"CDM"},{"code":"83690","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF CK (CPK)","code_information":[{"code":"Px00030112160","type":"CDM"},{"code":"82550","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":45.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PARATHORMONE (PARATHYROID HORMONE)","code_information":[{"code":"Px00030112161","type":"CDM"},{"code":"83970","type":"HCPCS"}],"standard_charges":[{"gross_charge":235.0,"discounted_cash":176.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC TRANSFERASE ASPARTATE AMINO AST SGOT","code_information":[{"code":"Px00030112162","type":"CDM"},{"code":"84450","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":28.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GENTAMICIN","code_information":[{"code":"Px00030112164","type":"CDM"},{"code":"80170","type":"HCPCS"}],"standard_charges":[{"gross_charge":239.0,"discounted_cash":179.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PROSTATE SPECIFIC ANTIGEN FREE","code_information":[{"code":"Px00030112165","type":"CDM"},{"code":"84154","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.0,"discounted_cash":70.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC VITAMIN B-12","code_information":[{"code":"Px00030112166","type":"CDM"},{"code":"82607","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":67.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD LAB","code_information":[{"code":"Px00030112168","type":"CDM"},{"code":"84155","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":18.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CREATININE CLEARANCE TEST","code_information":[{"code":"Px00030112169","type":"CDM"},{"code":"82575","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":42.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC SODIUM URINE","code_information":[{"code":"Px00030112172","type":"CDM"},{"code":"84300","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":39.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CYCLOSPORINE","code_information":[{"code":"Px00030112173","type":"CDM"},{"code":"80158","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":117.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DRUG ASSAY VALPROIC DIPROPYLACETIC ACID TOTAL CDM","code_information":[{"code":"Px00030112174","type":"CDM"},{"code":"80164","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":150.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TOCOPHEROL ALPHA VITAMIN E LAB","code_information":[{"code":"Px00030112175","type":"CDM"},{"code":"84446","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":25.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF VITAMIN K LAB","code_information":[{"code":"Px00030112185","type":"CDM"},{"code":"84597","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC GLUCOSE OTHER FLUID","code_information":[{"code":"Px00030112189","type":"CDM"},{"code":"82945","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY TRIIODOTHYRONINE (T3)","code_information":[{"code":"Px00030112193","type":"CDM"},{"code":"84480","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":64.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY BLD/SERUM CHOLESTEROL","code_information":[{"code":"Px00030112194","type":"CDM"},{"code":"82465","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":19.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF HOMOCYSTEINE LAB","code_information":[{"code":"Px00030112195","type":"CDM"},{"code":"83090","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":79.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC QUANTITATIVE ASSAY DRUG FLECAINIDE","code_information":[{"code":"Px00030112197","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":62.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY CREATININE","code_information":[{"code":"Px00030112217","type":"CDM"},{"code":"82565","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":18.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE PHENYTOIN TOTAL CDM","code_information":[{"code":"Px00030112228","type":"CDM"},{"code":"80185","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":96.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC POTASSIUM","code_information":[{"code":"Px00030112229","type":"CDM"},{"code":"84132","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF URINE/UREA-N","code_information":[{"code":"Px00030112231","type":"CDM"},{"code":"84540","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":22.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CREATININE BODY FLUID LAB","code_information":[{"code":"Px00030112238","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":39.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF MAGNESIUM CDM","code_information":[{"code":"Px00030112248","type":"CDM"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":34.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF CHROMIUM","code_information":[{"code":"Px00030112254","type":"CDM"},{"code":"82495","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":49.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PH BODY FLUID LAB","code_information":[{"code":"Px00030112273","type":"CDM"},{"code":"83986","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":36.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3 CDM","code_information":[{"code":"Px00030112278","type":"CDM"},{"code":"82274","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":42.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF RIBOFLAVIN-VITAMIN B-2 LAB","code_information":[{"code":"Px00030112286","type":"CDM"},{"code":"84252","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":53.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF APOLIPOPROTEIN B","code_information":[{"code":"Px00030112292","type":"CDM"},{"code":"82172","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":35.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC RIA NONANTIBODY ACETYLCHOLINE BINDING AB","code_information":[{"code":"Px00030112297","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":47.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC AMYLASE","code_information":[{"code":"Px00030112298","type":"CDM"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":37.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC TOTAL PROTEIN","code_information":[{"code":"Px00030112314","type":"CDM"},{"code":"84155","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":18.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANDROSTENEDIONE LAB","code_information":[{"code":"Px00030112315","type":"CDM"},{"code":"82157","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC GLUCOSE","code_information":[{"code":"Px00030112329","type":"CDM"},{"code":"82947","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":19.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF HISTAMINE LAB","code_information":[{"code":"Px00030112330","type":"CDM"},{"code":"83088","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC OTHER SOURCE ALBUMIN QUANTITATIVE EACH SPECIMEN","code_information":[{"code":"Px00030112351","type":"CDM"},{"code":"82042","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":51.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CREATININE OTHER SOURCE","code_information":[{"code":"Px00030112358","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":39.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF OSMOLALITY BLOOD","code_information":[{"code":"Px00030112375","type":"CDM"},{"code":"83930","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":88.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC SGOT (AST)","code_information":[{"code":"Px00030112384","type":"CDM"},{"code":"84450","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":28.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MYELOPEROXIDASE AB","code_information":[{"code":"Px00030112391","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CHORIONIC GONADOTROPIN QUANT","code_information":[{"code":"Px00030112393","type":"CDM"},{"code":"84702","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":50.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PROTEIN TOTAL URINE","code_information":[{"code":"Px00030112394","type":"CDM"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":18.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC GLUCOSE GESTATIONAL SCREEN","code_information":[{"code":"Px00030112396","type":"CDM"},{"code":"82950","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC GLUCOSE TOL GESTATIONAL","code_information":[{"code":"Px00030112397","type":"CDM"},{"code":"82951","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":34.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CEA","code_information":[{"code":"Px00030112404","type":"CDM"},{"code":"82378","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":54.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CO-OXIMETER PANEL ARTERIAL","code_information":[{"code":"Px00030112405","type":"CDM"},{"code":"82375","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":59.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CHOLESTEROL BODY FLUID","code_information":[{"code":"Px00030112407","type":"CDM"},{"code":"82465","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":19.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CO-OXIMETER PANEL VENOUS","code_information":[{"code":"Px00030112408","type":"CDM"},{"code":"82375","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":59.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PROTEIN TOTAL BODY FLUID LAB","code_information":[{"code":"Px00030112410","type":"CDM"},{"code":"84157","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":40.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PROTEIN TOTAL CSF","code_information":[{"code":"Px00030112411","type":"CDM"},{"code":"84157","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":40.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ALK PHOS BONE SPECIFIC (ARUP)","code_information":[{"code":"Px00030112413","type":"CDM"},{"code":"84080","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":12.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC AMINO ACIDS QNT PLASMA (ARUP)","code_information":[{"code":"Px00030112414","type":"CDM"},{"code":"82139","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.0,"discounted_cash":82.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANGIOTENSIN CONV ENZ CSF (ARUP)","code_information":[{"code":"Px00030112416","type":"CDM"},{"code":"82164","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":22.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF LIPASE BODY FLUID","code_information":[{"code":"Px00030112419","type":"CDM"},{"code":"83690","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BILE ACIDS TOTAL (ARUP)","code_information":[{"code":"Px00030112423","type":"CDM"},{"code":"82239","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":22.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ETHOSUXIMIDE (ZARONTIN) (ARUP)","code_information":[{"code":"Px00030112430","type":"CDM"},{"code":"80168","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":24.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC LIPID PANEL - REFLEX","code_information":[{"code":"Px00030112431","type":"CDM"},{"code":"80061","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":58.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MAGNESIUM (RBC) (ARUP)","code_information":[{"code":"Px00030112432","type":"CDM"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":34.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ORGANIC ACIDS TOTAL QUANT URINE LAB","code_information":[{"code":"Px00030112435","type":"CDM"},{"code":"83918","type":"HCPCS"}],"standard_charges":[{"gross_charge":230.0,"discounted_cash":172.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PCP CONFIRM QUANT (ARUP)","code_information":[{"code":"Px00030112436","type":"CDM"},{"code":"83992","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":66.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PREGNENOLONE LCMS (ARUP)","code_information":[{"code":"Px00030112439","type":"CDM"},{"code":"84140","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":33.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC TSH RECEPTOR AB (ARUP)","code_information":[{"code":"Px00030112441","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC VASOACTIVE INT POLY (VIP) (ARUP)","code_information":[{"code":"Px00030112442","type":"CDM"},{"code":"84586","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":47.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC VITAMIN B1 WHOLE BLOOD (ARUP)","code_information":[{"code":"Px00030112443","type":"CDM"},{"code":"84425","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":25.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CARCINOEMBRYONIC ANTIGEN CEA CDM","code_information":[{"code":"Px00030112474","type":"CDM"},{"code":"82378","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":54.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CALCIUM IONIZED - POST FILTER","code_information":[{"code":"Px00030112490","type":"CDM"},{"code":"82330","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":123.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC GLUCOSE TOLERANCE(3 SPECIMENS)","code_information":[{"code":"Px00030112505","type":"CDM"},{"code":"82951","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":34.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY QUAL/SEMIQUAN GLUTAMIC ACID DECARBOXY AB LAB","code_information":[{"code":"Px00030112590","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUAL/SEMIQUAL MULTIPLE STEP LAB","code_information":[{"code":"Px00030112591","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANTITATIVE NOS LAB","code_information":[{"code":"Px00030112612","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC GONADOTROPIN CHORIONIC QUALITATIVE LAB","code_information":[{"code":"Px00030112630","type":"CDM"},{"code":"84703","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC TSH","code_information":[{"code":"Px00030112660","type":"CDM"},{"code":"84443","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":40.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC UREA NITROGEN BODY FLUID","code_information":[{"code":"Px00030112662","type":"CDM"},{"code":"84520","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":18.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC GLUCOSE TOLERANCE(3 SPEC)","code_information":[{"code":"Px00030112719","type":"CDM"},{"code":"82951","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":34.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HEMOGLOBIN GLYCOSYLATED A1C LAB","code_information":[{"code":"Px00030112722","type":"CDM"},{"code":"83036","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MYELIN-ASSOC GLYCOPROT AB IGM LAB","code_information":[{"code":"Px00030112749","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ACETYL RECEPT BLOCKING AB","code_information":[{"code":"Px00030112801","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":47.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PHOSPHATASE ALKALINE ISOENZYMES CDM","code_information":[{"code":"Px00030112845","type":"CDM"},{"code":"84080","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":12.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ARSENIC (BLOOD)","code_information":[{"code":"Px00030112918","type":"CDM"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":12.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY UREA NITROGEN","code_information":[{"code":"Px00030112990","type":"CDM"},{"code":"84520","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":18.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY ZINC","code_information":[{"code":"Px00030112994","type":"CDM"},{"code":"84630","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":21.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BETA-HYDROXYBUTRIC ACID","code_information":[{"code":"Px00030113017","type":"CDM"},{"code":"82010","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":48.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CARBOXYHEMOGLOBIN CARBON MONO","code_information":[{"code":"Px00030113083","type":"CDM"},{"code":"82375","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":59.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CORTISOL","code_information":[{"code":"Px00030113147","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":135.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC C-TELOPEPTIDE CROSSLINK (CTXAR)","code_information":[{"code":"Px00030113181","type":"CDM"},{"code":"82523","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":56.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC COLLAGEN CROSS LINKS ANY METHOD LAB","code_information":[{"code":"Px00030113182","type":"CDM"},{"code":"82523","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":56.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3","code_information":[{"code":"Px00030113347","type":"CDM"},{"code":"82803","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.0,"discounted_cash":207.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC GESTATIONAL GLUCOSE 1 HOUR","code_information":[{"code":"Px00030113354","type":"CDM"},{"code":"82950","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUAL/SEMIQUAN MULTIPLE STEP CDM","code_information":[{"code":"Px00030113493","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF IRON CDM","code_information":[{"code":"Px00030113527","type":"CDM"},{"code":"83540","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":21.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC LACTATE(LD)(LDH)ENZYME","code_information":[{"code":"Px00030113542","type":"CDM"},{"code":"83615","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":56.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MANGANESE","code_information":[{"code":"Px00030113595","type":"CDM"},{"code":"83785","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":33.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC METHYLMALONIC SERUM","code_information":[{"code":"Px00030113634","type":"CDM"},{"code":"83921","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":46.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MYOGLOBIN URINE QUANT","code_information":[{"code":"Px00030113690","type":"CDM"},{"code":"83874","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PORPHOBILINOGEN URINE QUANTITATIVE CDM","code_information":[{"code":"Px00030113761","type":"CDM"},{"code":"84110","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":43.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PORPHYRINS URINE QUANTITATION & FRACTIONATION CDM","code_information":[{"code":"Px00030113766","type":"CDM"},{"code":"84120","type":"HCPCS"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":15.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PROTEIN ELECTROP FXJ&QUAN OTH FLUS CONCENTRATI CDM","code_information":[{"code":"Px00030113810","type":"CDM"},{"code":"84166","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":131.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CATECHOLAMINES FRACTIONATED LAB","code_information":[{"code":"Px00030113956","type":"CDM"},{"code":"82384","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":32.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CHEMILUMINESCENT ASSAY IGF BINDING PROTEIN-3 LAB","code_information":[{"code":"Px00030113987","type":"CDM"},{"code":"82397","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":41.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF NEPHELOMETRY EACH ANALYTE NES CDM","code_information":[{"code":"Px00030114059","type":"CDM"},{"code":"83883","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC TSH REFLEX TO FT4","code_information":[{"code":"Px00030114208","type":"CDM"},{"code":"84443","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":40.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ASCORBIC ACID BLOOD CDM","code_information":[{"code":"Px00030114256","type":"CDM"},{"code":"82180","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":30.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ASCORBIC ACID BLOOD","code_information":[{"code":"Px00030114257","type":"CDM"},{"code":"82180","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":30.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED LAB","code_information":[{"code":"Px00030114260","type":"CDM"},{"code":"82306","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":77.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PROTEIN TOTAL URINE RANDOM","code_information":[{"code":"Px00030114273","type":"CDM"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":18.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MICROALBUMIN URINE RANDOM","code_information":[{"code":"Px00030114274","type":"CDM"},{"code":"82043","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":25.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CALCIUM URINE RANDOM","code_information":[{"code":"Px00030114278","type":"CDM"},{"code":"82340","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.0,"discounted_cash":39.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CHLORIDE URINE RANDOM","code_information":[{"code":"Px00030114279","type":"CDM"},{"code":"82436","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":16.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CREATININE URINE RANDOM","code_information":[{"code":"Px00030114280","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":39.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC POTASSIUM URINE RANDOM","code_information":[{"code":"Px00030114283","type":"CDM"},{"code":"84133","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":20.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC SODIUM URINE RANDOM","code_information":[{"code":"Px00030114284","type":"CDM"},{"code":"84300","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":39.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC UREA NITROGEN URINE RANDOM","code_information":[{"code":"Px00030114285","type":"CDM"},{"code":"84540","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":22.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC URIC ACID URINE RANDOM","code_information":[{"code":"Px00030114286","type":"CDM"},{"code":"84560","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":43.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN AMPHETAMINES","code_information":[{"code":"Px00030114373","type":"CDM"},{"code":"80324","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":90.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING METHYLENEDIOXYAMPHETAMINES","code_information":[{"code":"Px00030114374","type":"CDM"},{"code":"80359","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":90.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE CDM","code_information":[{"code":"Px00030114382","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":57.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DRUG TEST PRSMV CHEM ANLYZR ALCOHOL PER DOS","code_information":[{"code":"Px00030114383","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":57.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE CDM","code_information":[{"code":"Px00030114384","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":57.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DRUG TEST PRSMV CHEM ANLYZR BARBITURATES PER DOS","code_information":[{"code":"Px00030114385","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":57.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE CDM","code_information":[{"code":"Px00030114387","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":57.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DRUG TEST PRSMV CHEM ANLYZR MECONIUM PER DOS","code_information":[{"code":"Px00030114391","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":57.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE CDM","code_information":[{"code":"Px00030114405","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":57.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BETA 2 GLYCOPROTEIN I ANTIBODY EACH LAB","code_information":[{"code":"Px00030200032","type":"CDM"},{"code":"86146","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CARDIOLIPIN ANTIBODY EACH IG CLASS LAB","code_information":[{"code":"Px00030200033","type":"CDM"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY TOXOPLASMA LAB","code_information":[{"code":"Px00030200108","type":"CDM"},{"code":"86777","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":30.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC INHIBIN A LAB","code_information":[{"code":"Px00030200110","type":"CDM"},{"code":"86336","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":54.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ISLET CELL ANTIBODY LAB","code_information":[{"code":"Px00030200117","type":"CDM"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":33.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC INHIBIN A","code_information":[{"code":"Px00030200120","type":"CDM"},{"code":"86336","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":54.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY EPSTEIN-BARR EB VIRUS NUCLEAR AG EBNA LAB","code_information":[{"code":"Px00030200128","type":"CDM"},{"code":"86664","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":79.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY EPSTEIN-BARR EB VIRUS VIRAL CAPSID VCA LAB","code_information":[{"code":"Px00030200129","type":"CDM"},{"code":"86665","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":93.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY MUMPS LAB","code_information":[{"code":"Px00030200130","type":"CDM"},{"code":"86735","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":66.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CARDIOLIPIN ANTIBODY EACH IG CLASS LAB","code_information":[{"code":"Px00030200134","type":"CDM"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC COMPLEMENT ANTIGEN EACH COMPONENT LAB","code_information":[{"code":"Px00030200136","type":"CDM"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON LAB","code_information":[{"code":"Px00030200149","type":"CDM"},{"code":"86480","type":"HCPCS"}],"standard_charges":[{"gross_charge":285.0,"discounted_cash":213.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY BORRELIA BURGDORFERI CONFIRMATORY TST LAB","code_information":[{"code":"Px00030200184","type":"CDM"},{"code":"86617","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":18.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY BORDETELLA LAB","code_information":[{"code":"Px00030200194","type":"CDM"},{"code":"86615","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":40.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY CANDIDA LAB","code_information":[{"code":"Px00030200251","type":"CDM"},{"code":"86628","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":27.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ACTIN SMOOTH MUSCLE ANTIBODY EACH LAB","code_information":[{"code":"Px00030200274","type":"CDM"},{"code":"86015","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":60.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB LAB","code_information":[{"code":"Px00030200280","type":"CDM"},{"code":"86037","type":"HCPCS"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":9.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB LAB","code_information":[{"code":"Px00030200281","type":"CDM"},{"code":"86037","type":"HCPCS"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":9.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB LAB","code_information":[{"code":"Px00030200282","type":"CDM"},{"code":"86037","type":"HCPCS"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":9.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB LAB","code_information":[{"code":"Px00030200284","type":"CDM"},{"code":"86037","type":"HCPCS"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":9.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ENDOMYSIAL ANTIBODY EACH IMMUNOGLOBULIN CLASS LAB","code_information":[{"code":"Px00030200286","type":"CDM"},{"code":"86231","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":33.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC GLIADIN ANTIBODY EACH IMMUNOGLOBULIN CLASS LAB","code_information":[{"code":"Px00030200289","type":"CDM"},{"code":"86258","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":60.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC TISSUE TRANSGLUTAMINASE EA IMMUNOGLOBULIN CLASS LAB","code_information":[{"code":"Px00030200294","type":"CDM"},{"code":"86364","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":60.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MITOCHONDRIAL ANTIBODY EACH LAB","code_information":[{"code":"Px00030200299","type":"CDM"},{"code":"86381","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":57.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC AQUAPORIN-4 ANTIBODY ELISA LAB","code_information":[{"code":"Px00030200304","type":"CDM"},{"code":"86051","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"discounted_cash":150.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS C ANTIBODY LAB","code_information":[{"code":"Px00030200414","type":"CDM"},{"code":"86803","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":105.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD LAB","code_information":[{"code":"Px00030200415","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":105.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC NATURAL KILLER CELLS TOTAL COUNT LAB","code_information":[{"code":"Px00030200430","type":"CDM"},{"code":"86357","type":"HCPCS"}],"standard_charges":[{"gross_charge":258.0,"discounted_cash":193.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD CDM","code_information":[{"code":"Px00030200431","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":105.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD CDM","code_information":[{"code":"Px00030200432","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":105.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY LAB","code_information":[{"code":"Px00030200491","type":"CDM"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":77.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IMMUNODIFFUSION GEL DIFFUSION QUAL EA AG/ANTBDY LAB","code_information":[{"code":"Px00030200524","type":"CDM"},{"code":"86331","type":"HCPCS"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":4.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC INHIBIN A LAB","code_information":[{"code":"Px00030200533","type":"CDM"},{"code":"86336","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":54.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ISLET CELL ANTIBODY LAB","code_information":[{"code":"Px00030200534","type":"CDM"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":33.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY ACTINOMYCES LAB","code_information":[{"code":"Px00030200544","type":"CDM"},{"code":"86602","type":"HCPCS"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":4.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY ASPERGILLUS LAB","code_information":[{"code":"Px00030200545","type":"CDM"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":11.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY BACTERIUM NOT ELSEWHERE SPECIFIED LAB","code_information":[{"code":"Px00030200546","type":"CDM"},{"code":"86609","type":"HCPCS"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":4.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY FUNGUS NOT ELSEWHERE SPECIFIED LAB","code_information":[{"code":"Px00030200547","type":"CDM"},{"code":"86671","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":16.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY TREPONEMA PALLIDUM LAB","code_information":[{"code":"Px00030200560","type":"CDM"},{"code":"86780","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":30.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY VIRUS NOT ELSEWHERE SPECIFIFED LAB","code_information":[{"code":"Px00030200616","type":"CDM"},{"code":"86790","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":42.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY LAB","code_information":[{"code":"Px00030200633","type":"CDM"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":77.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY LAB","code_information":[{"code":"Px00030200634","type":"CDM"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":77.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC NATURAL KILLER CELLS TOTAL COUNT LAB","code_information":[{"code":"Px00030200640","type":"CDM"},{"code":"86357","type":"HCPCS"}],"standard_charges":[{"gross_charge":258.0,"discounted_cash":193.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD","code_information":[{"code":"Px00030200642","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":105.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY ENTEROVIRUS LAB","code_information":[{"code":"Px00030200649","type":"CDM"},{"code":"86658","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":113.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC COMPLEMENT FUNCTIONAL ACTIVITY EACH COMPONENT LAB","code_information":[{"code":"Px00030200663","type":"CDM"},{"code":"86161","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":42.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC COMPLEMENT ANTIGEN EACH COMPONENT LAB","code_information":[{"code":"Px00030200664","type":"CDM"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH","code_information":[{"code":"Px00030200665","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY HISTOPLASMA LAB","code_information":[{"code":"Px00030200691","type":"CDM"},{"code":"86698","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":34.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY BORDETELLA","code_information":[{"code":"Px00030200695","type":"CDM"},{"code":"86615","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":40.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY BORDETELLA","code_information":[{"code":"Px00030200696","type":"CDM"},{"code":"86615","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":40.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CELLULAR FUNCTION ASSAY STIMUL&DETECT BIOMARKE","code_information":[{"code":"Px00030200697","type":"CDM"},{"code":"86352","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":90.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC VOLTAGE-GATED CALCIUM CHANNEL ANTIBODY EACH","code_information":[{"code":"Px00030200700","type":"CDM"},{"code":"86596","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB LAB","code_information":[{"code":"Px00030200717","type":"CDM"},{"code":"86037","type":"HCPCS"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":9.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB LAB","code_information":[{"code":"Px00030200718","type":"CDM"},{"code":"86037","type":"HCPCS"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":9.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB LAB","code_information":[{"code":"Px00030200719","type":"CDM"},{"code":"86037","type":"HCPCS"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":9.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY HLA CLASS I HIGH DEFINITION PANEL QUAL LAB","code_information":[{"code":"Px00030200811","type":"CDM"},{"code":"86832","type":"HCPCS"}],"standard_charges":[{"gross_charge":322.85,"discounted_cash":242.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY HLA CLASS II HIGH DEFINITION PANEL QUAL LAB","code_information":[{"code":"Px00030200812","type":"CDM"},{"code":"86833","type":"HCPCS"}],"standard_charges":[{"gross_charge":324.74,"discounted_cash":243.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC VOLTAGE-GATED CALCIUM CHANNEL ANTIBODY EACH LAB","code_information":[{"code":"Px00030200817","type":"CDM"},{"code":"86596","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ACTIN SMOOTH MUSCLE ANTIBODY EACH LAB","code_information":[{"code":"Px00030200882","type":"CDM"},{"code":"86015","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":60.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH LAB","code_information":[{"code":"Px00030200899","type":"CDM"},{"code":"86008","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY VIRUS DONOR HTLV I OR II LAB","code_information":[{"code":"Px00030201021","type":"CDM"},{"code":"86790","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":42.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY TREPONEMA PALLIDUM LAB","code_information":[{"code":"Px00030201022","type":"CDM"},{"code":"86780","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":30.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY ASPERGILLUS LAB","code_information":[{"code":"Px00030210064","type":"CDM"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":11.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM CDM","code_information":[{"code":"Px00030210074","type":"CDM"},{"code":"84165","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":47.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ELECTROPHORESIS CSF (AKA 84166)","code_information":[{"code":"Px00030210083","type":"CDM"},{"code":"84166","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":131.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ELECTROPHORESIS URINE","code_information":[{"code":"Px00030210084","type":"CDM"},{"code":"84166","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":131.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ADIPONECTIN(ARUP)","code_information":[{"code":"Px00030210088","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ESTRADIOL BY TMS(ARUP)","code_information":[{"code":"Px00030210089","type":"CDM"},{"code":"82670","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":97.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC LEPTIN(ARUP)","code_information":[{"code":"Px00030210091","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MAG AB IGM ELISA (ARUP)","code_information":[{"code":"Px00030210092","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC GAMMAGLOBULIN IGM","code_information":[{"code":"Px00030210101","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":48.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH CDM","code_information":[{"code":"Px00030210104","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":48.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC GAMMAGLOBULIN IGG","code_information":[{"code":"Px00030210105","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":48.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUAL/SEMIQUAN MULTIPLE STEP CDM","code_information":[{"code":"Px00030210127","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUAL/SEMIQUAN MULTIPLE STEP CDM","code_information":[{"code":"Px00030210170","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC FACTOR V LEIDEN PCR","code_information":[{"code":"Px00030210180","type":"CDM"},{"code":"81241","type":"HCPCS"}],"standard_charges":[{"gross_charge":341.0,"discounted_cash":255.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HIV-1 AG W/HIV-1 & HIV-2 AB","code_information":[{"code":"Px00030210183","type":"CDM"},{"code":"87389","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":90.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY ENTEROVIRUS POLIO","code_information":[{"code":"Px00030210185","type":"CDM"},{"code":"86658","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":113.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY BARTONELLA LAB","code_information":[{"code":"Px00030210188","type":"CDM"},{"code":"86611","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY BORRELIA BURGDORFERI LYME DISEASE LAB","code_information":[{"code":"Px00030210217","type":"CDM"},{"code":"86618","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":28.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC SARS COV-2 IMMUNE RESPONSE IGG","code_information":[{"code":"Px00030210241","type":"CDM"},{"code":"86769","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":42.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD LAB","code_information":[{"code":"Px00030210251","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":105.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY CYTOMEGALOVIRUS CMV LAB","code_information":[{"code":"Px00030210254","type":"CDM"},{"code":"86644","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":50.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY CYTOMEGALOVIRUS CMV IGM LAB","code_information":[{"code":"Px00030210255","type":"CDM"},{"code":"86645","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":57.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPECIFIC IGE","code_information":[{"code":"Px00030210302","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTI-SSA (RO) QUANTITATIVE","code_information":[{"code":"Px00030210311","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":105.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTI-SSB (LA) QUANTITATIVE","code_information":[{"code":"Px00030210312","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":105.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTISTREPTOLYSIN O QUANTITATIVE","code_information":[{"code":"Px00030210313","type":"CDM"},{"code":"86060","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ARC ANTIBODY IDENT PANEL","code_information":[{"code":"Px00030210316","type":"CDM"},{"code":"86870","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":120.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC COMPATIBILITY EACH UNIT ANTIGLOBULIN","code_information":[{"code":"Px00030210319","type":"CDM"},{"code":"86922","type":"HCPCS"}],"standard_charges":[{"gross_charge":334.0,"discounted_cash":250.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASPERGILLUS GLACTO AG EIA(ARUP)","code_information":[{"code":"Px00030210337","type":"CDM"},{"code":"87305","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.0,"discounted_cash":61.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PLATELET ANTIBODIES - HEPARIN","code_information":[{"code":"Px00030210346","type":"CDM"},{"code":"86022","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":50.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY HERPES SMPLX NON-SPECIFIC TYPE TEST LAB","code_information":[{"code":"Px00030210348","type":"CDM"},{"code":"86694","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":77.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HSV 2 ANTIBODY IGG","code_information":[{"code":"Px00030210349","type":"CDM"},{"code":"86696","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.0,"discounted_cash":104.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY MYCOPLSM CDM","code_information":[{"code":"Px00030210350","type":"CDM"},{"code":"86738","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":32.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY TREPONEMA PALLIDUM CDM","code_information":[{"code":"Px00030210360","type":"CDM"},{"code":"86780","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":30.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANA SCREEN QUANTITATIVE","code_information":[{"code":"Px00030210367","type":"CDM"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANA SCREEN BODY FLUID","code_information":[{"code":"Px00030210370","type":"CDM"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANA REFLEXIVE QUANTITATIVE","code_information":[{"code":"Px00030210371","type":"CDM"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC C-REACTIVE PROTEIN","code_information":[{"code":"Px00030210399","type":"CDM"},{"code":"86140","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":47.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MUMPS ANTIBODY IGG","code_information":[{"code":"Px00030210401","type":"CDM"},{"code":"86735","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":66.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CARDIOLIPIN ANTIBODY","code_information":[{"code":"Px00030210405","type":"CDM"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC COMPLEMENT TOTAL HEMOLYTIC CDM","code_information":[{"code":"Px00030210418","type":"CDM"},{"code":"86162","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC C4","code_information":[{"code":"Px00030210421","type":"CDM"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC C3","code_information":[{"code":"Px00030210426","type":"CDM"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC COMPLEMENT ANTIGEN EACH COMPONENT CDM","code_information":[{"code":"Px00030210428","type":"CDM"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC NUCLEAR ANTIGEN ANTIBODY ANTI-RNP-SMITH LAB","code_information":[{"code":"Px00030210431","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":105.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTI-DNA QUANTITATIVE","code_information":[{"code":"Px00030210432","type":"CDM"},{"code":"86225","type":"HCPCS"}],"standard_charges":[{"gross_charge":220.0,"discounted_cash":165.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC COMPLEMENT ANTIGEN2 - COMPLIMENT ANTIGEN II","code_information":[{"code":"Px00030210462","type":"CDM"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY HERPES SMPLX TYPE 1 IGG LAB","code_information":[{"code":"Px00030210466","type":"CDM"},{"code":"86695","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":71.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD LAB","code_information":[{"code":"Px00030210500","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":105.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD LAB","code_information":[{"code":"Px00030210501","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":105.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTI-ENA (SMITH) ANTIBODY","code_information":[{"code":"Px00030210521","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":105.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HERPES SIMPLEX TEST - TYPE 1 IGG","code_information":[{"code":"Px00030210524","type":"CDM"},{"code":"86695","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":71.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY RUBEOLA IGG LAB","code_information":[{"code":"Px00030210525","type":"CDM"},{"code":"86765","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC NUCLEAR ANTIGEN ANTIBODY - EXTRACTABLE AG AB","code_information":[{"code":"Px00030210532","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":105.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD CDM","code_information":[{"code":"Px00030210533","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":105.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HETEROPHILE ANTIBODIES","code_information":[{"code":"Px00030210538","type":"CDM"},{"code":"86308","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":28.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY INFECTIOUS AGENT ANTIBODY QUAN TETANUS CDM","code_information":[{"code":"Px00030210544","type":"CDM"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":53.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC TETANUS AB IGG(ARUP)","code_information":[{"code":"Px00030210546","type":"CDM"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":53.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY INFECTIOUS AGENT ANTIBODY QUAN NOS","code_information":[{"code":"Px00030210547","type":"CDM"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":53.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DIPTHERIA AND TETANUS AB (ARUP)","code_information":[{"code":"Px00030210551","type":"CDM"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":53.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY INFECTIOUS AGENT ANTIBODY QUAN NOS LAB","code_information":[{"code":"Px00030210552","type":"CDM"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":53.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY INFECTIOUS AGENT AB QUAN HEP B CDM","code_information":[{"code":"Px00030210564","type":"CDM"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":53.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC INTRINSIC FACTOR ANTIBODIES CDM","code_information":[{"code":"Px00030210572","type":"CDM"},{"code":"86340","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":30.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC RHEUMATOID FACTOR","code_information":[{"code":"Px00030210590","type":"CDM"},{"code":"86431","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":24.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON CDM","code_information":[{"code":"Px00030210598","type":"CDM"},{"code":"86480","type":"HCPCS"}],"standard_charges":[{"gross_charge":285.0,"discounted_cash":213.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC SYPHILIS TEST NON-TREP QUAL","code_information":[{"code":"Px00030210605","type":"CDM"},{"code":"86592","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":25.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC RPR TITER REFLEX","code_information":[{"code":"Px00030210610","type":"CDM"},{"code":"86593","type":"HCPCS"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":7.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASPERGILLUS ANTIBODY","code_information":[{"code":"Px00030210616","type":"CDM"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":11.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC COCCI AB (CF) (PANL)","code_information":[{"code":"Px00030210654","type":"CDM"},{"code":"86635","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":12.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC FUNGUS ANTIBODY","code_information":[{"code":"Px00030210707","type":"CDM"},{"code":"86671","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":16.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HIV-1","code_information":[{"code":"Px00030210715","type":"CDM"},{"code":"86701","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC RAPID HIV 1-2","code_information":[{"code":"Px00030210718","type":"CDM"},{"code":"86703","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":74.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HIV-1/HIV-2 SINGLE ASSAY","code_information":[{"code":"Px00030210719","type":"CDM"},{"code":"86703","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":74.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HEP B CORE (IGG-IGM) ANTIBODY","code_information":[{"code":"Px00030210728","type":"CDM"},{"code":"86704","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":62.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS B SURF ANTIBODY HBSAB CDM","code_information":[{"code":"Px00030210735","type":"CDM"},{"code":"86706","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":57.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS A ANTIBODY HAAB CDM","code_information":[{"code":"Px00030210737","type":"CDM"},{"code":"86708","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":65.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MUMPS VIRUS AB IGM (ARUP)","code_information":[{"code":"Px00030210740","type":"CDM"},{"code":"86735","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":66.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY MUMPS CDM","code_information":[{"code":"Px00030210747","type":"CDM"},{"code":"86735","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":66.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC RUBELLA ANTIBODY","code_information":[{"code":"Px00030210766","type":"CDM"},{"code":"86762","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC RUBELLA ANTIBODY (OF PANEL)","code_information":[{"code":"Px00030210771","type":"CDM"},{"code":"86762","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY WEST NILE VIRUS CDM","code_information":[{"code":"Px00030210775","type":"CDM"},{"code":"86789","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":24.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC VIRUS ANTIBODY NOS - HTLV-1","code_information":[{"code":"Px00030210794","type":"CDM"},{"code":"86790","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":42.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS C ANTIBODY CDM","code_information":[{"code":"Px00030210798","type":"CDM"},{"code":"86803","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":105.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BLOOD TYPING SEROLOGIC RH (D) LAB","code_information":[{"code":"Px00030210856","type":"CDM"},{"code":"86901","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BLOOD TYPING SEROLOGIC RH(D)","code_information":[{"code":"Px00030210861","type":"CDM"},{"code":"86901","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ARC RH PHENOTYPE","code_information":[{"code":"Px00030210863","type":"CDM"},{"code":"86906","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":111.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC COMPATIBILITY EACH UNIT IMMEDIATE SPIN TECHNIQUE LAB","code_information":[{"code":"Px00030210867","type":"CDM"},{"code":"86920","type":"HCPCS"}],"standard_charges":[{"gross_charge":334.0,"discounted_cash":250.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC COMPONENT POOLING","code_information":[{"code":"Px00030210877","type":"CDM"},{"code":"86965","type":"HCPCS"}],"standard_charges":[{"gross_charge":169.0,"discounted_cash":126.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY HTLV 1 AND 2  CDM","code_information":[{"code":"Px00030210894","type":"CDM"},{"code":"86790","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":42.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTIHUMAN GLOBULIN INDIRECT EACH ANTIBODY TITER LAB","code_information":[{"code":"Px00030210906","type":"CDM"},{"code":"86886","type":"HCPCS"}],"standard_charges":[{"gross_charge":324.0,"discounted_cash":243.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BLOOD TYPING SEROLOGIC ABO","code_information":[{"code":"Px00030210907","type":"CDM"},{"code":"86900","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":33.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTIGEN TYPING-UNIT","code_information":[{"code":"Px00030210908","type":"CDM"},{"code":"86902","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":54.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTIGEN TYPING-PATIENT","code_information":[{"code":"Px00030210909","type":"CDM"},{"code":"86905","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTINUCLEAR ANTIBODIES ANA LAB","code_information":[{"code":"Px00030210916","type":"CDM"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC JO-1 AB IGG (ARUP)","code_information":[{"code":"Px00030210931","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":105.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MONO TEST","code_information":[{"code":"Px00030210933","type":"CDM"},{"code":"86308","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":28.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC SYPHILIS TEST NON-TREP QUAL - CSF","code_information":[{"code":"Px00030210935","type":"CDM"},{"code":"86592","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":25.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS B CORE ANTIBODY HBCAB TOTAL CDM","code_information":[{"code":"Px00030210943","type":"CDM"},{"code":"86704","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":62.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS A ANTIBODY HAAB","code_information":[{"code":"Px00030210944","type":"CDM"},{"code":"86708","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":65.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IADNA BORDETELLA AMP PROBE TQ EA ORG CDM","code_information":[{"code":"Px00030210961","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CHLAMYDIA AMPLIFICATION APTIMA","code_information":[{"code":"Px00030210968","type":"CDM"},{"code":"87491","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":84.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IADNA CHLAMYDIA PNEUMONIAE AMPLIFIED PROBE TQ CDM","code_information":[{"code":"Px00030210971","type":"CDM"},{"code":"87486","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":97.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CMV PCR QUALITATIVE","code_information":[{"code":"Px00030210986","type":"CDM"},{"code":"87496","type":"HCPCS"}],"standard_charges":[{"gross_charge":393.0,"discounted_cash":294.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CYTOMEGALOVIRUS QUANT PCR(ARUP)","code_information":[{"code":"Px00030210994","type":"CDM"},{"code":"87497","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":93.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DETECT AGENT NOS-DNA AMPLIFIED PROBE","code_information":[{"code":"Px00030210995","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ENTEROVIRUS PCR","code_information":[{"code":"Px00030211001","type":"CDM"},{"code":"87498","type":"HCPCS"}],"standard_charges":[{"gross_charge":272.0,"discounted_cash":204.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ CDM","code_information":[{"code":"Px00030211005","type":"CDM"},{"code":"87591","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":84.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IADNA HEPATITIS B VIRUS QUANTIFICATION CDM","code_information":[{"code":"Px00030211009","type":"CDM"},{"code":"87517","type":"HCPCS"}],"standard_charges":[{"gross_charge":224.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HEP B SRF AG RFLX CNFRM(OF PANL)","code_information":[{"code":"Px00030211010","type":"CDM"},{"code":"87340","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":56.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HEP B SURF AG (HBSAG) RFLX CONFRM","code_information":[{"code":"Px00030211011","type":"CDM"},{"code":"87340","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":56.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HEP C PCR (QUAL)","code_information":[{"code":"Px00030211012","type":"CDM"},{"code":"87521","type":"HCPCS"}],"standard_charges":[{"gross_charge":261.0,"discounted_cash":195.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HEP C PCR (QUANT)","code_information":[{"code":"Px00030211013","type":"CDM"},{"code":"87522","type":"HCPCS"}],"standard_charges":[{"gross_charge":432.0,"discounted_cash":324.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS C GENOTYPING","code_information":[{"code":"Px00030211015","type":"CDM"},{"code":"87902","type":"HCPCS"}],"standard_charges":[{"gross_charge":2878.0,"discounted_cash":2158.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HERPES SIMPLEX PCR","code_information":[{"code":"Px00030211017","type":"CDM"},{"code":"87529","type":"HCPCS"}],"standard_charges":[{"gross_charge":247.0,"discounted_cash":185.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HIV-1 RNA QUANTITATION","code_information":[{"code":"Px00030211022","type":"CDM"},{"code":"87536","type":"HCPCS"}],"standard_charges":[{"gross_charge":662.0,"discounted_cash":496.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HSV PCR SOURCE OTHER","code_information":[{"code":"Px00030211028","type":"CDM"},{"code":"87529","type":"HCPCS"}],"standard_charges":[{"gross_charge":247.0,"discounted_cash":185.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HSV PCR TYPING","code_information":[{"code":"Px00030211029","type":"CDM"},{"code":"87529","type":"HCPCS"}],"standard_charges":[{"gross_charge":247.0,"discounted_cash":185.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IADNA MYCOBACTERIUM TB AMP PROBE TQ EA ORG CDM","code_information":[{"code":"Px00030211036","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IADNA LEGIONELLA PNEUMOPHILA AMPLIFIED PROBE TQ CDM","code_information":[{"code":"Px00030211044","type":"CDM"},{"code":"87541","type":"HCPCS"}],"standard_charges":[{"gross_charge":393.0,"discounted_cash":294.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MRSA PCR","code_information":[{"code":"Px00030211050","type":"CDM"},{"code":"87641","type":"HCPCS"}],"standard_charges":[{"gross_charge":272.0,"discounted_cash":204.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MYCOBACTERIUM TB PCR","code_information":[{"code":"Px00030211051","type":"CDM"},{"code":"87556","type":"HCPCS"}],"standard_charges":[{"gross_charge":393.0,"discounted_cash":294.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MYCOPLASMA PCR","code_information":[{"code":"Px00030211052","type":"CDM"},{"code":"87581","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":97.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IADNA NOROVIRUS AMP PROBE TQ EACH ORGANISM CDM","code_information":[{"code":"Px00030211053","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IADNA NOROVIRUS AMP PROBE TQ EACH ORGANISM CDM","code_information":[{"code":"Px00030211054","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IADNA PNEUMOCYSTIS JIROVECI AMP PROBE TQ EA ORG CDM","code_information":[{"code":"Px00030211056","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IADNA INFLUENZA RSV AMP PROBE TQ EA ORG CDM","code_information":[{"code":"Px00030211059","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IADNA S AUREUS AMPLIFIED PROBE TQ CDM","code_information":[{"code":"Px00030211062","type":"CDM"},{"code":"87640","type":"HCPCS"}],"standard_charges":[{"gross_charge":273.0,"discounted_cash":204.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IADNA VARICELLA ZOSTER AMP PROBE TQ EA ORG CDM","code_information":[{"code":"Px00030211073","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IMMUNOFIXATION SERUM","code_information":[{"code":"Px00030211078","type":"CDM"},{"code":"86334","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":114.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IMMUNOFIXATION URINE","code_information":[{"code":"Px00030211079","type":"CDM"},{"code":"86335","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"discounted_cash":150.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY VARICELLA-ZOSTER","code_information":[{"code":"Px00030211088","type":"CDM"},{"code":"86787","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY SCREEN RBC EACH SERUM TECHNIQUE LAB","code_information":[{"code":"Px00030211093","type":"CDM"},{"code":"86850","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY SCREEN RBC EACH SERUM TECHNIQUE","code_information":[{"code":"Px00030211094","type":"CDM"},{"code":"86850","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY SCREEN2","code_information":[{"code":"Px00030211095","type":"CDM"},{"code":"86850","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ARC DIRECT ANTIGLOBULIN TEST","code_information":[{"code":"Px00030211096","type":"CDM"},{"code":"86880","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":74.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC INTRINSIC FACTR BLOCK AB (ARUP)","code_information":[{"code":"Px00030211138","type":"CDM"},{"code":"86340","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":30.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC RH (D)","code_information":[{"code":"Px00030211143","type":"CDM"},{"code":"86901","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CROSSMATCH 1 UNIT","code_information":[{"code":"Px00030211144","type":"CDM"},{"code":"86920","type":"HCPCS"}],"standard_charges":[{"gross_charge":334.0,"discounted_cash":250.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ABO GROUP","code_information":[{"code":"Px00030211152","type":"CDM"},{"code":"86900","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":33.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY BACTERIUM NOT ELSEWHERE SPECIFIED LAB","code_information":[{"code":"Px00030211227","type":"CDM"},{"code":"86609","type":"HCPCS"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":4.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IMMUNODIFFUSION GEL DIFFUSION QUAL EA AG/ANTBDY LAB","code_information":[{"code":"Px00030211228","type":"CDM"},{"code":"86331","type":"HCPCS"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":4.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY ACTINOMYCES LAB","code_information":[{"code":"Px00030211229","type":"CDM"},{"code":"86602","type":"HCPCS"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":4.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY ASPERGILLUS LAB","code_information":[{"code":"Px00030211230","type":"CDM"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":11.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY FUNGUS NOT ELSEWHERE SPECIFIED LAB","code_information":[{"code":"Px00030211231","type":"CDM"},{"code":"86671","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":16.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC RPR QUANTITATIVE","code_information":[{"code":"Px00030211505","type":"CDM"},{"code":"86593","type":"HCPCS"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":7.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC INFLUENZA A-B PCR","code_information":[{"code":"Px00030211511","type":"CDM"},{"code":"87502","type":"HCPCS"}],"standard_charges":[{"gross_charge":208.0,"discounted_cash":156.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ZSTREP PNEUMONIAE","code_information":[{"code":"Px00030211512","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTI-HIV 1/2 AB & P24 AG","code_information":[{"code":"Px00030211540","type":"CDM"},{"code":"87389","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":90.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC C DIFFICILE TOXIN","code_information":[{"code":"Px00030310165","type":"CDM"},{"code":"87324","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":51.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PHOSPHOLIPID NEUTRALIZATION HEXAGONAL LAB","code_information":[{"code":"Px00030500004","type":"CDM"},{"code":"85598","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PROTHROMBIN TIME LAB","code_information":[{"code":"Px00030500005","type":"CDM"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC RUSSELL VIPER VENOM TIME DILUTED LAB","code_information":[{"code":"Px00030500006","type":"CDM"},{"code":"85613","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":25.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC THROMBIN TIME PLASMA LAB","code_information":[{"code":"Px00030500007","type":"CDM"},{"code":"85670","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":48.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD LAB","code_information":[{"code":"Px00030500008","type":"CDM"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":45.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC COAGJ&FIBRINOLYSIS FUNCTIONAL ACTV NOS EA ANAL LAB","code_information":[{"code":"Px00030500015","type":"CDM"},{"code":"85397","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":107.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BLOOD COUNT HEMATOCRIT LAB","code_information":[{"code":"Px00030500136","type":"CDM"},{"code":"85014","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":17.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC","code_information":[{"code":"Px00030500141","type":"CDM"},{"code":"85025","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BLOOD COUNT COMPLETE AUTOMATED LAB","code_information":[{"code":"Px00030500147","type":"CDM"},{"code":"85027","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":12.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BLOOD COUNT PLATELET AUTOMATED LAB","code_information":[{"code":"Px00030500148","type":"CDM"},{"code":"85049","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CLOTTING FACTOR VIII AHG 1 STAGE LAB","code_information":[{"code":"Px00030500155","type":"CDM"},{"code":"85240","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":29.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC SICKLING RBC REDUCTION LAB","code_information":[{"code":"Px00030500165","type":"CDM"},{"code":"85660","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":54.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD LAB","code_information":[{"code":"Px00030500169","type":"CDM"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":45.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PHOSPHOLIPID NEUTRALIZATION HEXAGONAL LAB","code_information":[{"code":"Px00030500190","type":"CDM"},{"code":"85598","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC SICKLING RBC REDUCTION LAB","code_information":[{"code":"Px00030500191","type":"CDM"},{"code":"85660","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":54.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PROTHROMBIN TIME LAB","code_information":[{"code":"Px00030500214","type":"CDM"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC COAGULATION TIME ACTIVATED LAB","code_information":[{"code":"Px00030500217","type":"CDM"},{"code":"85347","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BLOOD COUNT HEMATOCRIT LAB","code_information":[{"code":"Px00030500243","type":"CDM"},{"code":"85014","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":17.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BLOOD COUNT HEMOGLOBIN LAB","code_information":[{"code":"Px00030500244","type":"CDM"},{"code":"85018","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":17.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HEMOGLOBIN","code_information":[{"code":"Px00030510023","type":"CDM"},{"code":"85018","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":17.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HEMATOCRIT","code_information":[{"code":"Px00030510024","type":"CDM"},{"code":"85014","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":17.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC LAB","code_information":[{"code":"Px00030510029","type":"CDM"},{"code":"85025","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC AUTOMATED PLATELET COUNT","code_information":[{"code":"Px00030510030","type":"CDM"},{"code":"85049","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PROTHROMBIN TIME","code_information":[{"code":"Px00030510032","type":"CDM"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC THROMBOPLASTIN TIME PARTIAL","code_information":[{"code":"Px00030510033","type":"CDM"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":45.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BL SMEAR W/DIFF WBC COUNT","code_information":[{"code":"Px00030510034","type":"CDM"},{"code":"85007","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":34.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HEMOGLOBIN FETAL","code_information":[{"code":"Px00030510036","type":"CDM"},{"code":"85460","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":93.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC AUTOMATED RETICULOCYTE COUNT","code_information":[{"code":"Px00030510037","type":"CDM"},{"code":"85045","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":46.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CLOTTING INHIBITORS ANTITHROMBIN III ACTIVITY LAB","code_information":[{"code":"Px00030510039","type":"CDM"},{"code":"85300","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":72.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC SICKLING RBC REDUCTION LAB","code_information":[{"code":"Px00030510042","type":"CDM"},{"code":"85660","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":54.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CLOTTING INHIBITORS PROTEIN C ACTIVITY LAB","code_information":[{"code":"Px00030510049","type":"CDM"},{"code":"85303","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC THROMBIN TIME","code_information":[{"code":"Px00030510050","type":"CDM"},{"code":"85670","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":48.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC COMPLETE CBC AUTOMATED","code_information":[{"code":"Px00030510062","type":"CDM"},{"code":"85027","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":12.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC FIBRINOGEN","code_information":[{"code":"Px00030510063","type":"CDM"},{"code":"85384","type":"HCPCS"}],"standard_charges":[{"gross_charge":235.0,"discounted_cash":176.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BLOOD CLOT INHIBITOR","code_information":[{"code":"Px00030510068","type":"CDM"},{"code":"85306","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":93.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC FIBRIN DEGRADATION QUANT","code_information":[{"code":"Px00030510069","type":"CDM"},{"code":"85379","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":144.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC RBC SED RATE AUTOMATED","code_information":[{"code":"Px00030510076","type":"CDM"},{"code":"85652","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC AUTOMATED RBC COUNT","code_information":[{"code":"Px00030510077","type":"CDM"},{"code":"85041","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":19.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ACTIVATED PROTEIN C APC RESISTANCE ASSAY CDM","code_information":[{"code":"Px00030510084","type":"CDM"},{"code":"85307","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":45.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC RISTOCETIN COFACTOR","code_information":[{"code":"Px00030510091","type":"CDM"},{"code":"85245","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":29.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HEMATOCRIT BODY FLUID","code_information":[{"code":"Px00030510109","type":"CDM"},{"code":"85014","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":17.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC EOSINOPHIL COUNT WHOLE BLOOD","code_information":[{"code":"Px00030510116","type":"CDM"},{"code":"85048","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":12.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC COMPLETE CBC W/AUTO DIF WBC","code_information":[{"code":"Px00030510131","type":"CDM"},{"code":"85025","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC WBC COUNT ONLY","code_information":[{"code":"Px00030510148","type":"CDM"},{"code":"85048","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":12.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC RUSSELL VIPER VENOM TIME DILUTED LAB","code_information":[{"code":"Px00030510327","type":"CDM"},{"code":"85613","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":25.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC SEDIMENTATION RATE RBC AUTOMATED LAB","code_information":[{"code":"Px00030510399","type":"CDM"},{"code":"85652","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CELL CNT-DIFF BF","code_information":[{"code":"Px00030510404","type":"CDM"},{"code":"89051","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.0,"discounted_cash":61.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CELL CNT-DIFF CSF","code_information":[{"code":"Px00030510405","type":"CDM"},{"code":"89051","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.0,"discounted_cash":61.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CELL CNT-DIFF SYNOVIAL","code_information":[{"code":"Px00030510406","type":"CDM"},{"code":"89051","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.0,"discounted_cash":61.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CELL COUNT ONLY","code_information":[{"code":"Px00030510407","type":"CDM"},{"code":"89050","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.0,"discounted_cash":39.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CRYSTAL ANALYSIS BODY FLUID","code_information":[{"code":"Px00030510408","type":"CDM"},{"code":"89060","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":36.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CD4","code_information":[{"code":"Px00030510419","type":"CDM"},{"code":"86361","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":93.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC THROMBOPLASTIN TIME PRTL SUBSTIT PLASMA FRCTJ EA LAB","code_information":[{"code":"Px00030510426","type":"CDM"},{"code":"85732","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CORONAVIRUS AG IA LAB","code_information":[{"code":"Px00030600007","type":"CDM"},{"code":"87426","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":51.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES LAB","code_information":[{"code":"Px00030600012","type":"CDM"},{"code":"87624","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":78.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CULTURE BACTERIAL BLOOD AEROBIC W/ID ISOLATES LAB","code_information":[{"code":"Px00030600016","type":"CDM"},{"code":"87040","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SARSCOV2 & INF A&B AMP PRB","code_information":[{"code":"Px00030600052","type":"CDM"},{"code":"87636","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":121.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IADNA MYCOBACTERIA TUBERCULOSIS AMP PRB LAB","code_information":[{"code":"Px00030600103","type":"CDM"},{"code":"87556","type":"HCPCS"}],"standard_charges":[{"gross_charge":393.0,"discounted_cash":294.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IADNA NOS AMPLIFIED PROBE TQ EACH ORGANISM LAB","code_information":[{"code":"Px00030600110","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IADNA CANDIDA SPECIES DIRECT PROBE TQ LAB","code_information":[{"code":"Px00030600113","type":"CDM"},{"code":"87480","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":32.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CYTP C/V AUTO THIN LYR PREPJ SCR MNL RESCR PHYS LAB","code_information":[{"code":"Px00030600117","type":"CDM"},{"code":"88175","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":28.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC SARSCOV2 & INF A&B AMP PRB LAB","code_information":[{"code":"Px00030600318","type":"CDM"},{"code":"87636","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":93.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC ORTHOPOXVIRUS AMP PRB EACH LAB","code_information":[{"code":"Px00030600321","type":"CDM"},{"code":"87593","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.0,"discounted_cash":99.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IAAD IA HEPATITIS B SURFACE ANTIGEN LAB","code_information":[{"code":"Px00030600380","type":"CDM"},{"code":"87340","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":56.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IADNA CANDIDA SPECIES DIRECT PROBE TQ LAB","code_information":[{"code":"Px00030600384","type":"CDM"},{"code":"87480","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":32.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IADNA GARDNERELLA VAGINALIS DIRECT PROBE TQ LAB","code_information":[{"code":"Px00030600386","type":"CDM"},{"code":"87510","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":32.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IADNA TRICHOMONAS VAGINALIS DIRECT PROBE TQ LAB","code_information":[{"code":"Px00030600398","type":"CDM"},{"code":"87660","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":32.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH LAB","code_information":[{"code":"Px00030600400","type":"CDM"},{"code":"87661","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":43.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IADNA NOS AMPLIFIED PROBE TQ EACH ORGANISM LAB","code_information":[{"code":"Px00030600413","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IADNA NOS AMPLIFIED PROBE TQ EACH ORGANISM LAB","code_information":[{"code":"Px00030600415","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL LAB","code_information":[{"code":"Px00030600447","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":106.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC SMR PRIM SRC SPEC STAIN BODIES/PARASITS LAB","code_information":[{"code":"Px00030600518","type":"CDM"},{"code":"87207","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":113.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CONCENTRATION INFECTIOUS AGENTS LAB","code_information":[{"code":"Px00030600519","type":"CDM"},{"code":"87015","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CONCENTRATION INFECTIOUS AGENTS LAB","code_information":[{"code":"Px00030600525","type":"CDM"},{"code":"87015","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL LAB","code_information":[{"code":"Px00030600561","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":106.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL LAB","code_information":[{"code":"Px00030600562","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":106.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL","code_information":[{"code":"Px00030600564","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":106.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL","code_information":[{"code":"Px00030600566","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":106.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL LAB","code_information":[{"code":"Px00030600567","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":106.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CULTURE BACTERIAL ANY SOURCE ANAEROBIC ISO&ID LAB","code_information":[{"code":"Px00030600569","type":"CDM"},{"code":"87075","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.0,"discounted_cash":142.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CULTURE BACTERIAL ANY SOURCE ANAEROBIC ISO&ID LAB","code_information":[{"code":"Px00030600570","type":"CDM"},{"code":"87075","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.0,"discounted_cash":142.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CUL PRSMPTV PTHGNC ORGANISM SCRN W/COLONY ESTIMJ LAB","code_information":[{"code":"Px00030600573","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":71.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CUL PRSMPTV PTHGNC ORGANISM SCRN W/COLONY ESTIMJ LAB","code_information":[{"code":"Px00030600574","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":71.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CUL PRSMPTV PTHGNC ORGANISM SCRN W/COLONY ESTIMJ LAB","code_information":[{"code":"Px00030600575","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":71.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CUL PRSMPTV PTHGNC ORGANISM SCRN W/COLONY ESTIMJ LAB","code_information":[{"code":"Px00030600576","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":71.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CUL PRSMPTV PTHGNC ORGANISM SCRN W/COLONY ESTIMJ LAB","code_information":[{"code":"Px00030600577","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":71.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE LAB","code_information":[{"code":"Px00030600578","type":"CDM"},{"code":"87086","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":32.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CUL FNGI MOLD/YEAST PRSMPTV ID SKN HAIR/NAIL LAB","code_information":[{"code":"Px00030600579","type":"CDM"},{"code":"87101","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":45.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CULTURE FNGI MOLD/YEAST PRSMPTV OTH XCPT BLOOD","code_information":[{"code":"Px00030600580","type":"CDM"},{"code":"87102","type":"HCPCS"}],"standard_charges":[{"gross_charge":235.0,"discounted_cash":176.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CULTURE FNGI MOLD/YEAST PRSMPTV OTH XCPT BLOOD LAB","code_information":[{"code":"Px00030600581","type":"CDM"},{"code":"87102","type":"HCPCS"}],"standard_charges":[{"gross_charge":235.0,"discounted_cash":176.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CULTURE TUBERCLE/OTH ACID-FAST BACILLI ANY ISOL LAB","code_information":[{"code":"Px00030600583","type":"CDM"},{"code":"87116","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.0,"discounted_cash":137.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ LAB","code_information":[{"code":"Px00030600612","type":"CDM"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC SUSCEPTBILTY STDY ANTIMICRBIAL AGNT AGAR DILUTJ LAB","code_information":[{"code":"Px00030600613","type":"CDM"},{"code":"87181","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":27.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD LAB","code_information":[{"code":"Px00030600614","type":"CDM"},{"code":"87184","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":64.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC SUSCEPTIBILITY STUDY ANTIMICROBIAL ENZYME DETCJ LAB","code_information":[{"code":"Px00030600615","type":"CDM"},{"code":"87185","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":12.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES LAB","code_information":[{"code":"Px00030600619","type":"CDM"},{"code":"87624","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":78.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IADNA RESPIRATRY PROBE & REV TRNSCR 12-25 TARGET","code_information":[{"code":"Px00030600672","type":"CDM"},{"code":"87633","type":"HCPCS"}],"standard_charges":[{"gross_charge":688.0,"discounted_cash":516.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IADNA SARSCOV2 & INF A&B & RSV MULT AMP PROBE TQ LAB","code_information":[{"code":"Px00030600699","type":"CDM"},{"code":"87637","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":243.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IADNA MULTIPLE ORGANISMS AMPLIFIED PROBE TQ LAB","code_information":[{"code":"Px00030600711","type":"CDM"},{"code":"87801","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":27.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IADNA NOS AMPLIFIED PROBE TQ EACH ORGANISM LAB","code_information":[{"code":"Px00030600712","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL CDM","code_information":[{"code":"Px00030600784","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":81.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL CDM","code_information":[{"code":"Px00030600785","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":81.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL CDM","code_information":[{"code":"Px00030600786","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":81.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CULTURE BACTERIAL ANY SOURCE ANAEROBIC ISO&ID CDM","code_information":[{"code":"Px00030600787","type":"CDM"},{"code":"87075","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":109.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL","code_information":[{"code":"Px00030600788","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":81.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CULTURE BACTERIAL ANY SOURCE ANAEROBIC ISO&ID","code_information":[{"code":"Px00030600789","type":"CDM"},{"code":"87075","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":109.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC SMR PRIM SRC GRAM/GIEMSA STAIN BCT FUNGI/CELL","code_information":[{"code":"Px00030600790","type":"CDM"},{"code":"87205","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IADNA S AUREUS AMPLIFIED PROBE TQ CDM","code_information":[{"code":"Px00030600807","type":"CDM"},{"code":"87640","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":157.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IADNA S AUREUS METHICILLIN RESIST AMP PROBE TQ CDM","code_information":[{"code":"Px00030600808","type":"CDM"},{"code":"87641","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":156.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC VIRUS TISS CUL INOCULATION CYTOPATHIC EFFECT CDM","code_information":[{"code":"Px00030610035","type":"CDM"},{"code":"87252","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":56.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC OVA AND PARASITES EXAM","code_information":[{"code":"Px00030610133","type":"CDM"},{"code":"87177","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC STREP GROUP A AG RFLX CULTURE","code_information":[{"code":"Px00030610149","type":"CDM"},{"code":"87880","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":54.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC TRICHROME STAIN","code_information":[{"code":"Px00030610151","type":"CDM"},{"code":"87209","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":78.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PBP2 SCREEN","code_information":[{"code":"Px00030610153","type":"CDM"},{"code":"86403","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":44.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANAEROBIC DEFINITIVE ID","code_information":[{"code":"Px00030610155","type":"CDM"},{"code":"87076","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":74.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC GNI (GRAM NEG ID)","code_information":[{"code":"Px00030610157","type":"CDM"},{"code":"87077","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":45.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CULTURE SCREEN ONLY","code_information":[{"code":"Px00030610159","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":71.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC GPI (GRAM POS ID)","code_information":[{"code":"Px00030610164","type":"CDM"},{"code":"87077","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":45.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IADNA WEST NILE VIRUS AMP PROBE TQ EA ORG CDM","code_information":[{"code":"Px00030610167","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BACTERIAL CULTURE - OTHR SOURCE","code_information":[{"code":"Px00030610175","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":106.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CULTURE TRANSFUSION REACT UNIT","code_information":[{"code":"Px00030610176","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":106.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CULTURE-EAR","code_information":[{"code":"Px00030610177","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":106.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IAAD IA MULT STEP METHOD NOS EACH ORGANISM","code_information":[{"code":"Px00030610178","type":"CDM"},{"code":"87449","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.0,"discounted_cash":117.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IAAD IA QUAL/SEMIQUAN MULTIPLE STEP ASPERGILLUS LAB","code_information":[{"code":"Px00030610189","type":"CDM"},{"code":"87305","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.0,"discounted_cash":61.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ","code_information":[{"code":"Px00030610191","type":"CDM"},{"code":"87491","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":84.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ","code_information":[{"code":"Px00030610194","type":"CDM"},{"code":"87591","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":84.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IADNA NOS AMPLIFIED PROBE TQ EACH ORGANISM LAB","code_information":[{"code":"Px00030610207","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC COVID-19 AMP PRB HIGH THROUGHPUT PHS OREGON","code_information":[{"code":"Px00030610252","type":"CDM"},{"code":"87635","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":121.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CULTURE-EYE SURFACE","code_information":[{"code":"Px00030610325","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":106.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CULTURE-GENITAL-FEMALE","code_information":[{"code":"Px00030610329","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":106.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CULTURE-RESPIR UPPER","code_information":[{"code":"Px00030610331","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":106.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CULTURE-WOUND-SURFACE","code_information":[{"code":"Px00030610333","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":106.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CULTURE-WOUND-DEEP","code_information":[{"code":"Px00030610334","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":106.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CULTURE-SURGICAL TISSUE","code_information":[{"code":"Px00030610337","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":106.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CUL BACT AEROBIC ADDL METHS DEFINITIVE EA ISOL CDM","code_information":[{"code":"Px00030610366","type":"CDM"},{"code":"87077","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":45.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC AEROBIC DEFINITIVE ID","code_information":[{"code":"Px00030610371","type":"CDM"},{"code":"87077","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":45.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC AEROBIC-ID","code_information":[{"code":"Px00030610376","type":"CDM"},{"code":"87077","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":45.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CULTURE SCREEN ONLY","code_information":[{"code":"Px00030610387","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":71.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CULTURE-NOCARDIA","code_information":[{"code":"Px00030610399","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":71.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CULTURE-GONOCOCCUS","code_information":[{"code":"Px00030610405","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":71.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CULTURE-ANTIB RESIST ORG","code_information":[{"code":"Px00030610407","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":71.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CULTURE-YEAST","code_information":[{"code":"Px00030610422","type":"CDM"},{"code":"87102","type":"HCPCS"}],"standard_charges":[{"gross_charge":235.0,"discounted_cash":176.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC YBC (YEAST BIOCHEM)","code_information":[{"code":"Px00030610438","type":"CDM"},{"code":"87106","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":90.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC AFB CULTURE-BLOOD","code_information":[{"code":"Px00030610447","type":"CDM"},{"code":"87116","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.0,"discounted_cash":137.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HOMOGENIZATION","code_information":[{"code":"Px00030610472","type":"CDM"},{"code":"87176","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ LAB","code_information":[{"code":"Px00030610482","type":"CDM"},{"code":"87635","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":121.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC SUSCEPTIBILITY-DISK 2","code_information":[{"code":"Px00030610492","type":"CDM"},{"code":"87184","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":64.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC SUSCEPTIBILITY STUDY ANTIMICROBIAL ENZYME DETCJ LAB","code_information":[{"code":"Px00030610551","type":"CDM"},{"code":"87185","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":12.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC SMEAR GRAM STAIN","code_information":[{"code":"Px00030610563","type":"CDM"},{"code":"87205","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":39.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC GRAM STAIN","code_information":[{"code":"Px00030610566","type":"CDM"},{"code":"87205","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":39.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC TISSUE EXAM FOR FUNGI - HAIR/NAIL/SKIN","code_information":[{"code":"Px00030610576","type":"CDM"},{"code":"87220","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":16.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC GIARDIA ANTIGEN","code_information":[{"code":"Px00030610583","type":"CDM"},{"code":"87329","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.0,"discounted_cash":70.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANAEROBIC ID","code_information":[{"code":"Px00030610592","type":"CDM"},{"code":"87076","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":74.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IAAD IA NOT OTHERWISE SPECIFIED EACH ORGANISM CDM","code_information":[{"code":"Px00030610595","type":"CDM"},{"code":"87449","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.0,"discounted_cash":117.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC SPECIMEN CONC","code_information":[{"code":"Px00030610599","type":"CDM"},{"code":"87015","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CULTURE-ANAEROBE","code_information":[{"code":"Px00030610600","type":"CDM"},{"code":"87075","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.0,"discounted_cash":142.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PNEUMOCOCCAL AB IGG","code_information":[{"code":"Px00030610601","type":"CDM"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":53.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC COCCIDIOIDES AB BY CF(ARUP)","code_information":[{"code":"Px00030610603","type":"CDM"},{"code":"86635","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":12.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CULTURE-BLOOD","code_information":[{"code":"Px00030610604","type":"CDM"},{"code":"87040","type":"HCPCS"}],"standard_charges":[{"gross_charge":286.0,"discounted_cash":214.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CULTURE-RESPIR LOWER","code_information":[{"code":"Px00030610608","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":106.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CULTURE-IV CATH TIP","code_information":[{"code":"Px00030610609","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":106.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CULTURE-BODY FLUID","code_information":[{"code":"Px00030610610","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":106.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CULTURE-CSF","code_information":[{"code":"Px00030610611","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":106.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CULTURE-BRONCH BRUSH QUANT","code_information":[{"code":"Px00030610619","type":"CDM"},{"code":"87071","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":28.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CULTURE-YERSINIA","code_information":[{"code":"Px00030610621","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":71.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC H PYLORI UREASE TEST","code_information":[{"code":"Px00030610622","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":71.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CUL PRSMPTV PTHGNC ORGANISM SCRN W/COLONY ESTIMJ","code_information":[{"code":"Px00030610623","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":71.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CULTURE-METH RESIST S AUREUS","code_information":[{"code":"Px00030610628","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":71.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC COVID-19 AMP PRB PHS OREGON 87635","code_information":[{"code":"Px00030610631","type":"CDM"},{"code":"87635","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":121.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CULTURE-URINE","code_information":[{"code":"Px00030610634","type":"CDM"},{"code":"87086","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":32.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC FUNGUS CULTURE-HAIR NAIL SKIN","code_information":[{"code":"Px00030610637","type":"CDM"},{"code":"87101","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":45.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC FUNGUS CULTURE-OTHER","code_information":[{"code":"Px00030610638","type":"CDM"},{"code":"87102","type":"HCPCS"}],"standard_charges":[{"gross_charge":235.0,"discounted_cash":176.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC FUNGUS CULTURE BLOOD","code_information":[{"code":"Px00030610639","type":"CDM"},{"code":"87103","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MOLD ID","code_information":[{"code":"Px00030610644","type":"CDM"},{"code":"87107","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":36.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC AFB CULTURE","code_information":[{"code":"Px00030610647","type":"CDM"},{"code":"87116","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.0,"discounted_cash":137.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IMMUNOLOGIC ID","code_information":[{"code":"Px00030610648","type":"CDM"},{"code":"87147","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":67.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC SUSCEPTIBILITY-E TEST","code_information":[{"code":"Px00030610649","type":"CDM"},{"code":"87181","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":27.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC SUSCEPTIBILITY-DISK 1","code_information":[{"code":"Px00030610650","type":"CDM"},{"code":"87184","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":64.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC SUSCEPTIBILITY - MIC","code_information":[{"code":"Px00030610651","type":"CDM"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CASPOFUNGIN","code_information":[{"code":"Px00030610653","type":"CDM"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC FLUCONAZOLE","code_information":[{"code":"Px00030610654","type":"CDM"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC VORICONAZOLE","code_information":[{"code":"Px00030610658","type":"CDM"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IAAD IA HPYLORI STOOL CDM","code_information":[{"code":"Px00030610663","type":"CDM"},{"code":"87338","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":48.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE LAB","code_information":[{"code":"Px00030610668","type":"CDM"},{"code":"87493","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.0,"discounted_cash":165.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CALCOFLUOR STAIN","code_information":[{"code":"Px00030610672","type":"CDM"},{"code":"87206","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.0,"discounted_cash":82.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CRYPTOSPORIDIUM ANTIGEN","code_information":[{"code":"Px00030610682","type":"CDM"},{"code":"87328","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.0,"discounted_cash":70.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC NFCT AGENT DETECTION GI","code_information":[{"code":"Px00030610701","type":"CDM"},{"code":"87505","type":"HCPCS"}],"standard_charges":[{"gross_charge":295.0,"discounted_cash":221.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES LAB","code_information":[{"code":"Px00030610705","type":"CDM"},{"code":"87624","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":78.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY LAB","code_information":[{"code":"Px00030700003","type":"CDM"},{"code":"81003","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":20.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY LAB","code_information":[{"code":"Px00030700014","type":"CDM"},{"code":"81003","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":20.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY LAB","code_information":[{"code":"Px00030700015","type":"CDM"},{"code":"81001","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":34.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY LAB","code_information":[{"code":"Px00030700016","type":"CDM"},{"code":"81001","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":34.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY LAB","code_information":[{"code":"Px00030700017","type":"CDM"},{"code":"81003","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":20.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC URINALYSIS AUTO W/O SCOPE","code_information":[{"code":"Px00030710008","type":"CDM"},{"code":"81003","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":20.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY CDM","code_information":[{"code":"Px00030710009","type":"CDM"},{"code":"81001","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":34.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MICROSCOPIC EXAM OF URINE","code_information":[{"code":"Px00030710010","type":"CDM"},{"code":"81015","type":"HCPCS"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":7.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC FAT/LIPIDS FECES QUALITATIVE CDM","code_information":[{"code":"Px00030710011","type":"CDM"},{"code":"82705","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":19.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PH URINE DIPSTICK AUTO W/O MICROSCOPY LAB","code_information":[{"code":"Px00030710012","type":"CDM"},{"code":"81003","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":20.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC SPECIFIC GRAVITY URINE","code_information":[{"code":"Px00030710023","type":"CDM"},{"code":"81003","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":20.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC KRAS GENE ANALYSIS VARIANTS IN EXON 2 LAB","code_information":[{"code":"Px00030900034","type":"CDM"},{"code":"81275","type":"HCPCS"}],"standard_charges":[{"gross_charge":368.0,"discounted_cash":276.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC EGFR GENE ANALYSIS COMMON VARIANTS LAB","code_information":[{"code":"Px00030900035","type":"CDM"},{"code":"81235","type":"HCPCS"}],"standard_charges":[{"gross_charge":478.0,"discounted_cash":358.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC JAK2 GENE ANALYSIS P.VAL617PHE VARIANT","code_information":[{"code":"Px00030900036","type":"CDM"},{"code":"81270","type":"HCPCS"}],"standard_charges":[{"gross_charge":328.0,"discounted_cash":246.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC JAK2 TARGETED SEQUENCE ANALYSIS","code_information":[{"code":"Px00030900037","type":"CDM"},{"code":"81279","type":"HCPCS"}],"standard_charges":[{"gross_charge":364.0,"discounted_cash":273.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BRAF GENE ANALYSIS V600 VARIANT(S) LAB","code_information":[{"code":"Px00030900038","type":"CDM"},{"code":"81210","type":"HCPCS"}],"standard_charges":[{"gross_charge":402.0,"discounted_cash":301.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HEMATOLYMPHOID NEO/DO GSAP 5-50DNA/DNA&RNA ALYS","code_information":[{"code":"Px00030900039","type":"CDM"},{"code":"81450","type":"HCPCS"}],"standard_charges":[{"gross_charge":1000.0,"discounted_cash":750.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HEMATOLYMPHOID NEO/DO GSAP 5-50DNA/DNA&RNA ALYS","code_information":[{"code":"Px00030900040","type":"CDM"},{"code":"81450","type":"HCPCS"}],"standard_charges":[{"gross_charge":2512.0,"discounted_cash":1884.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC JAK2 GENE ANALYSIS P.VAL617PHE VARIANT LAB","code_information":[{"code":"Px00030900041","type":"CDM"},{"code":"81270","type":"HCPCS"}],"standard_charges":[{"gross_charge":377.0,"discounted_cash":282.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC JAK2 TARGETED SEQUENCE ANALYSIS LAB","code_information":[{"code":"Px00030900042","type":"CDM"},{"code":"81279","type":"HCPCS"}],"standard_charges":[{"gross_charge":419.0,"discounted_cash":314.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CALR GENE ANALYSIS COMMON VARIANTS IN EXON 9 LAB","code_information":[{"code":"Px00030900043","type":"CDM"},{"code":"81219","type":"HCPCS"}],"standard_charges":[{"gross_charge":299.0,"discounted_cash":224.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MPL GENE ANALYSIS COMMON VARIANTS LAB","code_information":[{"code":"Px00030900044","type":"CDM"},{"code":"81338","type":"HCPCS"}],"standard_charges":[{"gross_charge":432.0,"discounted_cash":324.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HEMATOLYMPHOID NEO/DO GSAP 5-50DNA/DNA&RNA ALYS LAB","code_information":[{"code":"Px00030900045","type":"CDM"},{"code":"81450","type":"HCPCS"}],"standard_charges":[{"gross_charge":2512.0,"discounted_cash":1884.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CEBPA GENE ANALYSIS FULL GENE SEQUENCE LAB","code_information":[{"code":"Px00030900046","type":"CDM"},{"code":"81218","type":"HCPCS"}],"standard_charges":[{"gross_charge":592.0,"discounted_cash":444.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC FLT3 GENE ANALYSIS INTERNAL TANDEM DUP VARIANTS LAB","code_information":[{"code":"Px00030900047","type":"CDM"},{"code":"81245","type":"HCPCS"}],"standard_charges":[{"gross_charge":299.0,"discounted_cash":224.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC FLT3 GENE ANLYS TYROSINE KINASE DOMAIN VARIANTS LAB","code_information":[{"code":"Px00030900048","type":"CDM"},{"code":"81246","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":112.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC NPM1 NUCLEOPHOSMIN GENE ANAL EXON 12 VARIANTS LAB","code_information":[{"code":"Px00030900049","type":"CDM"},{"code":"81310","type":"HCPCS"}],"standard_charges":[{"gross_charge":443.0,"discounted_cash":332.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CALR GENE ANALYSIS COMMON VARIANTS IN EXON 9 LAB","code_information":[{"code":"Px00030900050","type":"CDM"},{"code":"81219","type":"HCPCS"}],"standard_charges":[{"gross_charge":299.0,"discounted_cash":224.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MPL GENE ANALYSIS COMMON VARIANTS LAB","code_information":[{"code":"Px00030900051","type":"CDM"},{"code":"81338","type":"HCPCS"}],"standard_charges":[{"gross_charge":432.0,"discounted_cash":324.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC SO/HEMATOLYMPHOID NEO/DO 51/>GSAP DNA/DNA&RNA LAB","code_information":[{"code":"Px00030900052","type":"CDM"},{"code":"81455","type":"HCPCS"}],"standard_charges":[{"gross_charge":3795.0,"discounted_cash":2846.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC SO/HEMATOLYMPHOID NEO/DO 51/>GSAP DNA/DNA&RNA LAB","code_information":[{"code":"Px00030900053","type":"CDM"},{"code":"81455","type":"HCPCS"}],"standard_charges":[{"gross_charge":2990.0,"discounted_cash":2242.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC JAK2 GENE ANALYSIS P.VAL617PHE VARIANT","code_information":[{"code":"Px00030900054","type":"CDM"},{"code":"81270","type":"HCPCS"}],"standard_charges":[{"gross_charge":260.0,"discounted_cash":195.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC JAK2 TARGETED SEQUENCE ANALYSIS","code_information":[{"code":"Px00030900055","type":"CDM"},{"code":"81279","type":"HCPCS"}],"standard_charges":[{"gross_charge":364.0,"discounted_cash":273.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CALR GENE ANALYSIS COMMON VARIANTS IN EXON 9","code_information":[{"code":"Px00030900056","type":"CDM"},{"code":"81219","type":"HCPCS"}],"standard_charges":[{"gross_charge":328.0,"discounted_cash":246.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MPL GENE ANALYSIS COMMON VARIANTS","code_information":[{"code":"Px00030900057","type":"CDM"},{"code":"81338","type":"HCPCS"}],"standard_charges":[{"gross_charge":376.0,"discounted_cash":282.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MOLECULAR PATHOLOGY PROCEDURE LEVEL 4 LAB","code_information":[{"code":"Px00030900058","type":"CDM"},{"code":"81403","type":"HCPCS"}],"standard_charges":[{"gross_charge":419.0,"discounted_cash":314.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IDH1 COMMON VARIANTS LAB","code_information":[{"code":"Px00030900059","type":"CDM"},{"code":"81120","type":"HCPCS"}],"standard_charges":[{"gross_charge":555.0,"discounted_cash":416.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IDH2 COMMON VARIANTS CDM","code_information":[{"code":"Px00030900060","type":"CDM"},{"code":"81121","type":"HCPCS"}],"standard_charges":[{"gross_charge":340.0,"discounted_cash":255.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC KIT GENE ANALYSIS TARGETED SEQUENCE ANALYSIS LAB","code_information":[{"code":"Px00030900061","type":"CDM"},{"code":"81272","type":"HCPCS"}],"standard_charges":[{"gross_charge":478.0,"discounted_cash":358.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC NRAS GENE ANALYSIS VARIANTS IN EXON 2&3 LAB","code_information":[{"code":"Px00030900062","type":"CDM"},{"code":"81311","type":"HCPCS"}],"standard_charges":[{"gross_charge":478.0,"discounted_cash":358.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PDGFRA GENE ANALYS TARGETED SEQUENCE ANALYS LAB","code_information":[{"code":"Px00030900063","type":"CDM"},{"code":"81314","type":"HCPCS"}],"standard_charges":[{"gross_charge":478.0,"discounted_cash":358.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT CDM","code_information":[{"code":"Px00030900064","type":"CDM"},{"code":"81305","type":"HCPCS"}],"standard_charges":[{"gross_charge":426.0,"discounted_cash":319.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BRAF GENE ANALYSIS V600 VARIANT(S) LAB","code_information":[{"code":"Px00030900065","type":"CDM"},{"code":"81210","type":"HCPCS"}],"standard_charges":[{"gross_charge":402.0,"discounted_cash":301.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC KRAS GENE ANALYSIS VARIANTS IN EXON 2 LAB","code_information":[{"code":"Px00030900066","type":"CDM"},{"code":"81275","type":"HCPCS"}],"standard_charges":[{"gross_charge":368.0,"discounted_cash":276.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MOLECULAR PATHOLOGY PROCEDURE LEVEL 5 LAB","code_information":[{"code":"Px00030900067","type":"CDM"},{"code":"81404","type":"HCPCS"}],"standard_charges":[{"gross_charge":419.0,"discounted_cash":314.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC KIT GENE ANALYSIS TARGETED SEQUENCE ANALYSIS LAB","code_information":[{"code":"Px00030900068","type":"CDM"},{"code":"81272","type":"HCPCS"}],"standard_charges":[{"gross_charge":478.0,"discounted_cash":358.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PDGFRA GENE ANALYS TARGETED SEQUENCE ANALYS LAB","code_information":[{"code":"Px00030900069","type":"CDM"},{"code":"81314","type":"HCPCS"}],"standard_charges":[{"gross_charge":478.0,"discounted_cash":358.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC M/PHMTRC ALYS ISH QUANT/SEMIQ CPTR EACH MULTIPRB LAB","code_information":[{"code":"Px00031000032","type":"CDM"},{"code":"88374","type":"HCPCS"}],"standard_charges":[{"gross_charge":1720.0,"discounted_cash":1290.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CYTOGENOMIC NEOPLASIA MICROARRAY ANALYSIS LAB","code_information":[{"code":"Px00031000052","type":"CDM"},{"code":"81277","type":"HCPCS"}],"standard_charges":[{"gross_charge":4640.0,"discounted_cash":3480.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HLA II LOW RESOLUTION ONE ANTIGEN EQUIVALENT EA LAB","code_information":[{"code":"Px00031000061","type":"CDM"},{"code":"81377","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":121.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR LAB","code_information":[{"code":"Px00031000073","type":"CDM"},{"code":"81229","type":"HCPCS"}],"standard_charges":[{"gross_charge":942.0,"discounted_cash":706.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BCR/ABL1 MAJOR BREAKPNT QUALITATIVE/QUANTITATIVE LAB","code_information":[{"code":"Px00031000082","type":"CDM"},{"code":"81206","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":68.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BCR/ABL1 MINOR BREAKPNT QUALITATIVE/QUANTITATIVE","code_information":[{"code":"Px00031000083","type":"CDM"},{"code":"81207","type":"HCPCS"}],"standard_charges":[{"gross_charge":227.0,"discounted_cash":170.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ELECTRON MICROSCOPY DIAGNOSTIC LAB","code_information":[{"code":"Px00031000146","type":"CDM"},{"code":"88348","type":"HCPCS"}],"standard_charges":[{"gross_charge":373.0,"discounted_cash":279.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CYTOG ALYS CHRMOML ABNOR CPY NUMBER&SNP VRNT CGH","code_information":[{"code":"Px00031000150","type":"CDM"},{"code":"81229","type":"HCPCS"}],"standard_charges":[{"gross_charge":942.0,"discounted_cash":706.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC NFCT DS CHRNC HCV 6 BIOCHEM ASSAY SRM ALG LVR LAB","code_information":[{"code":"Px00031000152","type":"CDM"},{"code":"81596","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":86.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC F2 GENE ANALYSIS 20210G >A VARIANT LAB","code_information":[{"code":"Px00031000203","type":"CDM"},{"code":"81240","type":"HCPCS"}],"standard_charges":[{"gross_charge":341.0,"discounted_cash":255.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CFTR GENE ANALYSIS COMMON VARIANTS LAB","code_information":[{"code":"Px00031000230","type":"CDM"},{"code":"81220","type":"HCPCS"}],"standard_charges":[{"gross_charge":317.0,"discounted_cash":237.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR","code_information":[{"code":"Px00031000231","type":"CDM"},{"code":"81229","type":"HCPCS"}],"standard_charges":[{"gross_charge":942.0,"discounted_cash":706.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MICRODISSECTION PREP IDENTIFIED TARGET MANUAL LAB","code_information":[{"code":"Px00031000287","type":"CDM"},{"code":"88381","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.0,"discounted_cash":165.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MICRODISSECTION PREP IDENTIFIED TARGET MANUAL LAB","code_information":[{"code":"Px00031000288","type":"CDM"},{"code":"88381","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.0,"discounted_cash":165.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MICRODISSECTION PREP IDENTIFIED TARGET MANUAL LAB","code_information":[{"code":"Px00031000289","type":"CDM"},{"code":"88381","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.0,"discounted_cash":165.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MICRODISSECTION PREP IDENTIFIED TARGET MANUAL LAB","code_information":[{"code":"Px00031000290","type":"CDM"},{"code":"88381","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.0,"discounted_cash":165.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MICRODISSECTION PREP IDENTIFIED TARGET MANUAL LAB","code_information":[{"code":"Px00031000291","type":"CDM"},{"code":"88381","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.0,"discounted_cash":165.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MICRODISSECTION PREP IDENTIFIED TARGET MANUAL LAB","code_information":[{"code":"Px00031000292","type":"CDM"},{"code":"88381","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.0,"discounted_cash":165.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MICRODISSECTION PREP IDENTIFIED TARGET MANUAL LAB","code_information":[{"code":"Px00031000293","type":"CDM"},{"code":"88381","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.0,"discounted_cash":165.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MICRODISSECTION PREP IDENTIFIED TARGET MANUAL LAB","code_information":[{"code":"Px00031000294","type":"CDM"},{"code":"88381","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.0,"discounted_cash":165.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MICRODISSECTION PREP IDENTIFIED TARGET MANUAL LAB","code_information":[{"code":"Px00031000295","type":"CDM"},{"code":"88381","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.0,"discounted_cash":165.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MICRODISSECTION PREP IDENTIFIED TARGET MANUAL LAB","code_information":[{"code":"Px00031000296","type":"CDM"},{"code":"88381","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.0,"discounted_cash":165.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MICRODISSECTION PREP IDENTIFIED TARGET MANUAL LAB","code_information":[{"code":"Px00031000297","type":"CDM"},{"code":"88381","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.0,"discounted_cash":165.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC NATRIURETIC PEPTIDE LAB","code_information":[{"code":"Px00031000324","type":"CDM"},{"code":"83880","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"discounted_cash":150.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC NATRIURETIC PEPTIDE LAB","code_information":[{"code":"Px00031000325","type":"CDM"},{"code":"83880","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"discounted_cash":150.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HLA CLASS I&II LOW HLA-A -B -C -DRB1/3/4/5&DQB CDM","code_information":[{"code":"Px00031000469","type":"CDM"},{"code":"81370","type":"HCPCS"}],"standard_charges":[{"gross_charge":1528.0,"discounted_cash":1146.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HLA CLASS II TYPING LOW RESOLUTION ONE LOCUS EA CDM","code_information":[{"code":"Px00031000470","type":"CDM"},{"code":"81376","type":"HCPCS"}],"standard_charges":[{"gross_charge":316.0,"discounted_cash":237.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC TPMT GENE ANALAYSIS COMMON VARIANTS LAB","code_information":[{"code":"Px00031010165","type":"CDM"},{"code":"81335","type":"HCPCS"}],"standard_charges":[{"gross_charge":546.0,"discounted_cash":409.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PATHOGEN TEST FOR PLATELETS","code_information":[{"code":"Px00031010176","type":"CDM"},{"code":"P9100","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":138.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CYTOG ALYS CHRMOML ABNOR CPY NUMBER&SNP VRNT CGH LAB","code_information":[{"code":"Px00031010182","type":"CDM"},{"code":"81229","type":"HCPCS"}],"standard_charges":[{"gross_charge":942.0,"discounted_cash":706.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CYTOG ALYS CHRMOML ABNOR CPY NUMBER&SNP VRNT CGH LAB","code_information":[{"code":"Px00031010183","type":"CDM"},{"code":"81229","type":"HCPCS"}],"standard_charges":[{"gross_charge":942.0,"discounted_cash":706.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC M/PHMTRC ALYS TUMOR IMHCHEM EA ANTIBODY MANUAL","code_information":[{"code":"Px00031010216","type":"CDM"},{"code":"88360","type":"HCPCS"}],"standard_charges":[{"gross_charge":392.0,"discounted_cash":294.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IMHISTOCHEM/CYTCHM 1ST ANTIBODY STAIN PROCEDURE","code_information":[{"code":"Px00031010219","type":"CDM"},{"code":"88342","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.0,"discounted_cash":165.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BILL SURG LEVEL 3","code_information":[{"code":"Px00031010234","type":"CDM"},{"code":"88304","type":"HCPCS"}],"standard_charges":[{"gross_charge":285.0,"discounted_cash":213.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BILL SURG LEVEL 4","code_information":[{"code":"Px00031010235","type":"CDM"},{"code":"88305","type":"HCPCS"}],"standard_charges":[{"gross_charge":292.0,"discounted_cash":219.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BILL SURG SPECIAL STAINS GROUP 1","code_information":[{"code":"Px00031010239","type":"CDM"},{"code":"88312","type":"HCPCS"}],"standard_charges":[{"gross_charge":347.0,"discounted_cash":260.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BILL SURG SPECIAL STAINS GROUP 2","code_information":[{"code":"Px00031010240","type":"CDM"},{"code":"88313","type":"HCPCS"}],"standard_charges":[{"gross_charge":307.0,"discounted_cash":230.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CHROMOSOME ANALYSIS 20-25 CELLS LAB","code_information":[{"code":"Px00031010286","type":"CDM"},{"code":"88264","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":138.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CYTP FLU WASHGS/BRUSHINGS XCPT C/V SMRS INTERPJ LAB","code_information":[{"code":"Px00031010312","type":"CDM"},{"code":"88104","type":"HCPCS"}],"standard_charges":[{"gross_charge":236.0,"discounted_cash":177.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CYTO SPIN","code_information":[{"code":"Px00031010314","type":"CDM"},{"code":"88108","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.0,"discounted_cash":201.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CYTP SLCTV CELL ENHANCEMENT INTERPJ XCPT C/V LAB","code_information":[{"code":"Px00031010325","type":"CDM"},{"code":"88112","type":"HCPCS"}],"standard_charges":[{"gross_charge":217.0,"discounted_cash":162.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CYTP EVAL FINE NEEDLE ASPIRATE INTERP & REPORT LAB","code_information":[{"code":"Px00031010330","type":"CDM"},{"code":"88173","type":"HCPCS"}],"standard_charges":[{"gross_charge":463.0,"discounted_cash":347.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CYTOPATH SMEAR OTHER SOURCE PREP/SCREEN","code_information":[{"code":"Px00031010337","type":"CDM"},{"code":"88161","type":"HCPCS"}],"standard_charges":[{"gross_charge":261.0,"discounted_cash":195.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CYTP CONCENTRATION SMEARS & INTERPRETATION TECH LAB","code_information":[{"code":"Px00031010339","type":"CDM"},{"code":"88108","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.0,"discounted_cash":201.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DECALCIFICATION PROCEDURE LAB","code_information":[{"code":"Px00031010341","type":"CDM"},{"code":"88311","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":27.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC SPECIAL STAIN I&R GROUP III ENZYME CONSITUENTS LAB","code_information":[{"code":"Px00031010351","type":"CDM"},{"code":"88319","type":"HCPCS"}],"standard_charges":[{"gross_charge":474.0,"discounted_cash":355.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC FLOW CYTOMETRY INTERPJ 2-8 MARKERS LAB","code_information":[{"code":"Px00031010365","type":"CDM"},{"code":"88187","type":"HCPCS"}],"standard_charges":[{"gross_charge":388.0,"discounted_cash":291.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IMMUNOFLUORESCENCE PER SPEC 1ST SINGL ANTB STAIN LAB","code_information":[{"code":"Px00031010379","type":"CDM"},{"code":"88346","type":"HCPCS"}],"standard_charges":[{"gross_charge":339.0,"discounted_cash":254.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IMHISTOCHEM/CYTCHM 1ST ANTIBODY STAIN PROCEDURE LAB","code_information":[{"code":"Px00031010386","type":"CDM"},{"code":"88342","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.0,"discounted_cash":165.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IN SITU HYBRIDIZATION 1ST PROBE STAIN LAB","code_information":[{"code":"Px00031010391","type":"CDM"},{"code":"88365","type":"HCPCS"}],"standard_charges":[{"gross_charge":442.0,"discounted_cash":331.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PATH CONSLTJ SURG CYTOLOGIC EXAM INITIAL SITE LAB","code_information":[{"code":"Px00031010398","type":"CDM"},{"code":"88333","type":"HCPCS"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC M/PHMTRC ALYS ISH CPTR-ASST TECH 1ST PROBE STAIN LAB","code_information":[{"code":"Px00031010406","type":"CDM"},{"code":"88367","type":"HCPCS"}],"standard_charges":[{"gross_charge":242.0,"discounted_cash":181.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC M/PHMTRC ALYS IN SITU HYBRIDIZATION EA PROBE MNL LAB","code_information":[{"code":"Px00031010407","type":"CDM"},{"code":"88368","type":"HCPCS"}],"standard_charges":[{"gross_charge":715.0,"discounted_cash":536.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PATH CONSLTJ SURG EA ADDL BLK FROZEN SECTION LAB","code_information":[{"code":"Px00031010468","type":"CDM"},{"code":"88332","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.0,"discounted_cash":108.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PATH CONSLTJ SURG 1ST BLK FROZEN SCTJ 1 SPEC LAB","code_information":[{"code":"Px00031010473","type":"CDM"},{"code":"88331","type":"HCPCS"}],"standard_charges":[{"gross_charge":189.0,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PATHOLOGY CONSULTATION DURING SURGERY LAB","code_information":[{"code":"Px00031010476","type":"CDM"},{"code":"88329","type":"HCPCS"}],"standard_charges":[{"gross_charge":217.0,"discounted_cash":162.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC SPECIAL STAIN GROUP 1 MICROORGANISMS I&R LAB","code_information":[{"code":"Px00031010498","type":"CDM"},{"code":"88312","type":"HCPCS"}],"standard_charges":[{"gross_charge":347.0,"discounted_cash":260.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC SPCL STN 2 I&R EXCPT MICROORG/ENZYME/IMCYT LAB","code_information":[{"code":"Px00031010500","type":"CDM"},{"code":"88313","type":"HCPCS"}],"standard_charges":[{"gross_charge":307.0,"discounted_cash":230.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC LEVEL I SURG PATHOLOGY GROSS EXAMINATION ONLY LAB","code_information":[{"code":"Px00031010519","type":"CDM"},{"code":"88300","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":81.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC LEVEL II SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB","code_information":[{"code":"Px00031010520","type":"CDM"},{"code":"88302","type":"HCPCS"}],"standard_charges":[{"gross_charge":250.0,"discounted_cash":187.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC LEVEL III SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB","code_information":[{"code":"Px00031010522","type":"CDM"},{"code":"88304","type":"HCPCS"}],"standard_charges":[{"gross_charge":285.0,"discounted_cash":213.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB","code_information":[{"code":"Px00031010524","type":"CDM"},{"code":"88305","type":"HCPCS"}],"standard_charges":[{"gross_charge":292.0,"discounted_cash":219.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC LEVEL V SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB","code_information":[{"code":"Px00031010531","type":"CDM"},{"code":"88307","type":"HCPCS"}],"standard_charges":[{"gross_charge":799.0,"discounted_cash":599.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC LEVEL VI SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB","code_information":[{"code":"Px00031010536","type":"CDM"},{"code":"88309","type":"HCPCS"}],"standard_charges":[{"gross_charge":1070.0,"discounted_cash":802.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC M/PHMTRC ALYS TUMOR IMHCHEM EA ANTBDY CMPTR ASST LAB","code_information":[{"code":"Px00031010565","type":"CDM"},{"code":"88361","type":"HCPCS"}],"standard_charges":[{"gross_charge":429.0,"discounted_cash":321.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC M/PHMTRC ALYS TUMOR IMHCHEM EA ANTIBODY MANUAL LAB","code_information":[{"code":"Px00031010566","type":"CDM"},{"code":"88360","type":"HCPCS"}],"standard_charges":[{"gross_charge":392.0,"discounted_cash":294.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CYTP FINE NDL ASPIRATE IMMT CYTOHIST STD EA EVAL LAB","code_information":[{"code":"Px00031010594","type":"CDM"},{"code":"88177","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":58.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CYTP FINE NDL ASPIRATE IMMT CYTOHIST STD DX 1ST LAB","code_information":[{"code":"Px00031010595","type":"CDM"},{"code":"88172","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":140.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC TISS CUL NEO DISORDERS BONE MARROW BLOOD CELLS LAB","code_information":[{"code":"Px00031010599","type":"CDM"},{"code":"88237","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":121.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MOLECULAR PATHOLOGY PROCEDURE LEVEL 4 LAB","code_information":[{"code":"Px00031010610","type":"CDM"},{"code":"81403","type":"HCPCS"}],"standard_charges":[{"gross_charge":473.0,"discounted_cash":354.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CLL IGVH MUTATION","code_information":[{"code":"Px00031010612","type":"CDM"},{"code":"81260","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":117.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IMHISTOCHEM/CYTCHM EA ADDL ANTIBODY SLIDE LAB","code_information":[{"code":"Px00031010667","type":"CDM"},{"code":"88341","type":"HCPCS"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":151.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE LAB","code_information":[{"code":"Px00031010668","type":"CDM"},{"code":"88344","type":"HCPCS"}],"standard_charges":[{"gross_charge":897.0,"discounted_cash":672.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN FISH LAB","code_information":[{"code":"Px00031010669","type":"CDM"},{"code":"88364","type":"HCPCS"}],"standard_charges":[{"gross_charge":699.0,"discounted_cash":524.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC M/PHMTRC ALYS ISH QUANT/SEMIQ MNL PER SPEC EACH LAB","code_information":[{"code":"Px00031010671","type":"CDM"},{"code":"88369","type":"HCPCS"}],"standard_charges":[{"gross_charge":606.0,"discounted_cash":454.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC M/PHMTRC ALYS ISH QUANT/SEMIQ CPTR EACH MULTIPRB","code_information":[{"code":"Px00031010673","type":"CDM"},{"code":"88374","type":"HCPCS"}],"standard_charges":[{"gross_charge":1720.0,"discounted_cash":1290.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC M/PHMTRC ALYS ISH QUANT/SEMIQ MNL EACH MULTIPRB LAB","code_information":[{"code":"Px00031010674","type":"CDM"},{"code":"88377","type":"HCPCS"}],"standard_charges":[{"gross_charge":538.0,"discounted_cash":403.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MOLECULAR PATHOLOGY PROCEDURE LEVEL 5 LAB","code_information":[{"code":"Px00031010679","type":"CDM"},{"code":"81404","type":"HCPCS"}],"standard_charges":[{"gross_charge":1100.0,"discounted_cash":825.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC M/PHMTRC ALYS ISH QUANT/SEMIQ MNL EACH MULTIPRB LAB","code_information":[{"code":"Px00031010744","type":"CDM"},{"code":"88377","type":"HCPCS"}],"standard_charges":[{"gross_charge":538.0,"discounted_cash":403.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IN SITU HYBRIDIZATION EA MULTIPLEX PROBE STAIN LAB","code_information":[{"code":"Px00031010842","type":"CDM"},{"code":"88366","type":"HCPCS"}],"standard_charges":[{"gross_charge":726.0,"discounted_cash":544.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC FLOW CYTOMETRY INTERPJ 2-8 MARKERS","code_information":[{"code":"Px00031100047","type":"CDM"},{"code":"88187","type":"HCPCS"}],"standard_charges":[{"gross_charge":446.0,"discounted_cash":334.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BILL CYTO FNA INTERP","code_information":[{"code":"Px00031110004","type":"CDM"},{"code":"88173","type":"HCPCS"}],"standard_charges":[{"gross_charge":463.0,"discounted_cash":347.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BILL CYTO NON GYN CONC SMR-INT","code_information":[{"code":"Px00031110005","type":"CDM"},{"code":"88108","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.0,"discounted_cash":201.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BILL CYTO NON GYN LBC-INT","code_information":[{"code":"Px00031110006","type":"CDM"},{"code":"88112","type":"HCPCS"}],"standard_charges":[{"gross_charge":217.0,"discounted_cash":162.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CYTP CONCENTRATION SMEARS AND INTERPRETATION LAB","code_information":[{"code":"Px00031110010","type":"CDM"},{"code":"88108","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.0,"discounted_cash":201.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PAP SUREPATH DIAGNOSTIC","code_information":[{"code":"Px00031110030","type":"CDM"},{"code":"88142","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":64.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN CDM","code_information":[{"code":"Px00031110031","type":"CDM"},{"code":"88142","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":64.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN LAB","code_information":[{"code":"Px00031110032","type":"CDM"},{"code":"88142","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":64.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PAP-THIN PREP SCREENING","code_information":[{"code":"Px00031110033","type":"CDM"},{"code":"88142","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":64.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC VOLUME MEASUREMENT TIMED COLLECTION EACH CDM","code_information":[{"code":"Px00031900007","type":"CDM"},{"code":"81050","type":"HCPCS"}],"standard_charges":[{"gross_charge":19.0,"discounted_cash":14.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY CREATININE OTHER SOURCE (RL)","code_information":[{"code":"Px00031900015","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":39.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY WEST NILE VIRUS IGM CDM","code_information":[{"code":"Px00031900019","type":"CDM"},{"code":"86788","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":23.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY HIV-1 CDM","code_information":[{"code":"Px00031900032","type":"CDM"},{"code":"86701","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY HIV-2 CDM","code_information":[{"code":"Px00031900033","type":"CDM"},{"code":"86702","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":69.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IAAD IA HISTOPLASM CAPSULATUM CDM","code_information":[{"code":"Px00031900056","type":"CDM"},{"code":"87385","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ZINC CDM","code_information":[{"code":"Px00031900057","type":"CDM"},{"code":"84630","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":21.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANTITATIVE NOS (RL)","code_information":[{"code":"Px00031900059","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC THROMBOPLASTIN TIME PRTL SUBSTIT PLASMA FRCTJ EA CDM","code_information":[{"code":"Px00031900089","type":"CDM"},{"code":"85732","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ISLET CELL ANTIBODY CDM","code_information":[{"code":"Px00031900112","type":"CDM"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":33.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC NFCT AGENT DETECTION GI(RL)","code_information":[{"code":"Px00031900180","type":"CDM"},{"code":"87505","type":"HCPCS"}],"standard_charges":[{"gross_charge":295.0,"discounted_cash":221.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PROTOPORPHYRIN RBC QUANTITATIVE CDM","code_information":[{"code":"Px00031900182","type":"CDM"},{"code":"84202","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":17.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC LIPOPROTEIN-ASSOCIATED PHOSPHOLIPASE A2 CDM","code_information":[{"code":"Px00031900227","type":"CDM"},{"code":"83698","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":39.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ARSENIC CDM","code_information":[{"code":"Px00031900237","type":"CDM"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":12.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CREATININE OTHER SOURCE CDM","code_information":[{"code":"Px00031900238","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":39.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE GENTAMICIN CDM","code_information":[{"code":"Px00031900294","type":"CDM"},{"code":"80170","type":"HCPCS"}],"standard_charges":[{"gross_charge":239.0,"discounted_cash":179.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ADDL VESSEL AFTER BASIC VENOGRAM","code_information":[{"code":"Px00032000010","type":"CDM"},{"code":"76496","type":"HCPCS"}],"standard_charges":[{"gross_charge":402.0,"discounted_cash":301.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC XR EYE FOR FOREIGN BODY","code_information":[{"code":"Px00032010003","type":"CDM"},{"code":"70030","type":"HCPCS"}],"standard_charges":[{"gross_charge":191.0,"discounted_cash":143.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR TOE(S) MIN 2 VIEWS","code_information":[{"code":"Px00032010004","type":"CDM"},{"code":"73660","type":"HCPCS"}],"standard_charges":[{"gross_charge":346.0,"discounted_cash":259.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR MANDIBLE 1-3 VIEWS","code_information":[{"code":"Px00032010006","type":"CDM"},{"code":"70100","type":"HCPCS"}],"standard_charges":[{"gross_charge":696.0,"discounted_cash":522.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR MANDIBLE MIN 4 VIEWS","code_information":[{"code":"Px00032010007","type":"CDM"},{"code":"70110","type":"HCPCS"}],"standard_charges":[{"gross_charge":818.0,"discounted_cash":613.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR FACIAL BONES LT/3 VIEWS","code_information":[{"code":"Px00032010011","type":"CDM"},{"code":"70140","type":"HCPCS"}],"standard_charges":[{"gross_charge":645.0,"discounted_cash":483.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR FACIAL BONES MIN 3 VIEWS","code_information":[{"code":"Px00032010012","type":"CDM"},{"code":"70150","type":"HCPCS"}],"standard_charges":[{"gross_charge":720.0,"discounted_cash":540.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR NASAL BONES MIN 3 VIEWS","code_information":[{"code":"Px00032010014","type":"CDM"},{"code":"70160","type":"HCPCS"}],"standard_charges":[{"gross_charge":478.0,"discounted_cash":358.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR ORBITS MIN 4 VIEWS","code_information":[{"code":"Px00032010017","type":"CDM"},{"code":"70200","type":"HCPCS"}],"standard_charges":[{"gross_charge":498.0,"discounted_cash":373.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR SINUSES PARANASAL MIN 3 VIEWS","code_information":[{"code":"Px00032010020","type":"CDM"},{"code":"70220","type":"HCPCS"}],"standard_charges":[{"gross_charge":768.0,"discounted_cash":576.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR SKULL 1-3 VIEWS","code_information":[{"code":"Px00032010022","type":"CDM"},{"code":"70250","type":"HCPCS"}],"standard_charges":[{"gross_charge":360.0,"discounted_cash":270.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR SKULL MIN 4 VIEWS","code_information":[{"code":"Px00032010023","type":"CDM"},{"code":"70260","type":"HCPCS"}],"standard_charges":[{"gross_charge":360.0,"discounted_cash":270.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR JAW JOINT","code_information":[{"code":"Px00032010027","type":"CDM"},{"code":"70328","type":"HCPCS"}],"standard_charges":[{"gross_charge":339.0,"discounted_cash":254.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR JAW TEMPOROMANDIBULAR JOINT BIL","code_information":[{"code":"Px00032010028","type":"CDM"},{"code":"70330","type":"HCPCS"}],"standard_charges":[{"gross_charge":920.0,"discounted_cash":690.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR ABDOMEN 1 VIEW","code_information":[{"code":"Px00032010029","type":"CDM"},{"code":"74018","type":"HCPCS"}],"standard_charges":[{"gross_charge":426.0,"discounted_cash":319.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR NECK SOFT TISSUE","code_information":[{"code":"Px00032010031","type":"CDM"},{"code":"70360","type":"HCPCS"}],"standard_charges":[{"gross_charge":398.0,"discounted_cash":298.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR BONE LENGTH STUDY","code_information":[{"code":"Px00032010039","type":"CDM"},{"code":"77073","type":"HCPCS"}],"standard_charges":[{"gross_charge":396.0,"discounted_cash":297.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR BONE SURVEY LIMITED","code_information":[{"code":"Px00032010040","type":"CDM"},{"code":"77074","type":"HCPCS"}],"standard_charges":[{"gross_charge":609.0,"discounted_cash":456.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR ESOPHAGUS W CONTRAST","code_information":[{"code":"Px00032010041","type":"CDM"},{"code":"74220","type":"HCPCS"}],"standard_charges":[{"gross_charge":673.0,"discounted_cash":504.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR RIBS UNI 2 VIEWS","code_information":[{"code":"Px00032010045","type":"CDM"},{"code":"71100","type":"HCPCS"}],"standard_charges":[{"gross_charge":484.0,"discounted_cash":363.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR RIBS/CHEST UNI MIN 3 VIEWS","code_information":[{"code":"Px00032010046","type":"CDM"},{"code":"71101","type":"HCPCS"}],"standard_charges":[{"gross_charge":534.0,"discounted_cash":400.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR RIBS BIL 3 VIEWS","code_information":[{"code":"Px00032010048","type":"CDM"},{"code":"71110","type":"HCPCS"}],"standard_charges":[{"gross_charge":828.0,"discounted_cash":621.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR RIBS/CHEST BILAT","code_information":[{"code":"Px00032010049","type":"CDM"},{"code":"71111","type":"HCPCS"}],"standard_charges":[{"gross_charge":911.0,"discounted_cash":683.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR STERNUM MIN 2 VIEWS","code_information":[{"code":"Px00032010050","type":"CDM"},{"code":"71120","type":"HCPCS"}],"standard_charges":[{"gross_charge":377.0,"discounted_cash":282.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR STERNOCLAVICULAR JOINTS MIN 3 VIEWS","code_information":[{"code":"Px00032010051","type":"CDM"},{"code":"71130","type":"HCPCS"}],"standard_charges":[{"gross_charge":278.0,"discounted_cash":208.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR SPINE 1 VIEW ANY LEVEL","code_information":[{"code":"Px00032010053","type":"CDM"},{"code":"72020","type":"HCPCS"}],"standard_charges":[{"gross_charge":400.0,"discounted_cash":300.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR SPINE CERVICAL 2 OR 3 VIEWS","code_information":[{"code":"Px00032010055","type":"CDM"},{"code":"72040","type":"HCPCS"}],"standard_charges":[{"gross_charge":495.0,"discounted_cash":371.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR SPINE CERVICAL 4 OR 5 VIEWS","code_information":[{"code":"Px00032010056","type":"CDM"},{"code":"72050","type":"HCPCS"}],"standard_charges":[{"gross_charge":584.0,"discounted_cash":438.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR CERVICAL SPINE 6 OR MORE VIEWS","code_information":[{"code":"Px00032010057","type":"CDM"},{"code":"72052","type":"HCPCS"}],"standard_charges":[{"gross_charge":771.0,"discounted_cash":578.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR SPINE THORACIC 2 VIEWS","code_information":[{"code":"Px00032010059","type":"CDM"},{"code":"72070","type":"HCPCS"}],"standard_charges":[{"gross_charge":570.0,"discounted_cash":427.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR SPINE THORACIC 3 VIEWS","code_information":[{"code":"Px00032010060","type":"CDM"},{"code":"72072","type":"HCPCS"}],"standard_charges":[{"gross_charge":654.0,"discounted_cash":490.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR SPINE THORACIC MIN 4 VIEWS","code_information":[{"code":"Px00032010061","type":"CDM"},{"code":"72074","type":"HCPCS"}],"standard_charges":[{"gross_charge":683.0,"discounted_cash":512.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR SPINE THORACOLUMBAR MIN 2 VIEWS","code_information":[{"code":"Px00032010062","type":"CDM"},{"code":"72080","type":"HCPCS"}],"standard_charges":[{"gross_charge":265.0,"discounted_cash":198.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR SPINE LUMBOSACRAL 2 OR 3 VIEWS","code_information":[{"code":"Px00032010065","type":"CDM"},{"code":"72100","type":"HCPCS"}],"standard_charges":[{"gross_charge":495.0,"discounted_cash":371.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC SPINE LUMBOSACRAL MIN 4 VIEWS","code_information":[{"code":"Px00032010066","type":"CDM"},{"code":"72110","type":"HCPCS"}],"standard_charges":[{"gross_charge":658.0,"discounted_cash":493.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR SPINE LUMBOSACRAL INC BENDING MIN 6 VIEWS","code_information":[{"code":"Px00032010067","type":"CDM"},{"code":"72114","type":"HCPCS"}],"standard_charges":[{"gross_charge":873.0,"discounted_cash":654.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR SPINE 2-3 VIEWS LUMBAR BEND ONLY","code_information":[{"code":"Px00032010068","type":"CDM"},{"code":"72120","type":"HCPCS"}],"standard_charges":[{"gross_charge":485.0,"discounted_cash":363.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR PELVIS 1-2 VIEWS NO HIP VIEWS","code_information":[{"code":"Px00032010069","type":"CDM"},{"code":"72170","type":"HCPCS"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":285.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR PELVIS MIN 3 VIEWS NO HIP VIEWS","code_information":[{"code":"Px00032010072","type":"CDM"},{"code":"72190","type":"HCPCS"}],"standard_charges":[{"gross_charge":528.0,"discounted_cash":396.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR SACROILIAC JOINTS 1-2 VIEWS","code_information":[{"code":"Px00032010073","type":"CDM"},{"code":"72200","type":"HCPCS"}],"standard_charges":[{"gross_charge":458.0,"discounted_cash":343.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR SACROILIAC JOINTS 3/PLUS VIEWS","code_information":[{"code":"Px00032010074","type":"CDM"},{"code":"72202","type":"HCPCS"}],"standard_charges":[{"gross_charge":503.0,"discounted_cash":377.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR TAILBONE MIN 2 VIEWS","code_information":[{"code":"Px00032010075","type":"CDM"},{"code":"72220","type":"HCPCS"}],"standard_charges":[{"gross_charge":512.0,"discounted_cash":384.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR DISKOGRAPHY LUMBAR","code_information":[{"code":"Px00032010083","type":"CDM"},{"code":"72295","type":"HCPCS"}],"standard_charges":[{"gross_charge":6739.0,"discounted_cash":5054.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC XR CLAVICLE  COMPLETE","code_information":[{"code":"Px00032010085","type":"CDM"},{"code":"73000","type":"HCPCS"}],"standard_charges":[{"gross_charge":390.0,"discounted_cash":292.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR ELBOW LIMITED","code_information":[{"code":"Px00032010086","type":"CDM"},{"code":"73070","type":"HCPCS"}],"standard_charges":[{"gross_charge":388.0,"discounted_cash":291.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR HEEL MIN 2 VIEWS","code_information":[{"code":"Px00032010088","type":"CDM"},{"code":"73650","type":"HCPCS"}],"standard_charges":[{"gross_charge":356.0,"discounted_cash":267.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR SCAPULA COMPLETE","code_information":[{"code":"Px00032010089","type":"CDM"},{"code":"73010","type":"HCPCS"}],"standard_charges":[{"gross_charge":390.0,"discounted_cash":292.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR FOOT MIN 3 VIEWS","code_information":[{"code":"Px00032010091","type":"CDM"},{"code":"73630","type":"HCPCS"}],"standard_charges":[{"gross_charge":463.0,"discounted_cash":347.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR SHOULDER 1 VIEW","code_information":[{"code":"Px00032010092","type":"CDM"},{"code":"73020","type":"HCPCS"}],"standard_charges":[{"gross_charge":283.0,"discounted_cash":212.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR SHOULDER ARTHROGRAPHY","code_information":[{"code":"Px00032010097","type":"CDM"},{"code":"73040","type":"HCPCS"}],"standard_charges":[{"gross_charge":1548.0,"discounted_cash":1161.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR SHOULDER A-C JOINTS BIL","code_information":[{"code":"Px00032010099","type":"CDM"},{"code":"73050","type":"HCPCS"}],"standard_charges":[{"gross_charge":609.0,"discounted_cash":456.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR HUMERUS 1 VIEW","code_information":[{"code":"Px00032010101","type":"CDM"},{"code":"73060","type":"HCPCS"}],"standard_charges":[{"gross_charge":416.0,"discounted_cash":312.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR HUMERUS MIN 2 VIEWS","code_information":[{"code":"Px00032010102","type":"CDM"},{"code":"73060","type":"HCPCS"}],"standard_charges":[{"gross_charge":416.0,"discounted_cash":312.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR ELBOW 2 VIEWS","code_information":[{"code":"Px00032010105","type":"CDM"},{"code":"73070","type":"HCPCS"}],"standard_charges":[{"gross_charge":388.0,"discounted_cash":291.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR ELBOW COMPLETE MIN 3 VIEWS","code_information":[{"code":"Px00032010106","type":"CDM"},{"code":"73080","type":"HCPCS"}],"standard_charges":[{"gross_charge":602.0,"discounted_cash":451.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR ABDOMEN 2 VIEWS","code_information":[{"code":"Px00032010107","type":"CDM"},{"code":"74019","type":"HCPCS"}],"standard_charges":[{"gross_charge":480.0,"discounted_cash":360.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR FOOT 2 VIEWS","code_information":[{"code":"Px00032010110","type":"CDM"},{"code":"73620","type":"HCPCS"}],"standard_charges":[{"gross_charge":353.0,"discounted_cash":264.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR FOREARM 2 VIEWS","code_information":[{"code":"Px00032010112","type":"CDM"},{"code":"73090","type":"HCPCS"}],"standard_charges":[{"gross_charge":388.0,"discounted_cash":291.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR ARM INFANT MIN 2 VIEWS","code_information":[{"code":"Px00032010115","type":"CDM"},{"code":"73092","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":229.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR WRIST 1 VIEW","code_information":[{"code":"Px00032010117","type":"CDM"},{"code":"73100","type":"HCPCS"}],"standard_charges":[{"gross_charge":418.0,"discounted_cash":313.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR WRIST 2 VIEWS","code_information":[{"code":"Px00032010118","type":"CDM"},{"code":"73100","type":"HCPCS"}],"standard_charges":[{"gross_charge":418.0,"discounted_cash":313.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR WRIST COMPLETE MIN 3 VIEWS","code_information":[{"code":"Px00032010119","type":"CDM"},{"code":"73110","type":"HCPCS"}],"standard_charges":[{"gross_charge":478.0,"discounted_cash":358.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR WRIST ARTHROGRAPHY","code_information":[{"code":"Px00032010122","type":"CDM"},{"code":"73115","type":"HCPCS"}],"standard_charges":[{"gross_charge":890.0,"discounted_cash":667.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR HAND 1 VIEW","code_information":[{"code":"Px00032010125","type":"CDM"},{"code":"73120","type":"HCPCS"}],"standard_charges":[{"gross_charge":355.0,"discounted_cash":266.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR HAND 2 VIEWS","code_information":[{"code":"Px00032010127","type":"CDM"},{"code":"73120","type":"HCPCS"}],"standard_charges":[{"gross_charge":355.0,"discounted_cash":266.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR HAND MIN 3 VIEWS","code_information":[{"code":"Px00032010129","type":"CDM"},{"code":"73130","type":"HCPCS"}],"standard_charges":[{"gross_charge":461.0,"discounted_cash":345.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR FINGERS(S) MIN 2 VIEWS","code_information":[{"code":"Px00032010131","type":"CDM"},{"code":"73140","type":"HCPCS"}],"standard_charges":[{"gross_charge":317.0,"discounted_cash":237.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR ABDOMEN 3/PLUS VIEWS","code_information":[{"code":"Px00032010135","type":"CDM"},{"code":"74021","type":"HCPCS"}],"standard_charges":[{"gross_charge":532.0,"discounted_cash":399.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR HIP ARTHROGRAPHY","code_information":[{"code":"Px00032010140","type":"CDM"},{"code":"73525","type":"HCPCS"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":903.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR KNEE 1-2 VIEWS","code_information":[{"code":"Px00032010149","type":"CDM"},{"code":"73560","type":"HCPCS"}],"standard_charges":[{"gross_charge":424.0,"discounted_cash":318.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR KNEE 3 VIEWS","code_information":[{"code":"Px00032010152","type":"CDM"},{"code":"73562","type":"HCPCS"}],"standard_charges":[{"gross_charge":471.0,"discounted_cash":353.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR KNEE 4/PLUS VIEWS","code_information":[{"code":"Px00032010154","type":"CDM"},{"code":"73564","type":"HCPCS"}],"standard_charges":[{"gross_charge":684.0,"discounted_cash":513.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR KNEES STANDING BILAT","code_information":[{"code":"Px00032010156","type":"CDM"},{"code":"73565","type":"HCPCS"}],"standard_charges":[{"gross_charge":548.0,"discounted_cash":411.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR KNEE JOINT W CONTRAST","code_information":[{"code":"Px00032010157","type":"CDM"},{"code":"73580","type":"HCPCS"}],"standard_charges":[{"gross_charge":1537.0,"discounted_cash":1152.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR LOWER LEG 2 VIEWS","code_information":[{"code":"Px00032010159","type":"CDM"},{"code":"73590","type":"HCPCS"}],"standard_charges":[{"gross_charge":332.0,"discounted_cash":249.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR LEG INFANT MIN 2 VIEWS","code_information":[{"code":"Px00032010161","type":"CDM"},{"code":"73592","type":"HCPCS"}],"standard_charges":[{"gross_charge":527.0,"discounted_cash":395.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR ANKLE 2 VIEWS","code_information":[{"code":"Px00032010163","type":"CDM"},{"code":"73600","type":"HCPCS"}],"standard_charges":[{"gross_charge":455.0,"discounted_cash":341.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR ANKLE COMPLETE MIN 3 VIEWS","code_information":[{"code":"Px00032010165","type":"CDM"},{"code":"73610","type":"HCPCS"}],"standard_charges":[{"gross_charge":521.0,"discounted_cash":390.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR ABDOMEN COMPLETE SERIES","code_information":[{"code":"Px00032010175","type":"CDM"},{"code":"74022","type":"HCPCS"}],"standard_charges":[{"gross_charge":641.0,"discounted_cash":480.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR RADIOLOGIC EXAM SWALLOW FUNCTION CONTRAST STUDY","code_information":[{"code":"Px00032010179","type":"CDM"},{"code":"74230","type":"HCPCS"}],"standard_charges":[{"gross_charge":686.0,"discounted_cash":514.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR RADIOLOGIC EXAM UPR GI TRC SINGLE CONTRAST STUDY CDM","code_information":[{"code":"Px00032010181","type":"CDM"},{"code":"74240","type":"HCPCS"}],"standard_charges":[{"gross_charge":936.0,"discounted_cash":702.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR RADIOLOGIC EXAM UPR GI TRC DOUBLE CONTRAST STUDY CDM","code_information":[{"code":"Px00032010184","type":"CDM"},{"code":"74246","type":"HCPCS"}],"standard_charges":[{"gross_charge":779.0,"discounted_cash":584.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR SMALL INTESTINE W CONTRAST","code_information":[{"code":"Px00032010187","type":"CDM"},{"code":"74250","type":"HCPCS"}],"standard_charges":[{"gross_charge":749.0,"discounted_cash":561.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR RADIOLOGIC EXAM SMALL INT DOUBLE CONTRAST STUDY CDM","code_information":[{"code":"Px00032010188","type":"CDM"},{"code":"74251","type":"HCPCS"}],"standard_charges":[{"gross_charge":749.0,"discounted_cash":561.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR ABDOMEN PORTABLE 1 VIEW","code_information":[{"code":"Px00032010190","type":"CDM"},{"code":"74018","type":"HCPCS"}],"standard_charges":[{"gross_charge":426.0,"discounted_cash":319.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR COLON W CONTRAST","code_information":[{"code":"Px00032010191","type":"CDM"},{"code":"74270","type":"HCPCS"}],"standard_charges":[{"gross_charge":994.0,"discounted_cash":745.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR BILE DUCTS/PANCREAS INTRAOP","code_information":[{"code":"Px00032010196","type":"CDM"},{"code":"74300","type":"HCPCS"}],"standard_charges":[{"gross_charge":897.0,"discounted_cash":672.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR INTRO LONG GI TUBE","code_information":[{"code":"Px00032010204","type":"CDM"},{"code":"74340","type":"HCPCS"}],"standard_charges":[{"gross_charge":305.0,"discounted_cash":228.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR UROGRAPHY RETROGRADE W/WO KUB W CONTRAST","code_information":[{"code":"Px00032010211","type":"CDM"},{"code":"74420","type":"HCPCS"}],"standard_charges":[{"gross_charge":1100.0,"discounted_cash":825.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR CYSTOGRAPHY MIN 3 VIEWS W CONTRAST","code_information":[{"code":"Px00032010213","type":"CDM"},{"code":"74430","type":"HCPCS"}],"standard_charges":[{"gross_charge":1157.0,"discounted_cash":867.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR URETHRA/BLADDER RETRO W CONTRAST","code_information":[{"code":"Px00032010216","type":"CDM"},{"code":"74450","type":"HCPCS"}],"standard_charges":[{"gross_charge":756.0,"discounted_cash":567.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR URETHRA/BLADDER VOIDING","code_information":[{"code":"Px00032010217","type":"CDM"},{"code":"74455","type":"HCPCS"}],"standard_charges":[{"gross_charge":1033.0,"discounted_cash":774.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR UTERUS & FALLOPIAN TUBE W CONTRAST","code_information":[{"code":"Px00032010223","type":"CDM"},{"code":"74740","type":"HCPCS"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":645.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR FALLOPIAN TUBE CATH","code_information":[{"code":"Px00032010224","type":"CDM"},{"code":"74742","type":"HCPCS"}],"standard_charges":[{"gross_charge":1387.0,"discounted_cash":1040.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC XR AORTOGRAPHY THORACIC SERIALOGRAPHY W CONTRAST","code_information":[{"code":"Px00032010227","type":"CDM"},{"code":"75605","type":"HCPCS"}],"standard_charges":[{"gross_charge":18647.0,"discounted_cash":13985.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC XR AORTOGRAPHY ABDOMEN SERIALOGRAPHY W CONTRAST","code_information":[{"code":"Px00032010228","type":"CDM"},{"code":"75625","type":"HCPCS"}],"standard_charges":[{"gross_charge":11656.0,"discounted_cash":8742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC XR AORTOGRAPHY ABD BI ILIOFEM SERIALOGRAPHY W CONTRAST","code_information":[{"code":"Px00032010229","type":"CDM"},{"code":"75630","type":"HCPCS"}],"standard_charges":[{"gross_charge":11656.0,"discounted_cash":8742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC XR ANGIO SPINE SELECTIVE W CONTRAST","code_information":[{"code":"Px00032010239","type":"CDM"},{"code":"75705","type":"HCPCS"}],"standard_charges":[{"gross_charge":18647.0,"discounted_cash":13985.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC XR ANGIO EXTREMITY UNILATERAL W CONTRAST","code_information":[{"code":"Px00032010240","type":"CDM"},{"code":"75710","type":"HCPCS"}],"standard_charges":[{"gross_charge":11656.0,"discounted_cash":8742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":5345.0,"discounted_cash":4008.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR ANGIOGRAPHY EXTREMITY BILATERAL RS&I","code_information":[{"code":"Px00032010241","type":"CDM"},{"code":"75716","type":"HCPCS"}],"standard_charges":[{"gross_charge":17538.0,"discounted_cash":13153.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":11760.0,"discounted_cash":8820.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR ANGIO ABDOMEN VISCERAL W CONTRAST","code_information":[{"code":"Px00032010244","type":"CDM"},{"code":"75726","type":"HCPCS"}],"standard_charges":[{"gross_charge":20420.0,"discounted_cash":15315.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":11760.0,"discounted_cash":8820.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RS&I","code_information":[{"code":"Px00032010245","type":"CDM"},{"code":"75731","type":"HCPCS"}],"standard_charges":[{"gross_charge":9927.0,"discounted_cash":7445.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC XR ANGIO PELVIC W CONTRAST","code_information":[{"code":"Px00032010247","type":"CDM"},{"code":"75736","type":"HCPCS"}],"standard_charges":[{"gross_charge":11656.0,"discounted_cash":8742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC XR ANGIO PULMONARY W CONTRAST UNI","code_information":[{"code":"Px00032010248","type":"CDM"},{"code":"75741","type":"HCPCS"}],"standard_charges":[{"gross_charge":9632.0,"discounted_cash":7224.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":9720.0,"discounted_cash":7290.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR ANGIO PULMONARY W CONTRAST BIL","code_information":[{"code":"Px00032010249","type":"CDM"},{"code":"75743","type":"HCPCS"}],"standard_charges":[{"gross_charge":17538.0,"discounted_cash":13153.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC XR ARTERY LUNG NON-SELECTIVE","code_information":[{"code":"Px00032010250","type":"CDM"},{"code":"75746","type":"HCPCS"}],"standard_charges":[{"gross_charge":11656.0,"discounted_cash":8742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC XR ANGIO MAMMARY INTERNAL","code_information":[{"code":"Px00032010251","type":"CDM"},{"code":"75756","type":"HCPCS"}],"standard_charges":[{"gross_charge":9632.0,"discounted_cash":7224.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC XR ANGIO EA ADDITIONAL VESSEL","code_information":[{"code":"Px00032010252","type":"CDM"},{"code":"75774","type":"HCPCS"}],"standard_charges":[{"gross_charge":5512.0,"discounted_cash":4134.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC XR VEINS EXTREMITY UNI W CONTRAST","code_information":[{"code":"Px00032010260","type":"CDM"},{"code":"75820","type":"HCPCS"}],"standard_charges":[{"gross_charge":3740.0,"discounted_cash":2805.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC XR VEINS EXTREMITY BIL W CONTRAST","code_information":[{"code":"Px00032010261","type":"CDM"},{"code":"75822","type":"HCPCS"}],"standard_charges":[{"gross_charge":5397.0,"discounted_cash":4047.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC XR VEINS CAVAL INFERIOR W CONTRAST","code_information":[{"code":"Px00032010262","type":"CDM"},{"code":"75825","type":"HCPCS"}],"standard_charges":[{"gross_charge":11656.0,"discounted_cash":8742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC XR VEINS CAVAL SUPERIOR W CONTRAST","code_information":[{"code":"Px00032010263","type":"CDM"},{"code":"75827","type":"HCPCS"}],"standard_charges":[{"gross_charge":5434.0,"discounted_cash":4075.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC XR VEIN KIDNEY UNI W CONTRAST","code_information":[{"code":"Px00032010264","type":"CDM"},{"code":"75831","type":"HCPCS"}],"standard_charges":[{"gross_charge":14059.0,"discounted_cash":10544.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":10815.0,"discounted_cash":8111.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR VEIN ADRENAL GLAND","code_information":[{"code":"Px00032010266","type":"CDM"},{"code":"75840","type":"HCPCS"}],"standard_charges":[{"gross_charge":10815.0,"discounted_cash":8111.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC XR VEINS VENOUS SINUS W CONTRAST","code_information":[{"code":"Px00032010268","type":"CDM"},{"code":"75860","type":"HCPCS"}],"standard_charges":[{"gross_charge":3740.0,"discounted_cash":2805.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC XR VEIN W/O HEMODYN EVAL","code_information":[{"code":"Px00032010281","type":"CDM"},{"code":"75887","type":"HCPCS"}],"standard_charges":[{"gross_charge":3091.0,"discounted_cash":2318.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR VEIN HEPATIC W/ HEMODYN EVAL","code_information":[{"code":"Px00032010282","type":"CDM"},{"code":"75889","type":"HCPCS"}],"standard_charges":[{"gross_charge":11656.0,"discounted_cash":8742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":11760.0,"discounted_cash":8820.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR VEIN HEPATIC W/O HEMODYN EVAL","code_information":[{"code":"Px00032010283","type":"CDM"},{"code":"75891","type":"HCPCS"}],"standard_charges":[{"gross_charge":11656.0,"discounted_cash":8742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC XR TRANSCATH EMBOLIZ THERAPY W CONTRAST","code_information":[{"code":"Px00032010285","type":"CDM"},{"code":"75894","type":"HCPCS"}],"standard_charges":[{"gross_charge":9993.0,"discounted_cash":7494.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC XR ANGIO EXISTING CATH NO THROMBO","code_information":[{"code":"Px00032010287","type":"CDM"},{"code":"75898","type":"HCPCS"}],"standard_charges":[{"gross_charge":3740.0,"discounted_cash":2805.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC REMOVE CVA DEVICE OBSTRUCT","code_information":[{"code":"Px00032010289","type":"CDM"},{"code":"75901","type":"HCPCS"}],"standard_charges":[{"gross_charge":3176.0,"discounted_cash":2382.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC REMOVE CVA LUMEN OBSTRUCT","code_information":[{"code":"Px00032010290","type":"CDM"},{"code":"75902","type":"HCPCS"}],"standard_charges":[{"gross_charge":874.0,"discounted_cash":655.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR ENDOVASC THOR AORTA REPAIR SUBCLAV","code_information":[{"code":"Px00032010298","type":"CDM"},{"code":"75957","type":"HCPCS"}],"standard_charges":[{"gross_charge":11812.0,"discounted_cash":8859.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC VASCULAR BIOPSY TRANSCATHETER","code_information":[{"code":"Px00032010307","type":"CDM"},{"code":"75970","type":"HCPCS"}],"standard_charges":[{"gross_charge":4549.0,"discounted_cash":3411.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC XR CHANGE TUBE/CATH W CONTRAST","code_information":[{"code":"Px00032010311","type":"CDM"},{"code":"75984","type":"HCPCS"}],"standard_charges":[{"gross_charge":2534.0,"discounted_cash":1900.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":615.0,"discounted_cash":461.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR ABSCESS DRAINAGE W IMG GUIDANCE","code_information":[{"code":"Px00032010312","type":"CDM"},{"code":"75989","type":"HCPCS"}],"standard_charges":[{"gross_charge":2534.0,"discounted_cash":1900.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":474.0,"discounted_cash":355.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC FLUOROSCOPY UP TO 1 HR","code_information":[{"code":"Px00032010318","type":"CDM"},{"code":"76000","type":"HCPCS"}],"standard_charges":[{"gross_charge":708.0,"discounted_cash":531.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":1556.0,"discounted_cash":1167.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR PEDIATRIC FOREIGN BODY 1 VIEW","code_information":[{"code":"Px00032010320","type":"CDM"},{"code":"76010","type":"HCPCS"}],"standard_charges":[{"gross_charge":263.0,"discounted_cash":197.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR FISTULA/SINUS ABSCESS","code_information":[{"code":"Px00032010321","type":"CDM"},{"code":"76080","type":"HCPCS"}],"standard_charges":[{"gross_charge":595.0,"discounted_cash":446.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR SURGICAL SPECIMEN","code_information":[{"code":"Px00032010322","type":"CDM"},{"code":"76098","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":68.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC FLUORO CENTRAL VENOUS ACCESS DEV PLACEMENT","code_information":[{"code":"Px00032010330","type":"CDM"},{"code":"77001","type":"HCPCS"}],"standard_charges":[{"gross_charge":5828.0,"discounted_cash":4371.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":426.0,"discounted_cash":319.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC FL GUIDE PLCMT NEEDLE ADD ON","code_information":[{"code":"Px00032010331","type":"CDM"},{"code":"77002","type":"HCPCS"}],"standard_charges":[{"gross_charge":1019.0,"discounted_cash":764.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC FLUOROGUIDE FOR SPINE INJECT","code_information":[{"code":"Px00032010332","type":"CDM"},{"code":"77003","type":"HCPCS"}],"standard_charges":[{"gross_charge":723.0,"discounted_cash":542.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR BONE AGE STUDY","code_information":[{"code":"Px00032010338","type":"CDM"},{"code":"77072","type":"HCPCS"}],"standard_charges":[{"gross_charge":340.0,"discounted_cash":255.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR BONE SURVEY COMPLETE","code_information":[{"code":"Px00032010341","type":"CDM"},{"code":"77075","type":"HCPCS"}],"standard_charges":[{"gross_charge":1307.0,"discounted_cash":980.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR BONE SURVEY INFANT","code_information":[{"code":"Px00032010342","type":"CDM"},{"code":"77076","type":"HCPCS"}],"standard_charges":[{"gross_charge":906.0,"discounted_cash":679.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR JOINT SURVEY 1 VIEW","code_information":[{"code":"Px00032010343","type":"CDM"},{"code":"77077","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":124.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR DXA BONE DENSITY STUDY AXIAL","code_information":[{"code":"Px00032010344","type":"CDM"},{"code":"77080","type":"HCPCS"}],"standard_charges":[{"gross_charge":657.0,"discounted_cash":492.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BONE DENSITY PERIPHERAL SKELETON","code_information":[{"code":"Px00032010345","type":"CDM"},{"code":"77081","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":150.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR RADIOLOGIC SMALL INTESTINE FOLLOW-THROUGH STUDY CDM","code_information":[{"code":"Px00032010351","type":"CDM"},{"code":"74248","type":"HCPCS"}],"standard_charges":[{"gross_charge":367.0,"discounted_cash":275.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR RADIOLOGIC EXAM ESOPHAGUS DOUBLE CONTRAST STUDY CDM","code_information":[{"code":"Px00032010352","type":"CDM"},{"code":"74221","type":"HCPCS"}],"standard_charges":[{"gross_charge":880.0,"discounted_cash":660.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR SHOULDER COMPLETE MIN 2 VIEWS","code_information":[{"code":"Px00032010481","type":"CDM"},{"code":"73030","type":"HCPCS"}],"standard_charges":[{"gross_charge":400.0,"discounted_cash":300.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR FOREARM 1 VIEW","code_information":[{"code":"Px00032010483","type":"CDM"},{"code":"73090","type":"HCPCS"}],"standard_charges":[{"gross_charge":388.0,"discounted_cash":291.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR LOWER LEG LIMITED","code_information":[{"code":"Px00032010499","type":"CDM"},{"code":"73590","type":"HCPCS"}],"standard_charges":[{"gross_charge":332.0,"discounted_cash":249.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR ANKLE 1 VIEW","code_information":[{"code":"Px00032010503","type":"CDM"},{"code":"73600","type":"HCPCS"}],"standard_charges":[{"gross_charge":455.0,"discounted_cash":341.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR FOOT 1 VIEW","code_information":[{"code":"Px00032010505","type":"CDM"},{"code":"73620","type":"HCPCS"}],"standard_charges":[{"gross_charge":353.0,"discounted_cash":264.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR STERNUM 1 VIEW","code_information":[{"code":"Px00032010600","type":"CDM"},{"code":"71120","type":"HCPCS"}],"standard_charges":[{"gross_charge":377.0,"discounted_cash":282.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DXA BONE DENSITY AXIAL WITH VFA","code_information":[{"code":"Px00032010602","type":"CDM"},{"code":"77085","type":"HCPCS"}],"standard_charges":[{"gross_charge":1199.0,"discounted_cash":899.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR ENTIRE SPINE 1 VIEW","code_information":[{"code":"Px00032010604","type":"CDM"},{"code":"72081","type":"HCPCS"}],"standard_charges":[{"gross_charge":305.0,"discounted_cash":228.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR ENTIRE SPINE 2 OR 3 VIEWS","code_information":[{"code":"Px00032010605","type":"CDM"},{"code":"72082","type":"HCPCS"}],"standard_charges":[{"gross_charge":503.0,"discounted_cash":377.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR ENTIRE SPINE 4 OR 5 VIEWS","code_information":[{"code":"Px00032010606","type":"CDM"},{"code":"72083","type":"HCPCS"}],"standard_charges":[{"gross_charge":960.0,"discounted_cash":720.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR HIPS UNI W PELVIS WHEN PERFORMED 1 VIEW","code_information":[{"code":"Px00032010608","type":"CDM"},{"code":"73501","type":"HCPCS"}],"standard_charges":[{"gross_charge":257.0,"discounted_cash":192.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR HIPS UNI W PELVIS WHEN PERFORMED 2-3 VIEWS","code_information":[{"code":"Px00032010609","type":"CDM"},{"code":"73502","type":"HCPCS"}],"standard_charges":[{"gross_charge":305.0,"discounted_cash":228.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR HIPS UNI W PELVIS WHEN PERFORMED MIN 4 VIEWS","code_information":[{"code":"Px00032010610","type":"CDM"},{"code":"73503","type":"HCPCS"}],"standard_charges":[{"gross_charge":503.0,"discounted_cash":377.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR HIPS BIL W PELVIS WHEN PERFORMED 2 VIEWS","code_information":[{"code":"Px00032010611","type":"CDM"},{"code":"73521","type":"HCPCS"}],"standard_charges":[{"gross_charge":503.0,"discounted_cash":377.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR HIPS BIL W PELVIS WHEN PERFORMED 3-4 VIEWS","code_information":[{"code":"Px00032010612","type":"CDM"},{"code":"73522","type":"HCPCS"}],"standard_charges":[{"gross_charge":503.0,"discounted_cash":377.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR HIPS BIL W PELVIS WHEN PERFORMED MIN 5 VIEWS","code_information":[{"code":"Px00032010613","type":"CDM"},{"code":"73523","type":"HCPCS"}],"standard_charges":[{"gross_charge":876.0,"discounted_cash":657.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR FEMUR 1 VIEW","code_information":[{"code":"Px00032010614","type":"CDM"},{"code":"73551","type":"HCPCS"}],"standard_charges":[{"gross_charge":305.0,"discounted_cash":228.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR FEMUR MIN 2 VIEWS","code_information":[{"code":"Px00032010615","type":"CDM"},{"code":"73552","type":"HCPCS"}],"standard_charges":[{"gross_charge":305.0,"discounted_cash":228.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR CHEST 1 VIEW","code_information":[{"code":"Px00032410014","type":"CDM"},{"code":"71045","type":"HCPCS"}],"standard_charges":[{"gross_charge":377.0,"discounted_cash":282.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR CHEST 2 VIEWS","code_information":[{"code":"Px00032410015","type":"CDM"},{"code":"71046","type":"HCPCS"}],"standard_charges":[{"gross_charge":478.0,"discounted_cash":358.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR CHEST 3 VIEWS","code_information":[{"code":"Px00032410016","type":"CDM"},{"code":"71047","type":"HCPCS"}],"standard_charges":[{"gross_charge":518.0,"discounted_cash":388.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR CHEST 4/PLUS VIEWS","code_information":[{"code":"Px00032410017","type":"CDM"},{"code":"71048","type":"HCPCS"}],"standard_charges":[{"gross_charge":639.0,"discounted_cash":479.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC XR CHEST PORTABLE 1 VIEW","code_information":[{"code":"Px00032410018","type":"CDM"},{"code":"71045","type":"HCPCS"}],"standard_charges":[{"gross_charge":377.0,"discounted_cash":282.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CHEMO SQ OR IM NON HORMONAL CDM","code_information":[{"code":"Px00033110001","type":"CDM"},{"code":"96401","type":"HCPCS"}],"standard_charges":[{"gross_charge":821.0,"discounted_cash":615.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CHEMOTX ADMN SUBQ/IM HORMONAL ANTI-NEO CDM","code_information":[{"code":"Px00033110002","type":"CDM"},{"code":"96402","type":"HCPCS"}],"standard_charges":[{"gross_charge":337.0,"discounted_cash":252.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CHEMO IV PUSH INITIAL OR SINGLE DRUG CDM","code_information":[{"code":"Px00033110007","type":"CDM"},{"code":"96409","type":"HCPCS"}],"standard_charges":[{"gross_charge":728.0,"discounted_cash":546.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC THER RAD SIMULATION SIMPLE","code_information":[{"code":"Px00033310006","type":"CDM"},{"code":"77280","type":"HCPCS"}],"standard_charges":[{"gross_charge":1560.0,"discounted_cash":1170.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD RADIATION ONCOLOGY"}]},{"description":"HC THER RAD SIMULATION INTERMEDIATE","code_information":[{"code":"Px00033310007","type":"CDM"},{"code":"77285","type":"HCPCS"}],"standard_charges":[{"gross_charge":2471.0,"discounted_cash":1853.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD RADIATION ONCOLOGY"}]},{"description":"HC THER RAD SIMULATION COMPLEX","code_information":[{"code":"Px00033310008","type":"CDM"},{"code":"77290","type":"HCPCS"}],"standard_charges":[{"gross_charge":3175.0,"discounted_cash":2381.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD RADIATION ONCOLOGY"}]},{"description":"HC THER RAD SIMULATION 3D","code_information":[{"code":"Px00033310009","type":"CDM"},{"code":"77295","type":"HCPCS"}],"standard_charges":[{"gross_charge":11148.0,"discounted_cash":8361.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD RADIATION ONCOLOGY"}]},{"description":"HC BASIC DOSIMETRY CALC","code_information":[{"code":"Px00033310010","type":"CDM"},{"code":"77300","type":"HCPCS"}],"standard_charges":[{"gross_charge":949.0,"discounted_cash":711.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD RADIATION ONCOLOGY"}]},{"description":"HC RADIOTHERAPY DOSE PLAN, IMRT","code_information":[{"code":"Px00033310012","type":"CDM"},{"code":"77301","type":"HCPCS"}],"standard_charges":[{"gross_charge":11865.0,"discounted_cash":8898.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD RADIATION ONCOLOGY"}]},{"description":"HC SPECIAL TELETX PORT PLAN","code_information":[{"code":"Px00033310018","type":"CDM"},{"code":"77321","type":"HCPCS"}],"standard_charges":[{"gross_charge":2138.0,"discounted_cash":1603.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD RADIATION ONCOLOGY"}]},{"description":"HC SPECIAL RADIATION DOSIMETRY","code_information":[{"code":"Px00033310022","type":"CDM"},{"code":"77331","type":"HCPCS"}],"standard_charges":[{"gross_charge":796.0,"discounted_cash":597.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD RADIATION ONCOLOGY"}]},{"description":"HC TREATMENT DEVICES SIMPLE","code_information":[{"code":"Px00033310023","type":"CDM"},{"code":"77332","type":"HCPCS"}],"standard_charges":[{"gross_charge":1050.0,"discounted_cash":787.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD RADIATION ONCOLOGY"}]},{"description":"HC TREATMENT DEVICES INTERMEDIATE","code_information":[{"code":"Px00033310024","type":"CDM"},{"code":"77333","type":"HCPCS"}],"standard_charges":[{"gross_charge":1544.0,"discounted_cash":1158.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD RADIATION ONCOLOGY"}]},{"description":"HC TREATMENT DEVICES COMPLEX","code_information":[{"code":"Px00033310025","type":"CDM"},{"code":"77334","type":"HCPCS"}],"standard_charges":[{"gross_charge":2053.0,"discounted_cash":1539.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD RADIATION ONCOLOGY"}]},{"description":"HC CONTINUING PHYSICS CONSULT","code_information":[{"code":"Px00033310027","type":"CDM"},{"code":"77336","type":"HCPCS"}],"standard_charges":[{"gross_charge":1168.0,"discounted_cash":876.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD RADIATION ONCOLOGY"}]},{"description":"HC DESIGN MLC DEVICE FOR IMRT","code_information":[{"code":"Px00033310028","type":"CDM"},{"code":"77338","type":"HCPCS"}],"standard_charges":[{"gross_charge":3052.0,"discounted_cash":2289.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD RADIATION ONCOLOGY"}]},{"description":"HC SPECIAL PHYSICS CONSULT","code_information":[{"code":"Px00033310029","type":"CDM"},{"code":"77370","type":"HCPCS"}],"standard_charges":[{"gross_charge":1616.0,"discounted_cash":1212.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD RADIATION ONCOLOGY"}]},{"description":"HC SBRT DELIVERY","code_information":[{"code":"Px00033310035","type":"CDM"},{"code":"77373","type":"HCPCS"}],"standard_charges":[{"gross_charge":12894.0,"discounted_cash":9670.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD RADIATION ONCOLOGY"}]},{"description":"HC PORT VERIF FILMS PER 5 FRACTNS","code_information":[{"code":"Px00033310051","type":"CDM"},{"code":"77417","type":"HCPCS"}],"standard_charges":[{"gross_charge":464.0,"discounted_cash":348.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD RADIATION ONCOLOGY"}]},{"description":"HC SPECIAL RADIATION TREATMENT","code_information":[{"code":"Px00033310057","type":"CDM"},{"code":"77470","type":"HCPCS"}],"standard_charges":[{"gross_charge":4086.0,"discounted_cash":3064.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD RADIATION ONCOLOGY"}]},{"description":"HC INSERT UTERI TANDEMS/OVOIDS","code_information":[{"code":"Px00033310082","type":"CDM"},{"code":"57155","type":"HCPCS"}],"standard_charges":[{"gross_charge":4204.0,"discounted_cash":3153.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD RADIATION ONCOLOGY"}]},{"description":"HC INSERT VAGINAL BRACHYTX DEVICE","code_information":[{"code":"Px00033310083","type":"CDM"},{"code":"57156","type":"HCPCS"}],"standard_charges":[{"gross_charge":1473.0,"discounted_cash":1104.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD RADIATION ONCOLOGY"}]},{"description":"HC INSERT INTERSTITIAL MARKERS ABDOMINAL/PELVIC FOR RAD THERAPY","code_information":[{"code":"Px00033310085","type":"CDM"},{"code":"49411","type":"HCPCS"}],"standard_charges":[{"gross_charge":4274.0,"discounted_cash":3205.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC RESPIRATOR MOTION MGMT SIMUL","code_information":[{"code":"Px00033310090","type":"CDM"},{"code":"77293","type":"HCPCS"}],"standard_charges":[{"gross_charge":2678.0,"discounted_cash":2008.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD RADIATION ONCOLOGY"}]},{"description":"HC TELETHX ISODOSE PLAN SIMPLE","code_information":[{"code":"Px00033310091","type":"CDM"},{"code":"77306","type":"HCPCS"}],"standard_charges":[{"gross_charge":1852.0,"discounted_cash":1389.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD RADIATION ONCOLOGY"}]},{"description":"HC TELETHX ISODOSE PLAN COMPLEX","code_information":[{"code":"Px00033310092","type":"CDM"},{"code":"77307","type":"HCPCS"}],"standard_charges":[{"gross_charge":3714.0,"discounted_cash":2785.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD RADIATION ONCOLOGY"}]},{"description":"HC BRACHYTX ISODOSE PLAN SIMPLE","code_information":[{"code":"Px00033310093","type":"CDM"},{"code":"77316","type":"HCPCS"}],"standard_charges":[{"gross_charge":2471.0,"discounted_cash":1853.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD RADIATION ONCOLOGY"}]},{"description":"HC BRACHYTX ISODOSE INTERMEDIATE","code_information":[{"code":"Px00033310094","type":"CDM"},{"code":"77317","type":"HCPCS"}],"standard_charges":[{"gross_charge":2945.0,"discounted_cash":2208.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD RADIATION ONCOLOGY"}]},{"description":"HC BRACHYTX ISODOSE COMPLEX","code_information":[{"code":"Px00033310095","type":"CDM"},{"code":"77318","type":"HCPCS"}],"standard_charges":[{"gross_charge":3106.0,"discounted_cash":2329.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD RADIATION ONCOLOGY"}]},{"description":"HC IMRT DELIVERY SIMPLE","code_information":[{"code":"Px00033310096","type":"CDM"},{"code":"77385","type":"HCPCS"}],"standard_charges":[{"gross_charge":4117.0,"discounted_cash":3087.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD RADIATION ONCOLOGY"}]},{"description":"HC IMRT DELIVERY COMPLEX","code_information":[{"code":"Px00033310097","type":"CDM"},{"code":"77386","type":"HCPCS"}],"standard_charges":[{"gross_charge":6195.0,"discounted_cash":4646.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"},{"gross_charge":5237.0,"discounted_cash":3927.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD RADIATION ONCOLOGY"}]},{"description":"HC GUIDANCE FOR LOCLZJ TARGET VOL FOR RADJ TX DLVR","code_information":[{"code":"Px00033310098","type":"CDM"},{"code":"77387","type":"HCPCS"}],"standard_charges":[{"gross_charge":1558.0,"discounted_cash":1168.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD RADIATION ONCOLOGY"}]},{"description":"HC RAD TX SIMPLE","code_information":[{"code":"Px00033310099","type":"CDM"},{"code":"77402","type":"HCPCS"}],"standard_charges":[{"gross_charge":3000.0,"discounted_cash":2250.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD RADIATION ONCOLOGY"}]},{"description":"HC RAD TX INTERMEDIATE","code_information":[{"code":"Px00033310100","type":"CDM"},{"code":"77407","type":"HCPCS"}],"standard_charges":[{"gross_charge":3600.0,"discounted_cash":2700.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD RADIATION ONCOLOGY"}]},{"description":"HC RAD TX COMPLEX","code_information":[{"code":"Px00033310101","type":"CDM"},{"code":"77412","type":"HCPCS"}],"standard_charges":[{"gross_charge":912.0,"discounted_cash":684.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"},{"gross_charge":4100.0,"discounted_cash":3075.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD RADIATION ONCOLOGY"}]},{"description":"HC HDR RDNCL NTRSTL/INTRCAV BRACHTX 1 CHANNEL","code_information":[{"code":"Px00033320002","type":"CDM"},{"code":"77770","type":"HCPCS"}],"standard_charges":[{"gross_charge":7701.0,"discounted_cash":5775.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD RADIATION ONCOLOGY"}]},{"description":"HC HDR RDNCL NTRSTL/INTRCAV BRCHTX 2-12 CHANNELS","code_information":[{"code":"Px00033320003","type":"CDM"},{"code":"77771","type":"HCPCS"}],"standard_charges":[{"gross_charge":9006.0,"discounted_cash":6754.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD RADIATION ONCOLOGY"}]},{"description":"HC HDR RDNCL NTRSTL/INTRCAV BRCHTX OVER 12 CHANNELS","code_information":[{"code":"Px00033320004","type":"CDM"},{"code":"77772","type":"HCPCS"}],"standard_charges":[{"gross_charge":9195.0,"discounted_cash":6896.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD RADIATION ONCOLOGY"}]},{"description":"HC CHEMO IV PUSH ADDL DRUG CDM","code_information":[{"code":"Px00033510002","type":"CDM"},{"code":"96411","type":"HCPCS"}],"standard_charges":[{"gross_charge":271.0,"discounted_cash":203.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CHEMO IV INFUSION INITIAL HR CDM","code_information":[{"code":"Px00033510003","type":"CDM"},{"code":"96413","type":"HCPCS"}],"standard_charges":[{"gross_charge":1804.0,"discounted_cash":1353.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CHEMO IV INFUSION ADDL HR CDM","code_information":[{"code":"Px00033510004","type":"CDM"},{"code":"96415","type":"HCPCS"}],"standard_charges":[{"gross_charge":716.0,"discounted_cash":537.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CHEMO IV INFUSION PROLONG VIA PORTABLE OR IMPLANTABLE PUMP > 8HRS CDM","code_information":[{"code":"Px00033510005","type":"CDM"},{"code":"96416","type":"HCPCS"}],"standard_charges":[{"gross_charge":1211.0,"discounted_cash":908.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CHEMO IV INFUSION EA ADDL SEQ DRG CDM","code_information":[{"code":"Px00033510006","type":"CDM"},{"code":"96417","type":"HCPCS"}],"standard_charges":[{"gross_charge":1462.0,"discounted_cash":1096.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CHEMO IV ADMIN INTO CNS INC LUMBAR PUNCTURE CDM","code_information":[{"code":"Px00033510014","type":"CDM"},{"code":"96450","type":"HCPCS"}],"standard_charges":[{"gross_charge":1726.0,"discounted_cash":1294.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC TYSABRI INFUSION FIRST HR","code_information":[{"code":"Px00033510017","type":"CDM"},{"code":"96413","type":"HCPCS"}],"standard_charges":[{"gross_charge":1804.0,"discounted_cash":1353.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CHEMO IV INFUSION CONCURRENT OR CHEMO UNLISTED PROCEDURE CDM","code_information":[{"code":"Px00033510020","type":"CDM"},{"code":"96549","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CHEMO INITIATE PORTAB PUMP FOR HOME USE INCL PUMP EQUIP & F/U VISIT CDM","code_information":[{"code":"Px00033510024","type":"CDM"},{"code":"G0498","type":"HCPCS"}],"standard_charges":[{"gross_charge":1081.0,"discounted_cash":810.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC NM HEPATOBILIARY SYSTEM","code_information":[{"code":"Px00034010010","type":"CDM"},{"code":"78226","type":"HCPCS"}],"standard_charges":[{"gross_charge":2653.0,"discounted_cash":1989.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC THYROID MET IMAGING WHOLE BODY","code_information":[{"code":"Px00034110007","type":"CDM"},{"code":"78018","type":"HCPCS"}],"standard_charges":[{"gross_charge":1874.0,"discounted_cash":1405.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC NM PARATHYROID","code_information":[{"code":"Px00034110009","type":"CDM"},{"code":"78070","type":"HCPCS"}],"standard_charges":[{"gross_charge":1865.0,"discounted_cash":1398.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC NM LYMPH SYSTEM","code_information":[{"code":"Px00034110021","type":"CDM"},{"code":"78195","type":"HCPCS"}],"standard_charges":[{"gross_charge":1587.0,"discounted_cash":1190.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC SALIVARY GLAND IMAGING","code_information":[{"code":"Px00034110031","type":"CDM"},{"code":"78230","type":"HCPCS"}],"standard_charges":[{"gross_charge":1268.0,"discounted_cash":951.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC NM GASTRIC EMPTYING IMG STDY","code_information":[{"code":"Px00034110037","type":"CDM"},{"code":"78264","type":"HCPCS"}],"standard_charges":[{"gross_charge":3018.0,"discounted_cash":2263.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC NM ACUTE GI BLEED STUDY","code_information":[{"code":"Px00034110042","type":"CDM"},{"code":"78278","type":"HCPCS"}],"standard_charges":[{"gross_charge":2512.0,"discounted_cash":1884.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC NM INTESTINE MECKEL VOLVULUS","code_information":[{"code":"Px00034110044","type":"CDM"},{"code":"78290","type":"HCPCS"}],"standard_charges":[{"gross_charge":1932.0,"discounted_cash":1449.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC NM BONE AND OR JOINT IMAGING LIMITED AREA CDM","code_information":[{"code":"Px00034110047","type":"CDM"},{"code":"78300","type":"HCPCS"}],"standard_charges":[{"gross_charge":1617.0,"discounted_cash":1212.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC NM BONE AND OR JOINT IMAGING MULTIPLE AREAS CDM","code_information":[{"code":"Px00034110048","type":"CDM"},{"code":"78305","type":"HCPCS"}],"standard_charges":[{"gross_charge":2544.0,"discounted_cash":1908.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC NM BONE AND OR JOINT IMAGING WHOLE BODY CDM","code_information":[{"code":"Px00034110049","type":"CDM"},{"code":"78306","type":"HCPCS"}],"standard_charges":[{"gross_charge":2646.0,"discounted_cash":1984.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC NM BONE AND ORJOINT IMAGING 3 PHASE STUDY CDM","code_information":[{"code":"Px00034110050","type":"CDM"},{"code":"78315","type":"HCPCS"}],"standard_charges":[{"gross_charge":2746.0,"discounted_cash":2059.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC NM MYCARD PERFUS SPECT SINGLE","code_information":[{"code":"Px00034110055","type":"CDM"},{"code":"78451","type":"HCPCS"}],"standard_charges":[{"gross_charge":4871.0,"discounted_cash":3653.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC NM MYCARD PERFUS SPECT MULTIPLE","code_information":[{"code":"Px00034110056","type":"CDM"},{"code":"78452","type":"HCPCS"}],"standard_charges":[{"gross_charge":5091.0,"discounted_cash":3818.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC NM PULM PERFUSION PARTICULATE","code_information":[{"code":"Px00034110070","type":"CDM"},{"code":"78580","type":"HCPCS"}],"standard_charges":[{"gross_charge":2673.0,"discounted_cash":2004.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC NM PULM PERFUSION VENT IMAGING","code_information":[{"code":"Px00034110073","type":"CDM"},{"code":"78582","type":"HCPCS"}],"standard_charges":[{"gross_charge":2318.0,"discounted_cash":1738.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC NM PULM PERFUSION VENT DIFF","code_information":[{"code":"Px00034110077","type":"CDM"},{"code":"78598","type":"HCPCS"}],"standard_charges":[{"gross_charge":1698.0,"discounted_cash":1273.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BRAIN IMAGE W/FLOW 4/PLUS VIEWS COMPLETE","code_information":[{"code":"Px00034110082","type":"CDM"},{"code":"78606","type":"HCPCS"}],"standard_charges":[{"gross_charge":3392.0,"discounted_cash":2544.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CSF SHUNT EVALUATION","code_information":[{"code":"Px00034110087","type":"CDM"},{"code":"78645","type":"HCPCS"}],"standard_charges":[{"gross_charge":1917.0,"discounted_cash":1437.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC NM KIDNEY VASC FLOW FUNC W DRUG","code_information":[{"code":"Px00034110094","type":"CDM"},{"code":"78708","type":"HCPCS"}],"standard_charges":[{"gross_charge":2608.0,"discounted_cash":1956.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC NM RP LOCLZJ TUM PLNR 1 AREA SINGLE DAY IMAGING CDM","code_information":[{"code":"Px00034110102","type":"CDM"},{"code":"78800","type":"HCPCS"}],"standard_charges":[{"gross_charge":1906.0,"discounted_cash":1429.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC NM RP LOCLZJ TUM PLNR GTE 2 AREA GTE 1 D IMG OR 1 AREA IMG GT 2 D CDM","code_information":[{"code":"Px00034110103","type":"CDM"},{"code":"78801","type":"HCPCS"}],"standard_charges":[{"gross_charge":1949.0,"discounted_cash":1461.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC NM RP LOCLZJ TUM PLNR WHOLE BODY SINGLE DAY IMAGING CDM","code_information":[{"code":"Px00034110104","type":"CDM"},{"code":"78802","type":"HCPCS"}],"standard_charges":[{"gross_charge":1991.0,"discounted_cash":1493.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC RP LOCLZJ TUM SPECT 1 AREA/ACQUISJ 1 DAY IMG CDM","code_information":[{"code":"Px00034110105","type":"CDM"},{"code":"78803","type":"HCPCS"}],"standard_charges":[{"gross_charge":3644.0,"discounted_cash":2733.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC NM TUMOR LCLZN WB GTE 2 DAYS","code_information":[{"code":"Px00034110106","type":"CDM"},{"code":"78804","type":"HCPCS"}],"standard_charges":[{"gross_charge":3644.0,"discounted_cash":2733.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC NM HEPATOBILIARY SYSTEM W DRUG","code_information":[{"code":"Px00034110132","type":"CDM"},{"code":"78227","type":"HCPCS"}],"standard_charges":[{"gross_charge":2819.0,"discounted_cash":2114.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC THYROID IMAGING W OR W/O VASC FLOW W/UPTAKE SINGLE/MULT QUAN MEA","code_information":[{"code":"Px00034110144","type":"CDM"},{"code":"78014","type":"HCPCS"}],"standard_charges":[{"gross_charge":1742.0,"discounted_cash":1306.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PARATHYROID PLANAR IMAGING W/WO SUBTRACTION","code_information":[{"code":"Px00034110145","type":"CDM"},{"code":"78071","type":"HCPCS"}],"standard_charges":[{"gross_charge":1865.0,"discounted_cash":1398.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PARATHYROID IMAGING W/TOMOGRAPHIC SPECT & CT","code_information":[{"code":"Px00034110146","type":"CDM"},{"code":"78072","type":"HCPCS"}],"standard_charges":[{"gross_charge":1917.0,"discounted_cash":1437.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC RP LOCLZJ TUM SPECT W/CT 1 AREA/ACQUISJ 1DAY IMG CDM","code_information":[{"code":"Px00034110149","type":"CDM"},{"code":"78830","type":"HCPCS"}],"standard_charges":[{"gross_charge":5241.0,"discounted_cash":3930.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC RP LOCLZJ TUM SPECT 2 AREA/SEP ACQUISJ IMG CDM","code_information":[{"code":"Px00034110150","type":"CDM"},{"code":"78831","type":"HCPCS"}],"standard_charges":[{"gross_charge":5594.0,"discounted_cash":4195.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC RP LOCLZJ TUM SPECT CT 2AREA/SEP ACQUISJ IMG CDM","code_information":[{"code":"Px00034110151","type":"CDM"},{"code":"78832","type":"HCPCS"}],"standard_charges":[{"gross_charge":5946.0,"discounted_cash":4459.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC RADIOPHARM THERAPY, BY ORAL ADMIN","code_information":[{"code":"Px00034210001","type":"CDM"},{"code":"79005","type":"HCPCS"}],"standard_charges":[{"gross_charge":1046.0,"discounted_cash":784.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IV RADIOPHARM ADMIN","code_information":[{"code":"Px00034210002","type":"CDM"},{"code":"79101","type":"HCPCS"}],"standard_charges":[{"gross_charge":813.0,"discounted_cash":609.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC RADPHARM THER INTRA-ART PARTICULT","code_information":[{"code":"Px00034210007","type":"CDM"},{"code":"79445","type":"HCPCS"}],"standard_charges":[{"gross_charge":1121.0,"discounted_cash":840.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CT MAXILLOFACIAL W/O DYE LIMITED","code_information":[{"code":"Px00035010003","type":"CDM"},{"code":"70486","type":"HCPCS"}],"standard_charges":[{"gross_charge":1673.0,"discounted_cash":1254.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CT MAXILLOFACIAL WO & W CONTRAST","code_information":[{"code":"Px00035010006","type":"CDM"},{"code":"70488","type":"HCPCS"}],"standard_charges":[{"gross_charge":3943.0,"discounted_cash":2957.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CT SOFT TISSUE NECK WO CONTRAST","code_information":[{"code":"Px00035010007","type":"CDM"},{"code":"70490","type":"HCPCS"}],"standard_charges":[{"gross_charge":2402.0,"discounted_cash":1801.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CT SOFT TISSUE NECK W CONTRAST","code_information":[{"code":"Px00035010008","type":"CDM"},{"code":"70491","type":"HCPCS"}],"standard_charges":[{"gross_charge":3073.0,"discounted_cash":2304.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CT SOFT TISSUE NECK W & W/O CONTRAST","code_information":[{"code":"Px00035010009","type":"CDM"},{"code":"70492","type":"HCPCS"}],"standard_charges":[{"gross_charge":3465.0,"discounted_cash":2598.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CT ANGIOGRAPHY NECK W CONTRAST","code_information":[{"code":"Px00035010010","type":"CDM"},{"code":"70498","type":"HCPCS"}],"standard_charges":[{"gross_charge":3024.0,"discounted_cash":2268.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CT THORAX WO CONTRAST","code_information":[{"code":"Px00035010011","type":"CDM"},{"code":"71250","type":"HCPCS"}],"standard_charges":[{"gross_charge":2644.0,"discounted_cash":1983.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CT ANGIOGRAPHY CHEST","code_information":[{"code":"Px00035010013","type":"CDM"},{"code":"71275","type":"HCPCS"}],"standard_charges":[{"gross_charge":3347.0,"discounted_cash":2510.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CT ANGIO LWR EXTR W/O&W/DYE","code_information":[{"code":"Px00035010020","type":"CDM"},{"code":"73706","type":"HCPCS"}],"standard_charges":[{"gross_charge":1855.0,"discounted_cash":1391.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CTA ABDOMEN W & W/O CONTRAST","code_information":[{"code":"Px00035010023","type":"CDM"},{"code":"74175","type":"HCPCS"}],"standard_charges":[{"gross_charge":3199.0,"discounted_cash":2399.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CT ABD & PELVIS WO CONTRAST","code_information":[{"code":"Px00035010024","type":"CDM"},{"code":"74176","type":"HCPCS"}],"standard_charges":[{"gross_charge":2906.0,"discounted_cash":2179.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CT ABDOMEN & PELVIS W  CONTRAST","code_information":[{"code":"Px00035010025","type":"CDM"},{"code":"74177","type":"HCPCS"}],"standard_charges":[{"gross_charge":5409.0,"discounted_cash":4056.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CTA AORTA BIL ILIOFEM W & W/O CONTRAST","code_information":[{"code":"Px00035010031","type":"CDM"},{"code":"75635","type":"HCPCS"}],"standard_charges":[{"gross_charge":3125.0,"discounted_cash":2343.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC 3D RENDER W/O POSTPROCESS","code_information":[{"code":"Px00035010032","type":"CDM"},{"code":"76376","type":"HCPCS"}],"standard_charges":[{"gross_charge":889.0,"discounted_cash":666.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC 3D RENDERING W/POSTPROCESS","code_information":[{"code":"Px00035010033","type":"CDM"},{"code":"76377","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":13.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CT GUIDE PLCMT NEEDLE","code_information":[{"code":"Px00035010037","type":"CDM"},{"code":"77012","type":"HCPCS"}],"standard_charges":[{"gross_charge":2829.0,"discounted_cash":2121.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CT GUIDE FOR TISSUE ABLATION","code_information":[{"code":"Px00035010038","type":"CDM"},{"code":"77013","type":"HCPCS"}],"standard_charges":[{"gross_charge":2304.0,"discounted_cash":1728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CTA ABDOMEN PELVIS","code_information":[{"code":"Px00035010072","type":"CDM"},{"code":"74174","type":"HCPCS"}],"standard_charges":[{"gross_charge":5536.0,"discounted_cash":4152.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CTA HEAD&NECK W/NONCONTRAST IMG&POST-PXESSING CDM","code_information":[{"code":"Px00035100001","type":"CDM"},{"code":"70471","type":"HCPCS"}],"standard_charges":[{"gross_charge":1550.0,"discounted_cash":1162.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CT PERFUSION W/CONTRAST CBF","code_information":[{"code":"Px00035110001","type":"CDM"},{"code":"0042T","type":"HCPCS"}],"standard_charges":[{"gross_charge":1550.0,"discounted_cash":1162.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CT HEAD/BRAIN WO CONTRAST","code_information":[{"code":"Px00035110002","type":"CDM"},{"code":"70450","type":"HCPCS"}],"standard_charges":[{"gross_charge":2031.0,"discounted_cash":1523.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CT HEAD/BRAIN W CONTRAST","code_information":[{"code":"Px00035110007","type":"CDM"},{"code":"70460","type":"HCPCS"}],"standard_charges":[{"gross_charge":2682.0,"discounted_cash":2011.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CT HEAD/BRAIN W & W/O CONTRAST","code_information":[{"code":"Px00035110012","type":"CDM"},{"code":"70470","type":"HCPCS"}],"standard_charges":[{"gross_charge":2791.0,"discounted_cash":2093.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CT ORBIT/EAR/FOSSA WO CONTRAST","code_information":[{"code":"Px00035110014","type":"CDM"},{"code":"70480","type":"HCPCS"}],"standard_charges":[{"gross_charge":2609.0,"discounted_cash":1956.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CT ORBIT/EAR/FOSSA W CONTRAST","code_information":[{"code":"Px00035110017","type":"CDM"},{"code":"70481","type":"HCPCS"}],"standard_charges":[{"gross_charge":2892.0,"discounted_cash":2169.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CT ORBIT/EAR/FOSSA W & W/O CONTRAST","code_information":[{"code":"Px00035110019","type":"CDM"},{"code":"70482","type":"HCPCS"}],"standard_charges":[{"gross_charge":3661.0,"discounted_cash":2745.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CT MAXILLOFACIAL WO CONTRAST","code_information":[{"code":"Px00035110022","type":"CDM"},{"code":"70486","type":"HCPCS"}],"standard_charges":[{"gross_charge":1673.0,"discounted_cash":1254.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CT MAXILLOFACIAL W CONTRAST","code_information":[{"code":"Px00035110030","type":"CDM"},{"code":"70487","type":"HCPCS"}],"standard_charges":[{"gross_charge":3440.0,"discounted_cash":2580.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CT ANGIOGRAPHY HEAD W CONTRAST","code_information":[{"code":"Px00035110032","type":"CDM"},{"code":"70496","type":"HCPCS"}],"standard_charges":[{"gross_charge":3019.0,"discounted_cash":2264.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CT THORAX LW DOSE LNG CA SCR WO CONTRAST CDM","code_information":[{"code":"Px00035200001","type":"CDM"},{"code":"71271","type":"HCPCS"}],"standard_charges":[{"gross_charge":817.0,"discounted_cash":612.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CT THORAX W CONTRAST","code_information":[{"code":"Px00035210003","type":"CDM"},{"code":"71260","type":"HCPCS"}],"standard_charges":[{"gross_charge":3018.0,"discounted_cash":2263.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CT THORAX W & W/O CONTRAST","code_information":[{"code":"Px00035210006","type":"CDM"},{"code":"71270","type":"HCPCS"}],"standard_charges":[{"gross_charge":3388.0,"discounted_cash":2541.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CT NECK SPINE WO CONTRAST","code_information":[{"code":"Px00035210008","type":"CDM"},{"code":"72125","type":"HCPCS"}],"standard_charges":[{"gross_charge":2782.0,"discounted_cash":2086.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CT NECK SPINE W/DYE","code_information":[{"code":"Px00035210009","type":"CDM"},{"code":"72126","type":"HCPCS"}],"standard_charges":[{"gross_charge":2860.0,"discounted_cash":2145.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CT NECK SPINE W & W/O CONTRAST","code_information":[{"code":"Px00035210010","type":"CDM"},{"code":"72127","type":"HCPCS"}],"standard_charges":[{"gross_charge":2860.0,"discounted_cash":2145.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CT CHEST SPINE WO CONTRAST","code_information":[{"code":"Px00035210011","type":"CDM"},{"code":"72128","type":"HCPCS"}],"standard_charges":[{"gross_charge":2863.0,"discounted_cash":2147.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CT CHEST SPINE W CONTRAST","code_information":[{"code":"Px00035210012","type":"CDM"},{"code":"72129","type":"HCPCS"}],"standard_charges":[{"gross_charge":3128.0,"discounted_cash":2346.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CT CHEST SPINE W & W/O CONTRAST","code_information":[{"code":"Px00035210013","type":"CDM"},{"code":"72130","type":"HCPCS"}],"standard_charges":[{"gross_charge":3128.0,"discounted_cash":2346.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CT LUMBAR SPINE WO CONTRAST","code_information":[{"code":"Px00035210014","type":"CDM"},{"code":"72131","type":"HCPCS"}],"standard_charges":[{"gross_charge":2846.0,"discounted_cash":2134.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CT LUMBAR SPINE W CONTRAST","code_information":[{"code":"Px00035210015","type":"CDM"},{"code":"72132","type":"HCPCS"}],"standard_charges":[{"gross_charge":3128.0,"discounted_cash":2346.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CT LUMBAR SPINE W & W/O CONTRAST","code_information":[{"code":"Px00035210016","type":"CDM"},{"code":"72133","type":"HCPCS"}],"standard_charges":[{"gross_charge":3184.0,"discounted_cash":2388.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CTA PELVIS W & W/O CONTRAST","code_information":[{"code":"Px00035210017","type":"CDM"},{"code":"72191","type":"HCPCS"}],"standard_charges":[{"gross_charge":2335.0,"discounted_cash":1751.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CT PELVIS WO CONTRAST","code_information":[{"code":"Px00035210018","type":"CDM"},{"code":"72192","type":"HCPCS"}],"standard_charges":[{"gross_charge":1816.0,"discounted_cash":1362.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CT PELVIS W CONTRAST","code_information":[{"code":"Px00035210020","type":"CDM"},{"code":"72193","type":"HCPCS"}],"standard_charges":[{"gross_charge":2444.0,"discounted_cash":1833.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CT PELVIS W & W/O CONTRAST","code_information":[{"code":"Px00035210024","type":"CDM"},{"code":"72194","type":"HCPCS"}],"standard_charges":[{"gross_charge":2819.0,"discounted_cash":2114.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CT UPPER EXTREMITY WO CONTRAST","code_information":[{"code":"Px00035210029","type":"CDM"},{"code":"73200","type":"HCPCS"}],"standard_charges":[{"gross_charge":3192.0,"discounted_cash":2394.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CT LOWER EXTREMITY WO CONTRAST","code_information":[{"code":"Px00035210030","type":"CDM"},{"code":"73700","type":"HCPCS"}],"standard_charges":[{"gross_charge":2630.0,"discounted_cash":1972.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CT UPPER EXTREMITY W CONTRAST","code_information":[{"code":"Px00035210031","type":"CDM"},{"code":"73201","type":"HCPCS"}],"standard_charges":[{"gross_charge":3432.0,"discounted_cash":2574.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CT ANGIO UPR EXTRM W & W/O CONTRAST","code_information":[{"code":"Px00035210037","type":"CDM"},{"code":"73206","type":"HCPCS"}],"standard_charges":[{"gross_charge":1799.0,"discounted_cash":1349.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CT ABDOMEN WO CONTRAST","code_information":[{"code":"Px00035210038","type":"CDM"},{"code":"74150","type":"HCPCS"}],"standard_charges":[{"gross_charge":2050.0,"discounted_cash":1537.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CT LOWER EXTREMITY W CONTRAST","code_information":[{"code":"Px00035210040","type":"CDM"},{"code":"73701","type":"HCPCS"}],"standard_charges":[{"gross_charge":2678.0,"discounted_cash":2008.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CT ABDOMEN W CONTRAST","code_information":[{"code":"Px00035210046","type":"CDM"},{"code":"74160","type":"HCPCS"}],"standard_charges":[{"gross_charge":2895.0,"discounted_cash":2171.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CT ABDOMEN W & W/O CONTRAST","code_information":[{"code":"Px00035210047","type":"CDM"},{"code":"74170","type":"HCPCS"}],"standard_charges":[{"gross_charge":2992.0,"discounted_cash":2244.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CT ABDOMEN & PELVIS W & W/O CONTRAST","code_information":[{"code":"Px00035210054","type":"CDM"},{"code":"74178","type":"HCPCS"}],"standard_charges":[{"gross_charge":5715.0,"discounted_cash":4286.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CT THORAX W/O DYE F/U LUNG SCREENING","code_information":[{"code":"Px00035210105","type":"CDM"},{"code":"71250","type":"HCPCS"}],"standard_charges":[{"gross_charge":2644.0,"discounted_cash":1983.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ROBOTIC SURGICAL SYSTEM CDM","code_information":[{"code":"Px00036000019","type":"CDM"},{"code":"S2900","type":"HCPCS"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC RT BRONCH LEVEL 1 CDM","code_information":[{"code":"Px00036000021","type":"CDM"}],"standard_charges":[{"gross_charge":4878.0,"discounted_cash":3658.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Base Price)"}]},{"description":"HC RT BRONCH LEVEL 2 CDM","code_information":[{"code":"Px00036000022","type":"CDM"}],"standard_charges":[{"gross_charge":6405.0,"discounted_cash":4803.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Base Price)"}]},{"description":"HC RT BRONCH LEVEL 3 CDM","code_information":[{"code":"Px00036000023","type":"CDM"}],"standard_charges":[{"gross_charge":7480.0,"discounted_cash":5610.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Base Price)"}]},{"description":"HC RT BRONCH LEVEL 4 CDM","code_information":[{"code":"Px00036000024","type":"CDM"}],"standard_charges":[{"gross_charge":8333.0,"discounted_cash":6249.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Base Price)"}]},{"description":"HC RT BRONCH LEVEL 5 CDM","code_information":[{"code":"Px00036000025","type":"CDM"}],"standard_charges":[{"gross_charge":11382.0,"discounted_cash":8536.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Base Price)"}]},{"description":"HC RT BRONCH LEVEL 6 CDM","code_information":[{"code":"Px00036000026","type":"CDM"}],"standard_charges":[{"gross_charge":13043.0,"discounted_cash":9782.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Base Price)"}]},{"description":"HC ART BYP AXILL-FEM-FEMORAL","code_information":[{"code":"Px00036000028","type":"CDM"},{"code":"35654","type":"HCPCS"}],"standard_charges":[{"gross_charge":3956.0,"discounted_cash":2967.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC PAIN ROOM SERVICES LEVEL 1","code_information":[{"code":"Px00036010001","type":"CDM"}],"standard_charges":[{"gross_charge":2902.0,"discounted_cash":2176.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Base Price)"}]},{"description":"HC PAIN ROOM SERVICES LEVEL 2","code_information":[{"code":"Px00036010002","type":"CDM"}],"standard_charges":[{"gross_charge":3539.0,"discounted_cash":2654.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Base Price)"}]},{"description":"HC PAIN ROOM SERVICES LEVEL 3","code_information":[{"code":"Px00036010003","type":"CDM"}],"standard_charges":[{"gross_charge":4016.0,"discounted_cash":3012.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Base Price)"}]},{"description":"HC PAIN ROOM SERVICES LEVEL 4","code_information":[{"code":"Px00036010004","type":"CDM"}],"standard_charges":[{"gross_charge":4990.0,"discounted_cash":3742.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Base Price)"}]},{"description":"HC PAIN ROOM SERVICES LEVEL 5","code_information":[{"code":"Px00036010005","type":"CDM"}],"standard_charges":[{"gross_charge":6986.0,"discounted_cash":5239.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Base Price)"}]},{"description":"HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT","code_information":[{"code":"Px00036010060","type":"CDM"},{"code":"47490","type":"HCPCS"}],"standard_charges":[{"gross_charge":9789.0,"discounted_cash":7341.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":10266.0,"discounted_cash":7699.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CHANGE URETER STENT PERCUT","code_information":[{"code":"Px00036010061","type":"CDM"},{"code":"50382","type":"HCPCS"}],"standard_charges":[{"gross_charge":6597.0,"discounted_cash":4947.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC CHANGE EXT/INT URETER STENT","code_information":[{"code":"Px00036010063","type":"CDM"},{"code":"50387","type":"HCPCS"}],"standard_charges":[{"gross_charge":8888.0,"discounted_cash":6666.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":6585.0,"discounted_cash":4938.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC REMOVE RENAL TUBE W/FLUORO","code_information":[{"code":"Px00036010064","type":"CDM"},{"code":"50389","type":"HCPCS"}],"standard_charges":[{"gross_charge":2772.0,"discounted_cash":2079.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC INJ FORAMEN EPIDURAL C/T","code_information":[{"code":"Px00036010069","type":"CDM"},{"code":"64479","type":"HCPCS"}],"standard_charges":[{"gross_charge":2913.0,"discounted_cash":2184.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC INJ FORAMEN EPIDURAL L/S","code_information":[{"code":"Px00036010071","type":"CDM"},{"code":"64483","type":"HCPCS"}],"standard_charges":[{"gross_charge":2799.0,"discounted_cash":2099.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC NERVOUS SYSTEM SURGERY","code_information":[{"code":"Px00036010076","type":"CDM"},{"code":"36010076","type":"HCPCS"}],"standard_charges":[{"gross_charge":1443.0,"discounted_cash":1082.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC NEEDLE BIOPSY OF LIVER","code_information":[{"code":"Px00036010104","type":"CDM"},{"code":"47000","type":"HCPCS"}],"standard_charges":[{"gross_charge":7288.0,"discounted_cash":5466.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":4287.0,"discounted_cash":3215.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IDENTIFY SENTINEL NODE","code_information":[{"code":"Px00036010107","type":"CDM"},{"code":"38792","type":"HCPCS"}],"standard_charges":[{"gross_charge":718.0,"discounted_cash":538.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST","code_information":[{"code":"Px00036010110","type":"CDM"},{"code":"10160","type":"HCPCS"}],"standard_charges":[{"gross_charge":957.0,"discounted_cash":717.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DRAINAGE OF BREAST LESION","code_information":[{"code":"Px00036010111","type":"CDM"},{"code":"19000","type":"HCPCS"}],"standard_charges":[{"gross_charge":2298.0,"discounted_cash":1723.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC NEEDLE BX MUSCLE","code_information":[{"code":"Px00036010123","type":"CDM"},{"code":"20206","type":"HCPCS"}],"standard_charges":[{"gross_charge":3022.0,"discounted_cash":2266.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":2905.0,"discounted_cash":2178.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC INJECT SINUS TRACT FOR X-RAY PROC","code_information":[{"code":"Px00036010128","type":"CDM"},{"code":"20501","type":"HCPCS"}],"standard_charges":[{"gross_charge":640.0,"discounted_cash":480.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC INJ TENDON ORIGIN/INSERTION","code_information":[{"code":"Px00036010129","type":"CDM"},{"code":"20551","type":"HCPCS"}],"standard_charges":[{"gross_charge":1461.0,"discounted_cash":1095.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DRAIN/INJECT JOINT/BURSA SMALL W/O ULTRASOUND GUIDANCE","code_information":[{"code":"Px00036010130","type":"CDM"},{"code":"20600","type":"HCPCS"}],"standard_charges":[{"gross_charge":965.0,"discounted_cash":723.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DRAIN/INJECT JOINT/BURSA INTERM W/O ULTRASOUND GUIDANCE","code_information":[{"code":"Px00036010131","type":"CDM"},{"code":"20605","type":"HCPCS"}],"standard_charges":[{"gross_charge":1298.0,"discounted_cash":973.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC INJECTION FOR SHOULDER X-RAY","code_information":[{"code":"Px00036010133","type":"CDM"},{"code":"23350","type":"HCPCS"}],"standard_charges":[{"gross_charge":1245.0,"discounted_cash":933.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 1 1ST 30 MINS","code_information":[{"code":"Px00036010146","type":"CDM"}],"standard_charges":[{"gross_charge":10919.0,"discounted_cash":8189.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 2 1ST 30 MINS","code_information":[{"code":"Px00036010147","type":"CDM"}],"standard_charges":[{"gross_charge":12010.0,"discounted_cash":9007.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 3 1ST 30 MINS","code_information":[{"code":"Px00036010148","type":"CDM"}],"standard_charges":[{"gross_charge":13213.0,"discounted_cash":9909.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 4 1ST 30 MINS","code_information":[{"code":"Px00036010149","type":"CDM"}],"standard_charges":[{"gross_charge":14534.0,"discounted_cash":10900.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 5 1ST 30 MINS","code_information":[{"code":"Px00036010150","type":"CDM"}],"standard_charges":[{"gross_charge":15986.0,"discounted_cash":11989.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 6 1ST 30 MINS","code_information":[{"code":"Px00036010151","type":"CDM"}],"standard_charges":[{"gross_charge":16785.0,"discounted_cash":12588.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 7 1ST 30 MINS","code_information":[{"code":"Px00036010152","type":"CDM"}],"standard_charges":[{"gross_charge":17625.0,"discounted_cash":13218.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 8 1ST 30 MINS","code_information":[{"code":"Px00036010153","type":"CDM"}],"standard_charges":[{"gross_charge":18506.0,"discounted_cash":13879.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC VISC & INFRAREN ABD 1 PROSTH","code_information":[{"code":"Px00036010183","type":"CDM"},{"code":"34845","type":"HCPCS"}],"standard_charges":[{"gross_charge":34290.0,"discounted_cash":25717.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC VISC & INFRAREN ABD 2 PROSTH","code_information":[{"code":"Px00036010184","type":"CDM"},{"code":"34846","type":"HCPCS"}],"standard_charges":[{"gross_charge":37436.0,"discounted_cash":28077.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC OPEN/PERQ PLACE STENT 1ST ARTERY","code_information":[{"code":"Px00036010188","type":"CDM"},{"code":"37236","type":"HCPCS"}],"standard_charges":[{"gross_charge":42062.0,"discounted_cash":31546.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC OPEN/PERQ PLACE STENT EA ADD ARTERY","code_information":[{"code":"Px00036010189","type":"CDM"},{"code":"37237","type":"HCPCS"}],"standard_charges":[{"gross_charge":20340.0,"discounted_cash":15255.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC OPEN/PERQ PLACE STENT 1ST VEIN","code_information":[{"code":"Px00036010190","type":"CDM"},{"code":"37238","type":"HCPCS"}],"standard_charges":[{"gross_charge":42062.0,"discounted_cash":31546.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC VASC EMBOLIZE/OCCLUDE VENOUS","code_information":[{"code":"Px00036010192","type":"CDM"},{"code":"37241","type":"HCPCS"}],"standard_charges":[{"gross_charge":48393.0,"discounted_cash":36294.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":43285.0,"discounted_cash":32463.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC VASC EMBOLIZE/OCCLUDE ARTERY","code_information":[{"code":"Px00036010193","type":"CDM"},{"code":"37242","type":"HCPCS"}],"standard_charges":[{"gross_charge":48639.0,"discounted_cash":36479.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC VASC EMBOLIZE/OCCLUDE ORGAN","code_information":[{"code":"Px00036010194","type":"CDM"},{"code":"37243","type":"HCPCS"}],"standard_charges":[{"gross_charge":48639.0,"discounted_cash":36479.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":44217.0,"discounted_cash":33162.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC VASC EMBOLIZE/OCCLUDE BLEED","code_information":[{"code":"Px00036010195","type":"CDM"},{"code":"37244","type":"HCPCS"}],"standard_charges":[{"gross_charge":48393.0,"discounted_cash":36294.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC PERC FLUID COLLECT VISCERA","code_information":[{"code":"Px00036010196","type":"CDM"},{"code":"49405","type":"HCPCS"}],"standard_charges":[{"gross_charge":7279.0,"discounted_cash":5459.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PERC FLUID COLLECT PERI/RETRO","code_information":[{"code":"Px00036010197","type":"CDM"},{"code":"49406","type":"HCPCS"}],"standard_charges":[{"gross_charge":7487.0,"discounted_cash":5615.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 1 PER MIN","code_information":[{"code":"Px00036010212","type":"CDM"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":32.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 2 PER MIN","code_information":[{"code":"Px00036010214","type":"CDM"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":39.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 3 PER MIN","code_information":[{"code":"Px00036010216","type":"CDM"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":76.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 4 PER MIN","code_information":[{"code":"Px00036010218","type":"CDM"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":103.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 5 PER MIN","code_information":[{"code":"Px00036010220","type":"CDM"}],"standard_charges":[{"gross_charge":177.0,"discounted_cash":132.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 6 PER MIN","code_information":[{"code":"Px00036010222","type":"CDM"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":154.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 7 PER MIN","code_information":[{"code":"Px00036010224","type":"CDM"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":180.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 8 PER MIN","code_information":[{"code":"Px00036010226","type":"CDM"}],"standard_charges":[{"gross_charge":277.0,"discounted_cash":207.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PROCEDURE D/C AFTER ANESTH","code_information":[{"code":"Px00036010321","type":"CDM"}],"standard_charges":[{"gross_charge":183.0,"discounted_cash":137.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BIOPSY OF SALIVARY GLAND, NEEDLE","code_information":[{"code":"Px00036010331","type":"CDM"},{"code":"42400","type":"HCPCS"}],"standard_charges":[{"gross_charge":3747.0,"discounted_cash":2810.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BIOPSY OF PROSTATE","code_information":[{"code":"Px00036010343","type":"CDM"},{"code":"55700","type":"HCPCS"}],"standard_charges":[{"gross_charge":4881.0,"discounted_cash":3660.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CATHETER FOR HYSTEROGRAPHY","code_information":[{"code":"Px00036010345","type":"CDM"},{"code":"58340","type":"HCPCS"}],"standard_charges":[{"gross_charge":274.0,"discounted_cash":205.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC REOPEN FALLOPIAN TUBE","code_information":[{"code":"Px00036010347","type":"CDM"},{"code":"58345","type":"HCPCS"}],"standard_charges":[{"gross_charge":10027.0,"discounted_cash":7520.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ASPIRATION AND/OR INJECTION THYROID CYST CDM","code_information":[{"code":"Px00036010350","type":"CDM"},{"code":"60300","type":"HCPCS"}],"standard_charges":[{"gross_charge":2564.0,"discounted_cash":1923.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PAIN ROOM SERVICES LEVEL 6","code_information":[{"code":"Px00036010371","type":"CDM"}],"standard_charges":[{"gross_charge":8163.0,"discounted_cash":6122.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Base Price)"}]},{"description":"HC BONE MARROW BIOPSY","code_information":[{"code":"Px00036010406","type":"CDM"},{"code":"38221","type":"HCPCS"}],"standard_charges":[{"gross_charge":9206.0,"discounted_cash":6904.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC THERAPEUTIC APHERESIS","code_information":[{"code":"Px00036010480","type":"CDM"},{"code":"36514","type":"HCPCS"}],"standard_charges":[{"gross_charge":7128.0,"discounted_cash":5346.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MINOR EPI STEROID INJECTION PROC","code_information":[{"code":"Px00036010857","type":"CDM"}],"standard_charges":[{"gross_charge":1230.0,"discounted_cash":922.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC AMNIOCENTESIS DIAGNOSTIC CDM","code_information":[{"code":"Px00036010901","type":"CDM"},{"code":"59000","type":"HCPCS"}],"standard_charges":[{"gross_charge":2747.0,"discounted_cash":2060.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC EXTERNAL CEPHALIC VERSION W/WO TOCOLYSIS CDM","code_information":[{"code":"Px00036010936","type":"CDM"},{"code":"59412","type":"HCPCS"}],"standard_charges":[{"gross_charge":8693.0,"discounted_cash":6519.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC C-SECTION","code_information":[{"code":"Px00036010960","type":"CDM"}],"standard_charges":[{"gross_charge":21444.0,"discounted_cash":16083.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC NEWBORN STABILIZATION AT DELIVERY - RESP THER CDM","code_information":[{"code":"Px00036010965","type":"CDM"},{"code":"99465","type":"HCPCS"}],"standard_charges":[{"gross_charge":1087.0,"discounted_cash":815.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC C-SECTION MULTI","code_information":[{"code":"Px00036010966","type":"CDM"}],"standard_charges":[{"gross_charge":25741.0,"discounted_cash":19305.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC INJECTION FOR ELBOW X-RAY","code_information":[{"code":"Px00036011001","type":"CDM"},{"code":"24220","type":"HCPCS"}],"standard_charges":[{"gross_charge":544.0,"discounted_cash":408.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HIP ARTHROGRAM PROC","code_information":[{"code":"Px00036011002","type":"CDM"},{"code":"27093","type":"HCPCS"}],"standard_charges":[{"gross_charge":2923.0,"discounted_cash":2192.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC AMPUTATION TOE & METATARSAL","code_information":[{"code":"Px00036011032","type":"CDM"},{"code":"28810","type":"HCPCS"}],"standard_charges":[{"gross_charge":12279.0,"discounted_cash":9209.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC DIAGNOSTIC LAPAROSCOPY SEPARATE PROC","code_information":[{"code":"Px00036011051","type":"CDM"},{"code":"49320","type":"HCPCS"}],"standard_charges":[{"gross_charge":18689.0,"discounted_cash":14016.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC RMV & RPLC PCMK GEN SNG LEAD SYST","code_information":[{"code":"Px00036012002","type":"CDM"},{"code":"33227","type":"HCPCS"}],"standard_charges":[{"gross_charge":33913.0,"discounted_cash":25434.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC RMV & RPLC PCMK GEN DUAL LEAD SYS","code_information":[{"code":"Px00036012003","type":"CDM"},{"code":"33228","type":"HCPCS"}],"standard_charges":[{"gross_charge":38686.0,"discounted_cash":29014.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC RMV&RPLC PCMK GEN MULT LEAD SYS","code_information":[{"code":"Px00036012004","type":"CDM"},{"code":"33229","type":"HCPCS"}],"standard_charges":[{"gross_charge":38686.0,"discounted_cash":29014.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC RMV&RPLC ICD GEN DUAL LEAD SYST","code_information":[{"code":"Px00036012008","type":"CDM"},{"code":"33263","type":"HCPCS"}],"standard_charges":[{"gross_charge":83315.0,"discounted_cash":62486.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC RMV&RPLC ICD GEN MULT LEAD SYST","code_information":[{"code":"Px00036012009","type":"CDM"},{"code":"33264","type":"HCPCS"}],"standard_charges":[{"gross_charge":83315.0,"discounted_cash":62486.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC RENAL ARTERGM 1ST ORD COMP BILAT","code_information":[{"code":"Px00036012011","type":"CDM"},{"code":"36252","type":"HCPCS"}],"standard_charges":[{"gross_charge":10919.0,"discounted_cash":8189.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC REMOVE IVC FILTER COMPLETE","code_information":[{"code":"Px00036012015","type":"CDM"},{"code":"37193","type":"HCPCS"}],"standard_charges":[{"gross_charge":9697.0,"discounted_cash":7272.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC ABDOM PARACENTESIS DX/THER W/O IMAGING GUIDANCE CDM","code_information":[{"code":"Px00036012016","type":"CDM"},{"code":"49082","type":"HCPCS"}],"standard_charges":[{"gross_charge":2526.0,"discounted_cash":1894.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC EXCISION LINGUAL FRENUM FRENECTOMY CDM","code_information":[{"code":"Px00036100000","type":"CDM"},{"code":"41115","type":"HCPCS"}],"standard_charges":[{"gross_charge":4906.0,"discounted_cash":3679.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC INS NON INDWELLING BLADDER CATH / STRAIGHT CDM","code_information":[{"code":"Px00036100021","type":"CDM"},{"code":"51701","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.0,"discounted_cash":184.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC INS TEMP INDWELLING BLADDER CATH SIMPLE / FOLEY CDM","code_information":[{"code":"Px00036100022","type":"CDM"},{"code":"51702","type":"HCPCS"}],"standard_charges":[{"gross_charge":626.0,"discounted_cash":469.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC TCAT PLMT XTRC VRT CRTD STENT RS&I PRQ 1ST VSL CDM","code_information":[{"code":"Px00036100039","type":"CDM"},{"code":"0075T","type":"HCPCS"}],"standard_charges":[{"gross_charge":52325.0,"discounted_cash":39243.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC ABLTJ PERC CRYOABLTJ IMG GDN UXTR/PERPH NERVE CDM","code_information":[{"code":"Px00036100042","type":"CDM"},{"code":"0440T","type":"HCPCS"}],"standard_charges":[{"gross_charge":8169.0,"discounted_cash":6126.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ABLTJ PERC CRYOABLTJ IMG GDN LXTR/PERPH NERVE CDM","code_information":[{"code":"Px00036100043","type":"CDM"},{"code":"0441T","type":"HCPCS"}],"standard_charges":[{"gross_charge":5082.0,"discounted_cash":3811.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ABLTJ PERC CRYOABLTJ IMG GDN NRV PLEX/TRNCL NRV CDM","code_information":[{"code":"Px00036100044","type":"CDM"},{"code":"0442T","type":"HCPCS"}],"standard_charges":[{"gross_charge":30198.0,"discounted_cash":22648.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC OCCLUSIVE DEVICE IN VEIN ART CDM","code_information":[{"code":"Px00036100048","type":"CDM"},{"code":"G0269","type":"HCPCS"}],"standard_charges":[{"gross_charge":3735.0,"discounted_cash":2801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC DSTR W NEUROL OTH PERIP NR","code_information":[{"code":"Px00036100072","type":"CDM"},{"code":"64640","type":"HCPCS"}],"standard_charges":[{"gross_charge":4948.0,"discounted_cash":3711.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BYP OTH/THN VEIN FEMORAL-FEMORAL CDM","code_information":[{"code":"Px00036100075","type":"CDM"},{"code":"35661","type":"HCPCS"}],"standard_charges":[{"gross_charge":3891.0,"discounted_cash":2918.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CORE NEEDLE BX LUNG/MEDIASTINUM PERQ W/IMG CDM","code_information":[{"code":"Px00036100080","type":"CDM"},{"code":"32408","type":"HCPCS"}],"standard_charges":[{"gross_charge":5314.0,"discounted_cash":3985.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC LIGATION OF EXTERMITY ARTERY CDM","code_information":[{"code":"Px00036100217","type":"CDM"},{"code":"37618","type":"HCPCS"}],"standard_charges":[{"gross_charge":7620.0,"discounted_cash":5715.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC RPR AA HERNIA 1ST/LESS THAN 3 CM NCRC8/STRANGULATED","code_information":[{"code":"Px00036100235","type":"CDM"},{"code":"49592","type":"HCPCS"}],"standard_charges":[{"gross_charge":25229.0,"discounted_cash":18921.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC REVSC EVASC IVT ANGIOP UNI SF LES 1ST VSL CDM","code_information":[{"code":"Px00036100293","type":"CDM"},{"code":"37254","type":"HCPCS"}],"standard_charges":[{"gross_charge":20340.0,"discounted_cash":15255.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC REVSC EVASC IVT ANGIOP UNI SF LES EA ADDL VSL CDM","code_information":[{"code":"Px00036100294","type":"CDM"},{"code":"37255","type":"HCPCS"}],"standard_charges":[{"gross_charge":20340.0,"discounted_cash":15255.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC REVSC EVASC IVT ANGIOP UNI CPLX LES 1ST VSL CDM","code_information":[{"code":"Px00036100295","type":"CDM"},{"code":"37256","type":"HCPCS"}],"standard_charges":[{"gross_charge":20340.0,"discounted_cash":15255.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC REVSC EVASC IVT ANGIOP UNI CPLX LES EA ADDL VSL CDM","code_information":[{"code":"Px00036100296","type":"CDM"},{"code":"37257","type":"HCPCS"}],"standard_charges":[{"gross_charge":20340.0,"discounted_cash":15255.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC REVSC EVASC IVT ST PLMT UNI SF LES 1ST VSL CDM","code_information":[{"code":"Px00036100297","type":"CDM"},{"code":"37258","type":"HCPCS"}],"standard_charges":[{"gross_charge":42062.0,"discounted_cash":31546.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC REVSC EVASC IVT ST PLMT UNI SF LES EA ADDL VSL CDM","code_information":[{"code":"Px00036100298","type":"CDM"},{"code":"37259","type":"HCPCS"}],"standard_charges":[{"gross_charge":20340.0,"discounted_cash":15255.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC REVSC EVASC IVT ST PLMT UNI CPLX LES 1ST VSL CDM","code_information":[{"code":"Px00036100299","type":"CDM"},{"code":"37260","type":"HCPCS"}],"standard_charges":[{"gross_charge":42062.0,"discounted_cash":31546.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC REVSC EVASC IVT ST PLMT UNI CPLX LES EA ADDL VSL CDM","code_information":[{"code":"Px00036100300","type":"CDM"},{"code":"37261","type":"HCPCS"}],"standard_charges":[{"gross_charge":20340.0,"discounted_cash":15255.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC INTRAVASCULAR LITHOTRIPSY IVT WITHIN SAME ARTERY CDM","code_information":[{"code":"Px00036100301","type":"CDM"},{"code":"37262","type":"HCPCS"}],"standard_charges":[{"gross_charge":48639.0,"discounted_cash":36479.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC REVSC EVASC FPVT ANGIOP UNI SF LES 1ST VSL CDM","code_information":[{"code":"Px00036100302","type":"CDM"},{"code":"37263","type":"HCPCS"}],"standard_charges":[{"gross_charge":20340.0,"discounted_cash":15255.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC REVSC EVASC FPVT ANGIOP UNI SF LES EA ADDL VSL CDM","code_information":[{"code":"Px00036100303","type":"CDM"},{"code":"37264","type":"HCPCS"}],"standard_charges":[{"gross_charge":10170.0,"discounted_cash":7627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC REVSC EVASC FPVT ANGIOP UNI CPLX LES 1ST VSL CDM","code_information":[{"code":"Px00036100304","type":"CDM"},{"code":"37265","type":"HCPCS"}],"standard_charges":[{"gross_charge":20340.0,"discounted_cash":15255.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC REVSC EVASC FPVT ANGIOP UNI CPLX LES EA ADDL VSL CDM","code_information":[{"code":"Px00036100305","type":"CDM"},{"code":"37266","type":"HCPCS"}],"standard_charges":[{"gross_charge":10170.0,"discounted_cash":7627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC REVSC EVASC FPVT ST PLMT UNI SF LES 1ST VSL CDM","code_information":[{"code":"Px00036100306","type":"CDM"},{"code":"37267","type":"HCPCS"}],"standard_charges":[{"gross_charge":42062.0,"discounted_cash":31546.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC REVSC EVASC FPVT ST PLMT UNI SF LES EA ADDL VSL CDM","code_information":[{"code":"Px00036100307","type":"CDM"},{"code":"37268","type":"HCPCS"}],"standard_charges":[{"gross_charge":21031.0,"discounted_cash":15773.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC REVSC EVASC FPVT ST PLMT UNI CPLX LES 1ST VSL CDM","code_information":[{"code":"Px00036100308","type":"CDM"},{"code":"37269","type":"HCPCS"}],"standard_charges":[{"gross_charge":42062.0,"discounted_cash":31546.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC REVSC EVASC FPVT ST PLMT UNI CPLX LES EA ADD VSL CDM","code_information":[{"code":"Px00036100309","type":"CDM"},{"code":"37270","type":"HCPCS"}],"standard_charges":[{"gross_charge":21031.0,"discounted_cash":15773.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC REVSC EVASC FPVT ATHRC UNI SF LES 1ST VSL CDM","code_information":[{"code":"Px00036100310","type":"CDM"},{"code":"37271","type":"HCPCS"}],"standard_charges":[{"gross_charge":42062.0,"discounted_cash":31546.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC REVSC EVASC FPVT ATHRC UNI SF LES EA ADDL VSL CDM","code_information":[{"code":"Px00036100311","type":"CDM"},{"code":"37272","type":"HCPCS"}],"standard_charges":[{"gross_charge":21031.0,"discounted_cash":15773.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC REVSC EVASC FPVT ATHRC UNI CPLX LES 1ST VSL CDM","code_information":[{"code":"Px00036100312","type":"CDM"},{"code":"37273","type":"HCPCS"}],"standard_charges":[{"gross_charge":42062.0,"discounted_cash":31546.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC REVSC EVASC FPVT ATHRC UNI CPLX LES EA ADDL VSL CDM","code_information":[{"code":"Px00036100313","type":"CDM"},{"code":"37274","type":"HCPCS"}],"standard_charges":[{"gross_charge":21031.0,"discounted_cash":15773.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC REVSC EVASC FPVT ST ATHRC UNI SF LES 1ST VSL CDM","code_information":[{"code":"Px00036100314","type":"CDM"},{"code":"37275","type":"HCPCS"}],"standard_charges":[{"gross_charge":71536.0,"discounted_cash":53652.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC REVSC EVASC FPVT ST ATHRC UNI SF LES EA ADDL VSL CDM","code_information":[{"code":"Px00036100315","type":"CDM"},{"code":"37276","type":"HCPCS"}],"standard_charges":[{"gross_charge":35768.0,"discounted_cash":26826.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC REVSC EVASC FPVT ST ATHRC UNI CPLX LES 1ST VSL CDM","code_information":[{"code":"Px00036100316","type":"CDM"},{"code":"37277","type":"HCPCS"}],"standard_charges":[{"gross_charge":71536.0,"discounted_cash":53652.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC REVSC EVSC FPVT ST ATHRC UNI CPLX LES EA ADD VSL CDM","code_information":[{"code":"Px00036100317","type":"CDM"},{"code":"37278","type":"HCPCS"}],"standard_charges":[{"gross_charge":35768.0,"discounted_cash":26826.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC REVSC EVASC TPVT ANGIOP UNI SF LES 1ST VSL CDM","code_information":[{"code":"Px00036100319","type":"CDM"},{"code":"37280","type":"HCPCS"}],"standard_charges":[{"gross_charge":20340.0,"discounted_cash":15255.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC REVSC EVASC TPVT ANGIOP UNI SF LES EA ADDL VSL CDM","code_information":[{"code":"Px00036100320","type":"CDM"},{"code":"37281","type":"HCPCS"}],"standard_charges":[{"gross_charge":20340.0,"discounted_cash":15255.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC REVSC EVASC TPVT ANGIOP UNI CPLX LES 1ST VSL CDM","code_information":[{"code":"Px00036100321","type":"CDM"},{"code":"37282","type":"HCPCS"}],"standard_charges":[{"gross_charge":20340.0,"discounted_cash":15255.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC REVSC EVASC TPVT ANGIOP UNI CPLX LES EA ADDL VSL CDM","code_information":[{"code":"Px00036100322","type":"CDM"},{"code":"37283","type":"HCPCS"}],"standard_charges":[{"gross_charge":20340.0,"discounted_cash":15255.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC REVSC EVASC TPVT ST PLMT UNI SF LES 1ST VSL CDM","code_information":[{"code":"Px00036100323","type":"CDM"},{"code":"37284","type":"HCPCS"}],"standard_charges":[{"gross_charge":54091.0,"discounted_cash":40568.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC REVSC EVASC TPVT ST PLMT UNI CPLX LES 1ST VSL CDM","code_information":[{"code":"Px00036100325","type":"CDM"},{"code":"37286","type":"HCPCS"}],"standard_charges":[{"gross_charge":54091.0,"discounted_cash":40568.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC REVSC EVASC TPVT ATHRC UNI SF LES 1ST VSL CDM","code_information":[{"code":"Px00036100327","type":"CDM"},{"code":"37288","type":"HCPCS"}],"standard_charges":[{"gross_charge":42062.0,"discounted_cash":31546.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC REVSC EVASC TPVT ATHRC UNI CPLX LES 1ST VSL CDM","code_information":[{"code":"Px00036100329","type":"CDM"},{"code":"37290","type":"HCPCS"}],"standard_charges":[{"gross_charge":42062.0,"discounted_cash":31546.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC BIOPSY PROSTATE INCISIONAL ANY APPROACH CDM","code_information":[{"code":"Px00036100340","type":"CDM"},{"code":"55705","type":"HCPCS"}],"standard_charges":[{"gross_charge":4881.0,"discounted_cash":3660.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BIOPSY PROSTATE TRANSRECTAL ULTRASOUND-GUIDED CDM","code_information":[{"code":"Px00036100341","type":"CDM"},{"code":"55707","type":"HCPCS"}],"standard_charges":[{"gross_charge":5836.0,"discounted_cash":4377.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BX PROSTATE TRANSRECTAL US GID W/MRI FUS GDN 1ST CDM","code_information":[{"code":"Px00036100342","type":"CDM"},{"code":"55708","type":"HCPCS"}],"standard_charges":[{"gross_charge":5836.0,"discounted_cash":4377.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BX PROSTATE TRANSPERINEAL ULTRASOUND-GUIDED CDM","code_information":[{"code":"Px00036100343","type":"CDM"},{"code":"55709","type":"HCPCS"}],"standard_charges":[{"gross_charge":5836.0,"discounted_cash":4377.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BX PROSTATE TRANSPERINEAL US GID W/MRI FUS GDN 1 CDM","code_information":[{"code":"Px00036100344","type":"CDM"},{"code":"55710","type":"HCPCS"}],"standard_charges":[{"gross_charge":5836.0,"discounted_cash":4377.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DECLOT BY THROMBOLYTIC AGENT IMPLANT DEVICE/CATH","code_information":[{"code":"Px00036110005","type":"CDM"},{"code":"36593","type":"HCPCS"}],"standard_charges":[{"gross_charge":1124.0,"discounted_cash":843.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ABLATE PULM TUMOR PERQ CRYBL","code_information":[{"code":"Px00036110006","type":"CDM"},{"code":"32994","type":"HCPCS"}],"standard_charges":[{"gross_charge":12988.0,"discounted_cash":9741.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DX BONE MARROW BX & ASPIR - UNILATERAL","code_information":[{"code":"Px00036110023","type":"CDM"},{"code":"38222","type":"HCPCS"}],"standard_charges":[{"gross_charge":12918.0,"discounted_cash":9688.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC SEL CATH PLCM 3RD ORD","code_information":[{"code":"Px00036110037","type":"CDM"},{"code":"36217","type":"HCPCS"}],"standard_charges":[{"gross_charge":1640.0,"discounted_cash":1230.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC NASAL/OROGASTRIC W/TUBE PLMT","code_information":[{"code":"Px00036110042","type":"CDM"},{"code":"43752","type":"HCPCS"}],"standard_charges":[{"gross_charge":1031.0,"discounted_cash":773.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":953.0,"discounted_cash":714.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PLMT FEM-FEM PROSTC GRF EVASC AORTIC ARYSM RPR","code_information":[{"code":"Px00036110070","type":"CDM"},{"code":"34813","type":"HCPCS"}],"standard_charges":[{"gross_charge":8838.0,"discounted_cash":6628.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE","code_information":[{"code":"Px00036110071","type":"CDM"},{"code":"62270","type":"HCPCS"}],"standard_charges":[{"gross_charge":1960.0,"discounted_cash":1470.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC INJECT EPIDURAL PATCH","code_information":[{"code":"Px00036110072","type":"CDM"},{"code":"62273","type":"HCPCS"}],"standard_charges":[{"gross_charge":1960.0,"discounted_cash":1470.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC FRENOTOMY LINGUAL CDM","code_information":[{"code":"Px00036110073","type":"CDM"},{"code":"41010","type":"HCPCS"}],"standard_charges":[{"gross_charge":5216.0,"discounted_cash":3912.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC INTRO GASTROINTESTINAL TUBE","code_information":[{"code":"Px00036110105","type":"CDM"},{"code":"44500","type":"HCPCS"}],"standard_charges":[{"gross_charge":2925.0,"discounted_cash":2193.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CNTRST NJX ASSMT ABSC/CST VIA DRG CATH/TUBE SPX","code_information":[{"code":"Px00036110110","type":"CDM"},{"code":"49424","type":"HCPCS"}],"standard_charges":[{"gross_charge":1028.0,"discounted_cash":771.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PLACE GASTROSTOMY TUBE PERC","code_information":[{"code":"Px00036110112","type":"CDM"},{"code":"49440","type":"HCPCS"}],"standard_charges":[{"gross_charge":6895.0,"discounted_cash":5171.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":6171.0,"discounted_cash":4628.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CHANGE G-TUBE TO G-J PERC","code_information":[{"code":"Px00036110113","type":"CDM"},{"code":"49446","type":"HCPCS"}],"standard_charges":[{"gross_charge":6895.0,"discounted_cash":5171.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":8040.0,"discounted_cash":6030.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC REPLACE G/C TUBE PERC","code_information":[{"code":"Px00036110114","type":"CDM"},{"code":"49450","type":"HCPCS"}],"standard_charges":[{"gross_charge":3193.0,"discounted_cash":2394.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":3723.0,"discounted_cash":2792.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC REPLACE DUOD/JEJ TUBE PERC","code_information":[{"code":"Px00036110115","type":"CDM"},{"code":"49451","type":"HCPCS"}],"standard_charges":[{"gross_charge":3193.0,"discounted_cash":2394.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":3723.0,"discounted_cash":2792.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC REPLACEMENT GASTRO-JEJUNOSTOMY TUBE PERCUTANEOUS","code_information":[{"code":"Px00036110116","type":"CDM"},{"code":"49452","type":"HCPCS"}],"standard_charges":[{"gross_charge":3177.0,"discounted_cash":2382.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":3177.0,"discounted_cash":2382.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC FLUORO EXAM OF G/COLON TUBE","code_information":[{"code":"Px00036110118","type":"CDM"},{"code":"49465","type":"HCPCS"}],"standard_charges":[{"gross_charge":973.0,"discounted_cash":729.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC INJECTION FOR BLADDER X-RAY","code_information":[{"code":"Px00036110122","type":"CDM"},{"code":"51600","type":"HCPCS"}],"standard_charges":[{"gross_charge":586.0,"discounted_cash":439.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC INJECTION FOR BLADDER X-RAY RETROGRADE","code_information":[{"code":"Px00036110123","type":"CDM"},{"code":"51610","type":"HCPCS"}],"standard_charges":[{"gross_charge":1052.0,"discounted_cash":789.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC INJECTION FOR MYELOGRAM","code_information":[{"code":"Px00036110126","type":"CDM"},{"code":"62284","type":"HCPCS"}],"standard_charges":[{"gross_charge":760.0,"discounted_cash":570.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC INJECT FOR SPINE DISK X-RAY LUMBAR","code_information":[{"code":"Px00036110127","type":"CDM"},{"code":"62290","type":"HCPCS"}],"standard_charges":[{"gross_charge":5828.0,"discounted_cash":4371.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC INJECT SI JOINT ARTHRGRPHY&/ANES/STEROID W/IMA CDM","code_information":[{"code":"Px00036110130","type":"CDM"},{"code":"27096","type":"HCPCS"}],"standard_charges":[{"gross_charge":1159.0,"discounted_cash":869.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BYP OTH/THN VEIN FEMORAL-POPLITEAL","code_information":[{"code":"Px00036110132","type":"CDM"},{"code":"35656","type":"HCPCS"}],"standard_charges":[{"gross_charge":40528.0,"discounted_cash":30396.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC XPOSE ENDOPROSTH BRACHIAL","code_information":[{"code":"Px00036110135","type":"CDM"},{"code":"34834","type":"HCPCS"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":677.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC TRLUML PERIP ATHRC ILIAC ART","code_information":[{"code":"Px00036110142","type":"CDM"},{"code":"0238T","type":"HCPCS"}],"standard_charges":[{"gross_charge":49744.0,"discounted_cash":37308.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC FEM ARTERY REPAIR W/PATCH GRAFT","code_information":[{"code":"Px00036110144","type":"CDM"},{"code":"35286","type":"HCPCS"}],"standard_charges":[{"gross_charge":20777.0,"discounted_cash":15582.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC PERC NEEDLE BIOPSY CHEST LINING","code_information":[{"code":"Px00036110158","type":"CDM"},{"code":"32400","type":"HCPCS"}],"standard_charges":[{"gross_charge":3111.0,"discounted_cash":2333.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC INSERT PLEURAL CATH","code_information":[{"code":"Px00036110166","type":"CDM"},{"code":"32550","type":"HCPCS"}],"standard_charges":[{"gross_charge":16950.0,"discounted_cash":12712.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC LYSE CHEST FIBRIN INIT DAY","code_information":[{"code":"Px00036110167","type":"CDM"},{"code":"32561","type":"HCPCS"}],"standard_charges":[{"gross_charge":1670.0,"discounted_cash":1252.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC LYSE CHEST FIBRIN SUBQ DAY","code_information":[{"code":"Px00036110168","type":"CDM"},{"code":"32562","type":"HCPCS"}],"standard_charges":[{"gross_charge":1670.0,"discounted_cash":1252.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC INSERTION OF HEART PACEMAKER","code_information":[{"code":"Px00036110169","type":"CDM"},{"code":"33206","type":"HCPCS"}],"standard_charges":[{"gross_charge":40543.0,"discounted_cash":30407.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC INSERTION PERM HEART PACEMAKER","code_information":[{"code":"Px00036110170","type":"CDM"},{"code":"33207","type":"HCPCS"}],"standard_charges":[{"gross_charge":40543.0,"discounted_cash":30407.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC INSERTION PERM AV PACER","code_information":[{"code":"Px00036110171","type":"CDM"},{"code":"33208","type":"HCPCS"}],"standard_charges":[{"gross_charge":49085.0,"discounted_cash":36813.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC INSERTION OF HEART ELECTRODE 33210","code_information":[{"code":"Px00036110172","type":"CDM"},{"code":"33210","type":"HCPCS"}],"standard_charges":[{"gross_charge":20019.0,"discounted_cash":15014.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC REPOSITION PACING-IMPLANTABLE DEFIB LEAD","code_information":[{"code":"Px00036110179","type":"CDM"},{"code":"33215","type":"HCPCS"}],"standard_charges":[{"gross_charge":7030.0,"discounted_cash":5272.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC INSERT 1 ELECTRODE PM-IMPLANTABLE DEFIB","code_information":[{"code":"Px00036110180","type":"CDM"},{"code":"33216","type":"HCPCS"}],"standard_charges":[{"gross_charge":26100.0,"discounted_cash":19575.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC L VENTRIC PACING LEAD ADD-ON","code_information":[{"code":"Px00036110187","type":"CDM"},{"code":"33225","type":"HCPCS"}],"standard_charges":[{"gross_charge":48836.0,"discounted_cash":36627.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC REMOVAL OF PACEMAKER SYSTEM","code_information":[{"code":"Px00036110189","type":"CDM"},{"code":"33233","type":"HCPCS"}],"standard_charges":[{"gross_charge":27066.0,"discounted_cash":20299.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC REMOVAL PACEMAKER ELECTRODE","code_information":[{"code":"Px00036110192","type":"CDM"},{"code":"33235","type":"HCPCS"}],"standard_charges":[{"gross_charge":10690.0,"discounted_cash":8017.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC CAROTID ENDART W/PATCH GRAFT","code_information":[{"code":"Px00036110201","type":"CDM"},{"code":"35301","type":"HCPCS"}],"standard_charges":[{"gross_charge":22775.0,"discounted_cash":17081.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC TEAEC W/WO PATCH GRAFT COMMON FEMORAL","code_information":[{"code":"Px00036110203","type":"CDM"},{"code":"35371","type":"HCPCS"}],"standard_charges":[{"gross_charge":25816.0,"discounted_cash":19362.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION","code_information":[{"code":"Px00036110239","type":"CDM"},{"code":"10005","type":"HCPCS"}],"standard_charges":[{"gross_charge":3661.0,"discounted_cash":2745.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC FINE NEEDLE ASPIRATION BX W/US GDN EA ADDL","code_information":[{"code":"Px00036110242","type":"CDM"},{"code":"10006","type":"HCPCS"}],"standard_charges":[{"gross_charge":1832.0,"discounted_cash":1374.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC FINE NEEDLE ASPIRATION BX W/CT GDN 1ST LESION","code_information":[{"code":"Px00036110244","type":"CDM"},{"code":"10009","type":"HCPCS"}],"standard_charges":[{"gross_charge":3661.0,"discounted_cash":2745.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC FINE NEEDLE ASPIRATION BX W/CT GDN EA ADDL","code_information":[{"code":"Px00036110245","type":"CDM"},{"code":"10010","type":"HCPCS"}],"standard_charges":[{"gross_charge":1537.0,"discounted_cash":1152.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PUNCH BIOPSY SKIN SINGLE LESION","code_information":[{"code":"Px00036110250","type":"CDM"},{"code":"11104","type":"HCPCS"}],"standard_charges":[{"gross_charge":1026.0,"discounted_cash":769.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC INCISIONAL BIOPSY SKIN SINGLE LESION","code_information":[{"code":"Px00036110252","type":"CDM"},{"code":"11106","type":"HCPCS"}],"standard_charges":[{"gross_charge":2058.0,"discounted_cash":1543.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC NJX PX KNEE ARTHG OR CNTRST ENHNCD CT/MRI KNEE","code_information":[{"code":"Px00036110253","type":"CDM"},{"code":"27369","type":"HCPCS"}],"standard_charges":[{"gross_charge":1301.0,"discounted_cash":975.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC INSERTION SUBQ CARDIAC RHYTHM MONITOR W/PRGRMG","code_information":[{"code":"Px00036110256","type":"CDM"},{"code":"33285","type":"HCPCS"}],"standard_charges":[{"gross_charge":31693.0,"discounted_cash":23769.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC REMOVAL SUBCUTANEOUS CARDIAC RHYTHM MONITOR","code_information":[{"code":"Px00036110257","type":"CDM"},{"code":"33286","type":"HCPCS"}],"standard_charges":[{"gross_charge":2555.0,"discounted_cash":1916.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC INSERTION PICC W/RS&I 5 YR/>","code_information":[{"code":"Px00036110260","type":"CDM"},{"code":"36573","type":"HCPCS"}],"standard_charges":[{"gross_charge":6910.0,"discounted_cash":5182.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC THERAPEUTIC APHERESIS PLATELETS CDM","code_information":[{"code":"Px00036110292","type":"CDM"},{"code":"36513","type":"HCPCS"}],"standard_charges":[{"gross_charge":2161.0,"discounted_cash":1620.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ENDOVASC TAA REPR W/O SUBCL","code_information":[{"code":"Px00036110362","type":"CDM"},{"code":"33881","type":"HCPCS"}],"standard_charges":[{"gross_charge":47877.0,"discounted_cash":35907.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC REMOVAL IMPLANTABLE DEVICE","code_information":[{"code":"Px00036110366","type":"CDM"},{"code":"36589","type":"HCPCS"}],"standard_charges":[{"gross_charge":3177.0,"discounted_cash":2382.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":3465.0,"discounted_cash":2598.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC REMOVE AORTIC ASSIST DEVICE","code_information":[{"code":"Px00036110367","type":"CDM"},{"code":"33968","type":"HCPCS"}],"standard_charges":[{"gross_charge":5943.0,"discounted_cash":4457.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC ENDOVAS ILIAC A DEVICE ADDON","code_information":[{"code":"Px00036110376","type":"CDM"},{"code":"34808","type":"HCPCS"}],"standard_charges":[{"gross_charge":40688.0,"discounted_cash":30516.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC XPOSE FOR ENDOPROSTH FEMORL","code_information":[{"code":"Px00036110377","type":"CDM"},{"code":"34812","type":"HCPCS"}],"standard_charges":[{"gross_charge":908.0,"discounted_cash":681.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC PSEUDOANEURYSM INJECTION TRT","code_information":[{"code":"Px00036110385","type":"CDM"},{"code":"36002","type":"HCPCS"}],"standard_charges":[{"gross_charge":2347.0,"discounted_cash":1760.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":2347.0,"discounted_cash":1760.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC INJECTION EXT VENOGRAPHY","code_information":[{"code":"Px00036110386","type":"CDM"},{"code":"36005","type":"HCPCS"}],"standard_charges":[{"gross_charge":1624.0,"discounted_cash":1218.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC PLACE CATHETER IN VEIN","code_information":[{"code":"Px00036110388","type":"CDM"},{"code":"36010","type":"HCPCS"}],"standard_charges":[{"gross_charge":1640.0,"discounted_cash":1230.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC VENOUS PLACEMENT 1ST ORDER","code_information":[{"code":"Px00036110389","type":"CDM"},{"code":"36011","type":"HCPCS"}],"standard_charges":[{"gross_charge":1672.0,"discounted_cash":1254.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC SLCT CATH 2ND VENOUS","code_information":[{"code":"Px00036110390","type":"CDM"},{"code":"36012","type":"HCPCS"}],"standard_charges":[{"gross_charge":1672.0,"discounted_cash":1254.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC PLACE CATHETER IN HEART/PULM ARTERY","code_information":[{"code":"Px00036110391","type":"CDM"},{"code":"36013","type":"HCPCS"}],"standard_charges":[{"gross_charge":1624.0,"discounted_cash":1218.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC RT/LT PULMONARY PLACEMENT","code_information":[{"code":"Px00036110392","type":"CDM"},{"code":"36014","type":"HCPCS"}],"standard_charges":[{"gross_charge":1624.0,"discounted_cash":1218.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC SELECT SEGMENTAL PULMONARY ART","code_information":[{"code":"Px00036110393","type":"CDM"},{"code":"36015","type":"HCPCS"}],"standard_charges":[{"gross_charge":1672.0,"discounted_cash":1254.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC INTRO CATH EXTRM ART","code_information":[{"code":"Px00036110397","type":"CDM"},{"code":"36140","type":"HCPCS"}],"standard_charges":[{"gross_charge":1640.0,"discounted_cash":1230.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC ESTABLISH ACCESS TO AORTA","code_information":[{"code":"Px00036110401","type":"CDM"},{"code":"36160","type":"HCPCS"}],"standard_charges":[{"gross_charge":1562.0,"discounted_cash":1171.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PLACE CATHETER IN AORTA","code_information":[{"code":"Px00036110402","type":"CDM"},{"code":"36200","type":"HCPCS"}],"standard_charges":[{"gross_charge":1640.0,"discounted_cash":1230.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC PLACE CATHETER IN THOR/BRA ARTERY","code_information":[{"code":"Px00036110403","type":"CDM"},{"code":"36215","type":"HCPCS"}],"standard_charges":[{"gross_charge":1640.0,"discounted_cash":1230.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC BRACHIOCEPHALIC ANGIO 2ND ORDER","code_information":[{"code":"Px00036110404","type":"CDM"},{"code":"36216","type":"HCPCS"}],"standard_charges":[{"gross_charge":1263.0,"discounted_cash":947.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ABD/PELVIC ANGIO 1ST ORDER","code_information":[{"code":"Px00036110408","type":"CDM"},{"code":"36245","type":"HCPCS"}],"standard_charges":[{"gross_charge":1640.0,"discounted_cash":1230.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC ABD/PELVIC ANGIO 2ND ORDER","code_information":[{"code":"Px00036110409","type":"CDM"},{"code":"36246","type":"HCPCS"}],"standard_charges":[{"gross_charge":1640.0,"discounted_cash":1230.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC ABD/PELVIC ANGIO 3RD ORDER","code_information":[{"code":"Px00036110410","type":"CDM"},{"code":"36247","type":"HCPCS"}],"standard_charges":[{"gross_charge":1640.0,"discounted_cash":1230.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC ABD/PELVIC ANGIO ADDT","code_information":[{"code":"Px00036110411","type":"CDM"},{"code":"36248","type":"HCPCS"}],"standard_charges":[{"gross_charge":1640.0,"discounted_cash":1230.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC VESSEL INJECTION PROCEDURE","code_information":[{"code":"Px00036110413","type":"CDM"},{"code":"36299","type":"HCPCS"}],"standard_charges":[{"gross_charge":1282.0,"discounted_cash":961.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC INSERTION OF CATHETER VEIN","code_information":[{"code":"Px00036110416","type":"CDM"},{"code":"36481","type":"HCPCS"}],"standard_charges":[{"gross_charge":1624.0,"discounted_cash":1218.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC INSERT NON TUNNEL CV CATH GTE 5 YR","code_information":[{"code":"Px00036110418","type":"CDM"},{"code":"36556","type":"HCPCS"}],"standard_charges":[{"gross_charge":5784.0,"discounted_cash":4338.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":7070.0,"discounted_cash":5302.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC INSERT TUNNELED CVC W/O SQ PORT/PMP/YOUNGER THAN 5 YRS","code_information":[{"code":"Px00036110424","type":"CDM"},{"code":"36557","type":"HCPCS"}],"standard_charges":[{"gross_charge":18213.0,"discounted_cash":13659.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":20457.0,"discounted_cash":15342.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC INSERT TUNNELED CV CATH > 5","code_information":[{"code":"Px00036110425","type":"CDM"},{"code":"36558","type":"HCPCS"}],"standard_charges":[{"gross_charge":13487.0,"discounted_cash":10115.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":13487.0,"discounted_cash":10115.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC INSERT TUNNELED CV CATH W/PORT > 5","code_information":[{"code":"Px00036110427","type":"CDM"},{"code":"36561","type":"HCPCS"}],"standard_charges":[{"gross_charge":16056.0,"discounted_cash":12042.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":16056.0,"discounted_cash":12042.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC INSERTION PICC WO IMG GDN GTE 5 YR","code_information":[{"code":"Px00036110432","type":"CDM"},{"code":"36569","type":"HCPCS"}],"standard_charges":[{"gross_charge":5814.0,"discounted_cash":4360.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":5740.0,"discounted_cash":4305.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC REPLACE TUNNELED CV CATH W/O PUMP","code_information":[{"code":"Px00036110441","type":"CDM"},{"code":"36581","type":"HCPCS"}],"standard_charges":[{"gross_charge":13098.0,"discounted_cash":9823.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC COMPLETE REPLACEMENT PICC RS&I","code_information":[{"code":"Px00036110443","type":"CDM"},{"code":"36584","type":"HCPCS"}],"standard_charges":[{"gross_charge":5784.0,"discounted_cash":4338.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC REPLACE PICVAD CATH","code_information":[{"code":"Px00036110444","type":"CDM"},{"code":"36585","type":"HCPCS"}],"standard_charges":[{"gross_charge":15590.0,"discounted_cash":11692.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":15590.0,"discounted_cash":11692.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC REMOVE TUNNEL CV CATH WO PORT PUMP","code_information":[{"code":"Px00036110445","type":"CDM"},{"code":"36589","type":"HCPCS"}],"standard_charges":[{"gross_charge":3177.0,"discounted_cash":2382.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":3465.0,"discounted_cash":2598.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PERICARDIOCENTESIS W/IMG GUIDANCE WHEN PERFORMED CDM","code_information":[{"code":"Px00036110446","type":"CDM"},{"code":"33016","type":"HCPCS"}],"standard_charges":[{"gross_charge":7080.0,"discounted_cash":5310.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":7080.0,"discounted_cash":5310.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC REMOVAL TUNNELED CV CATH W/PORT OR PUMP","code_information":[{"code":"Px00036110449","type":"CDM"},{"code":"36590","type":"HCPCS"}],"standard_charges":[{"gross_charge":5988.0,"discounted_cash":4491.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":5273.0,"discounted_cash":3954.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MECH REMOV TUNNELED CV CATH","code_information":[{"code":"Px00036110452","type":"CDM"},{"code":"36595","type":"HCPCS"}],"standard_charges":[{"gross_charge":10823.0,"discounted_cash":8117.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":8018.0,"discounted_cash":6013.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MECH REMOV TUNNELED CV CATH THRU DEVICE LUMEN","code_information":[{"code":"Px00036110453","type":"CDM"},{"code":"36596","type":"HCPCS"}],"standard_charges":[{"gross_charge":5144.0,"discounted_cash":3858.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC REPOSITION VENOUS CATHETER","code_information":[{"code":"Px00036110454","type":"CDM"},{"code":"36597","type":"HCPCS"}],"standard_charges":[{"gross_charge":5784.0,"discounted_cash":4338.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":5784.0,"discounted_cash":4338.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC INJ W/FLUOR EVAL CV DEVICE","code_information":[{"code":"Px00036110455","type":"CDM"},{"code":"36598","type":"HCPCS"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":731.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC INSERTION CATHETER ARTERY CDM","code_information":[{"code":"Px00036110457","type":"CDM"},{"code":"36620","type":"HCPCS"}],"standard_charges":[{"gross_charge":410.0,"discounted_cash":307.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PERQ PRCRD DRG GTE 6YR W/O CONGENITAL CAR ANOMALY CDM","code_information":[{"code":"Px00036110459","type":"CDM"},{"code":"33017","type":"HCPCS"}],"standard_charges":[{"gross_charge":4795.0,"discounted_cash":3596.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC PERQ PERICARDIAL DRG W/INSJ NDWELLG CATH W/CT CDM","code_information":[{"code":"Px00036110462","type":"CDM"},{"code":"33019","type":"HCPCS"}],"standard_charges":[{"gross_charge":6268.0,"discounted_cash":4701.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC INSERT HEPATIC SHUNT (TIPS)","code_information":[{"code":"Px00036110474","type":"CDM"},{"code":"37182","type":"HCPCS"}],"standard_charges":[{"gross_charge":71018.0,"discounted_cash":53263.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":24496.0,"discounted_cash":18372.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC REVISE HEPATIC SHUNT TIPS","code_information":[{"code":"Px00036110475","type":"CDM"},{"code":"37183","type":"HCPCS"}],"standard_charges":[{"gross_charge":62077.0,"discounted_cash":46557.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC PRIM ART MECH THROMBECTOMY","code_information":[{"code":"Px00036110476","type":"CDM"},{"code":"37184","type":"HCPCS"}],"standard_charges":[{"gross_charge":17904.0,"discounted_cash":13428.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC PRIM ART M-THROMBECT ADD-ON","code_information":[{"code":"Px00036110477","type":"CDM"},{"code":"37185","type":"HCPCS"}],"standard_charges":[{"gross_charge":17904.0,"discounted_cash":13428.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC SEC ART M-THROMBECT ADD-ON","code_information":[{"code":"Px00036110478","type":"CDM"},{"code":"37186","type":"HCPCS"}],"standard_charges":[{"gross_charge":17904.0,"discounted_cash":13428.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC VENOUS MECH THROMBECTOMY","code_information":[{"code":"Px00036110479","type":"CDM"},{"code":"37187","type":"HCPCS"}],"standard_charges":[{"gross_charge":17995.0,"discounted_cash":13496.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":23742.0,"discounted_cash":17806.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC THROMBOLYTIC THERAPY STROKE","code_information":[{"code":"Px00036110481","type":"CDM"},{"code":"37195","type":"HCPCS"}],"standard_charges":[{"gross_charge":614.0,"discounted_cash":460.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC TRANSCATHETER BIOPSY","code_information":[{"code":"Px00036110482","type":"CDM"},{"code":"37200","type":"HCPCS"}],"standard_charges":[{"gross_charge":12844.0,"discounted_cash":9633.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC TRANSCATH STENT CCA W/EPS","code_information":[{"code":"Px00036110493","type":"CDM"},{"code":"37215","type":"HCPCS"}],"standard_charges":[{"gross_charge":56808.0,"discounted_cash":42606.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC TRANSCATH STENT CCA W/O EPS","code_information":[{"code":"Px00036110494","type":"CDM"},{"code":"37216","type":"HCPCS"}],"standard_charges":[{"gross_charge":41854.0,"discounted_cash":31390.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC ILIAC REVASC","code_information":[{"code":"Px00036110495","type":"CDM"},{"code":"37220","type":"HCPCS"}],"standard_charges":[{"gross_charge":20340.0,"discounted_cash":15255.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC ILIAC REVASC W/STENT","code_information":[{"code":"Px00036110496","type":"CDM"},{"code":"37221","type":"HCPCS"}],"standard_charges":[{"gross_charge":42062.0,"discounted_cash":31546.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC ILIAC REVASC ADD-ON","code_information":[{"code":"Px00036110497","type":"CDM"},{"code":"37222","type":"HCPCS"}],"standard_charges":[{"gross_charge":20340.0,"discounted_cash":15255.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC ILIAC REVASC W/STENT ADD-ON","code_information":[{"code":"Px00036110498","type":"CDM"},{"code":"37223","type":"HCPCS"}],"standard_charges":[{"gross_charge":20340.0,"discounted_cash":15255.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC FEM/POPL REVAS W/TLA","code_information":[{"code":"Px00036110499","type":"CDM"},{"code":"37224","type":"HCPCS"}],"standard_charges":[{"gross_charge":20340.0,"discounted_cash":15255.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC FEM/POPL REVAS W/ATHER","code_information":[{"code":"Px00036110500","type":"CDM"},{"code":"37225","type":"HCPCS"}],"standard_charges":[{"gross_charge":42062.0,"discounted_cash":31546.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC THERAPEUTIC APHERESIS RED BLOOD CELLS CDM","code_information":[{"code":"Px00036110501","type":"CDM"},{"code":"36512","type":"HCPCS"}],"standard_charges":[{"gross_charge":8782.0,"discounted_cash":6586.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC FEM/POPL REVASC W/STENT","code_information":[{"code":"Px00036110502","type":"CDM"},{"code":"37226","type":"HCPCS"}],"standard_charges":[{"gross_charge":42062.0,"discounted_cash":31546.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC FEM/POPL REVASC STNT & ATHER","code_information":[{"code":"Px00036110503","type":"CDM"},{"code":"37227","type":"HCPCS"}],"standard_charges":[{"gross_charge":71536.0,"discounted_cash":53652.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC TIB/PER REVASC W/TLA","code_information":[{"code":"Px00036110504","type":"CDM"},{"code":"37228","type":"HCPCS"}],"standard_charges":[{"gross_charge":20340.0,"discounted_cash":15255.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC TIB/PER REVASC W/ATHER","code_information":[{"code":"Px00036110505","type":"CDM"},{"code":"37229","type":"HCPCS"}],"standard_charges":[{"gross_charge":42062.0,"discounted_cash":31546.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC TIB/PER REVASC W/STENT","code_information":[{"code":"Px00036110506","type":"CDM"},{"code":"37230","type":"HCPCS"}],"standard_charges":[{"gross_charge":54091.0,"discounted_cash":40568.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC TIB/PER REVASC ADD-ON","code_information":[{"code":"Px00036110508","type":"CDM"},{"code":"37232","type":"HCPCS"}],"standard_charges":[{"gross_charge":20340.0,"discounted_cash":15255.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC FAST PROCEDURE  FOOT/TOES  TENEX","code_information":[{"code":"Px00036110512","type":"CDM"},{"code":"28899","type":"HCPCS"}],"standard_charges":[{"gross_charge":1104.0,"discounted_cash":828.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC LARYNGOSCOPY FLEXIBLE DIAGNOSTIC","code_information":[{"code":"Px00036110516","type":"CDM"},{"code":"31575","type":"HCPCS"}],"standard_charges":[{"gross_charge":592.0,"discounted_cash":444.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD RADIATION ONCOLOGY"}]},{"description":"HC LIGATION OF A-V FISTULA","code_information":[{"code":"Px00036110518","type":"CDM"},{"code":"37607","type":"HCPCS"}],"standard_charges":[{"gross_charge":9867.0,"discounted_cash":7400.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC TEMPORAL ARTERY PROCEDURE","code_information":[{"code":"Px00036110519","type":"CDM"},{"code":"37609","type":"HCPCS"}],"standard_charges":[{"gross_charge":5314.0,"discounted_cash":3985.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC EVASC RPR ILIAC ART TM OF A-ILIAC ART NDGFT UNI CDM","code_information":[{"code":"Px00036110523","type":"CDM"},{"code":"34717","type":"HCPCS"}],"standard_charges":[{"gross_charge":39061.0,"discounted_cash":29295.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC EVASC RPR ILIAC ART N/A A-ILIAC ART NDGFT UNI CDM","code_information":[{"code":"Px00036110524","type":"CDM"},{"code":"34718","type":"HCPCS"}],"standard_charges":[{"gross_charge":56713.0,"discounted_cash":42534.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC VASCULAR SURGERY PROCEDURE","code_information":[{"code":"Px00036110532","type":"CDM"},{"code":"37799","type":"HCPCS"}],"standard_charges":[{"gross_charge":2438.0,"discounted_cash":1828.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT CDM","code_information":[{"code":"Px00036110536","type":"CDM"},{"code":"62328","type":"HCPCS"}],"standard_charges":[{"gross_charge":4007.0,"discounted_cash":3005.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":4007.0,"discounted_cash":3005.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BONE BIOPSY TROCAR/NEEDLE SUPERFICIAL","code_information":[{"code":"Px00036110558","type":"CDM"},{"code":"20220","type":"HCPCS"}],"standard_charges":[{"gross_charge":3912.0,"discounted_cash":2934.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IR INJ TRIGGER POINT(S)1TO2 MUSC","code_information":[{"code":"Px00036110560","type":"CDM"},{"code":"20552","type":"HCPCS"}],"standard_charges":[{"gross_charge":1461.0,"discounted_cash":1095.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US","code_information":[{"code":"Px00036110562","type":"CDM"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":1752.0,"discounted_cash":1314.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC TREATMENT OF BONE CYST","code_information":[{"code":"Px00036110563","type":"CDM"},{"code":"20615","type":"HCPCS"}],"standard_charges":[{"gross_charge":4119.0,"discounted_cash":3089.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC THERAPEUTIC SPINAL PNXR DRAINAGE CSF W/FLUOR/CT CDM","code_information":[{"code":"Px00036110570","type":"CDM"},{"code":"62329","type":"HCPCS"}],"standard_charges":[{"gross_charge":4007.0,"discounted_cash":3005.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":4007.0,"discounted_cash":3005.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC INJECTION AA&/STRD NERVES NRVTG SI JOINT W/IMG CDM","code_information":[{"code":"Px00036110578","type":"CDM"},{"code":"64451","type":"HCPCS"}],"standard_charges":[{"gross_charge":4007.0,"discounted_cash":3005.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC RENAL ARTERY 1ST ORD W/S&I UNILATERAL","code_information":[{"code":"Px00036110581","type":"CDM"},{"code":"36251","type":"HCPCS"}],"standard_charges":[{"gross_charge":11656.0,"discounted_cash":8742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC RENAL ARTERY 1ST ORD W/S&I BILATERAL","code_information":[{"code":"Px00036110582","type":"CDM"},{"code":"36252","type":"HCPCS"}],"standard_charges":[{"gross_charge":10919.0,"discounted_cash":8189.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC RENAL ARTERY 2ND ORD PLUS W/S&I UNILATERAL","code_information":[{"code":"Px00036110583","type":"CDM"},{"code":"36253","type":"HCPCS"}],"standard_charges":[{"gross_charge":11714.0,"discounted_cash":8785.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC INSERTION IVC FILTER W/WO S&I","code_information":[{"code":"Px00036110585","type":"CDM"},{"code":"37191","type":"HCPCS"}],"standard_charges":[{"gross_charge":15579.0,"discounted_cash":11684.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC REMOVAL IVC FILTER W/WO S&I","code_information":[{"code":"Px00036110586","type":"CDM"},{"code":"37193","type":"HCPCS"}],"standard_charges":[{"gross_charge":9697.0,"discounted_cash":7272.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IMG CDM","code_information":[{"code":"Px00036110587","type":"CDM"},{"code":"64454","type":"HCPCS"}],"standard_charges":[{"gross_charge":4007.0,"discounted_cash":3005.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC MANUAL PREP AND INSERTION DEEP DRUG DELIVERY DEV CDM","code_information":[{"code":"Px00036110591","type":"CDM"},{"code":"20700","type":"HCPCS"}],"standard_charges":[{"gross_charge":393.0,"discounted_cash":294.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC REMOVAL DEEP DRUG DELIVERY DEVICE CDM","code_information":[{"code":"Px00036110592","type":"CDM"},{"code":"20701","type":"HCPCS"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":965.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MANUAL PREP&INSJ INTRAMEDULLARY DRUG DLVR DEVICE CDM","code_information":[{"code":"Px00036110593","type":"CDM"},{"code":"20702","type":"HCPCS"}],"standard_charges":[{"gross_charge":393.0,"discounted_cash":294.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC REMOVAL INTRAMEDULLARY DRUG DELIVERY DEVICE CDM","code_information":[{"code":"Px00036110597","type":"CDM"},{"code":"20703","type":"HCPCS"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":965.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST","code_information":[{"code":"Px00036110602","type":"CDM"},{"code":"10160","type":"HCPCS"}],"standard_charges":[{"gross_charge":1718.0,"discounted_cash":1288.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":957.0,"discounted_cash":717.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DEB SUBQ TISSUE FIRST 20 SQ CM OR LESS","code_information":[{"code":"Px00036110604","type":"CDM"},{"code":"11042","type":"HCPCS"}],"standard_charges":[{"gross_charge":1260.0,"discounted_cash":945.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC BONE BIOPSY TROCAR/NEEDLE","code_information":[{"code":"Px00036110611","type":"CDM"},{"code":"20225","type":"HCPCS"}],"standard_charges":[{"gross_charge":4173.0,"discounted_cash":3129.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC INJECTION SINUS TRACT DIAGNOSTIC","code_information":[{"code":"Px00036110612","type":"CDM"},{"code":"20501","type":"HCPCS"}],"standard_charges":[{"gross_charge":610.0,"discounted_cash":457.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MANUAL PREP&INSJ I-ARTIC DRUG DELIVERY DEVICE CDM","code_information":[{"code":"Px00036110616","type":"CDM"},{"code":"20704","type":"HCPCS"}],"standard_charges":[{"gross_charge":393.0,"discounted_cash":294.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC REMOVAL INTRA-ARTICULAR DRUG DELIVERY DEVICE CDM","code_information":[{"code":"Px00036110617","type":"CDM"},{"code":"20705","type":"HCPCS"}],"standard_charges":[{"gross_charge":1150.0,"discounted_cash":862.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC INSERT EMERGENCY AIRWAY CDM","code_information":[{"code":"Px00036110619","type":"CDM"},{"code":"31500","type":"HCPCS"}],"standard_charges":[{"gross_charge":1745.0,"discounted_cash":1308.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC TUBE THORACOSTOMY INCLUDES WATER SEAL","code_information":[{"code":"Px00036110622","type":"CDM"},{"code":"32551","type":"HCPCS"}],"standard_charges":[{"gross_charge":2398.0,"discounted_cash":1798.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CHEST SURGERY PROCEDURE","code_information":[{"code":"Px00036110624","type":"CDM"},{"code":"32999","type":"HCPCS"}],"standard_charges":[{"gross_charge":1725.0,"discounted_cash":1293.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":1661.0,"discounted_cash":1245.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC INTRODUCTION NEEDLE/INTRACATHETER VEIN","code_information":[{"code":"Px00036110641","type":"CDM"},{"code":"36000","type":"HCPCS"}],"standard_charges":[{"gross_charge":232.0,"discounted_cash":174.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MEAS POST-VOIDING RESIDUAL URINE&/BLADDER CAP CDM","code_information":[{"code":"Px00036110646","type":"CDM"},{"code":"51798","type":"HCPCS"}],"standard_charges":[{"gross_charge":369.0,"discounted_cash":276.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC NEEDLE BIOPSY PANCREAS","code_information":[{"code":"Px00036110659","type":"CDM"},{"code":"48102","type":"HCPCS"}],"standard_charges":[{"gross_charge":2977.0,"discounted_cash":2232.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE CDM","code_information":[{"code":"Px00036110662","type":"CDM"},{"code":"49083","type":"HCPCS"}],"standard_charges":[{"gross_charge":2758.0,"discounted_cash":2068.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BIOPSY ABDOMINAL MASS","code_information":[{"code":"Px00036110664","type":"CDM"},{"code":"49180","type":"HCPCS"}],"standard_charges":[{"gross_charge":4204.0,"discounted_cash":3153.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC INSERT TUN INTRAPERITONEAL CATH PERC","code_information":[{"code":"Px00036110667","type":"CDM"},{"code":"49418","type":"HCPCS"}],"standard_charges":[{"gross_charge":16454.0,"discounted_cash":12340.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":11686.0,"discounted_cash":8764.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC EXCHANGE DRAINAGE CATHETER","code_information":[{"code":"Px00036110671","type":"CDM"},{"code":"49423","type":"HCPCS"}],"standard_charges":[{"gross_charge":7146.0,"discounted_cash":5359.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":5354.0,"discounted_cash":4015.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC RENAL BIOPSY PERQ","code_information":[{"code":"Px00036110673","type":"CDM"},{"code":"50200","type":"HCPCS"}],"standard_charges":[{"gross_charge":5306.0,"discounted_cash":3979.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":3808.0,"discounted_cash":2856.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DRAINAGE OF KIDNEY LESION","code_information":[{"code":"Px00036110677","type":"CDM"},{"code":"50390","type":"HCPCS"}],"standard_charges":[{"gross_charge":3702.0,"discounted_cash":2776.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DRAIN BLADDER W/CATH INSERTION","code_information":[{"code":"Px00036110683","type":"CDM"},{"code":"51102","type":"HCPCS"}],"standard_charges":[{"gross_charge":11382.0,"discounted_cash":8536.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CYSTOSTOMY TUBE CHANGE","code_information":[{"code":"Px00036110687","type":"CDM"},{"code":"51705","type":"HCPCS"}],"standard_charges":[{"gross_charge":1447.0,"discounted_cash":1085.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CHANGE OF BLADDER TUBE","code_information":[{"code":"Px00036110688","type":"CDM"},{"code":"51710","type":"HCPCS"}],"standard_charges":[{"gross_charge":3330.0,"discounted_cash":2497.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC TRANSCATH OCCLUSION CNS","code_information":[{"code":"Px00036110698","type":"CDM"},{"code":"61624","type":"HCPCS"}],"standard_charges":[{"gross_charge":56806.0,"discounted_cash":42604.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC TRANSCATH OCCLUSION NON-CNS","code_information":[{"code":"Px00036110699","type":"CDM"},{"code":"61626","type":"HCPCS"}],"standard_charges":[{"gross_charge":37328.0,"discounted_cash":27996.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC INTERDISCAL PERQ ASPIR DX","code_information":[{"code":"Px00036110700","type":"CDM"},{"code":"62267","type":"HCPCS"}],"standard_charges":[{"gross_charge":4113.0,"discounted_cash":3084.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DRAIN CEREBRO SPINAL FLUID","code_information":[{"code":"Px00036110702","type":"CDM"},{"code":"62272","type":"HCPCS"}],"standard_charges":[{"gross_charge":2293.0,"discounted_cash":1719.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANALYZE SPINE INFUSION PUMP W/O REPROGAM","code_information":[{"code":"Px00036110714","type":"CDM"},{"code":"62367","type":"HCPCS"}],"standard_charges":[{"gross_charge":1241.0,"discounted_cash":930.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANALYZE SPINE INFUSION PUMP W/REPROGAM","code_information":[{"code":"Px00036110715","type":"CDM"},{"code":"62368","type":"HCPCS"}],"standard_charges":[{"gross_charge":1884.0,"discounted_cash":1413.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":1509.0,"discounted_cash":1131.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC N BLOCK OTHER PERIPHERAL","code_information":[{"code":"Px00036110718","type":"CDM"},{"code":"64450","type":"HCPCS"}],"standard_charges":[{"gross_charge":1844.0,"discounted_cash":1383.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC INJ PARAVERT F JNT L/S 1 LEV","code_information":[{"code":"Px00036110728","type":"CDM"},{"code":"64493","type":"HCPCS"}],"standard_charges":[{"gross_charge":2953.0,"discounted_cash":2214.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC N BLOCK INJ CELIAC PLEXUS","code_information":[{"code":"Px00036110734","type":"CDM"},{"code":"64530","type":"HCPCS"}],"standard_charges":[{"gross_charge":3998.0,"discounted_cash":2998.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC NON HOSP DELIVERY EPISIOTOMY/VAG REPAIR CDM","code_information":[{"code":"Px00036110737","type":"CDM"},{"code":"59300","type":"HCPCS"}],"standard_charges":[{"gross_charge":10106.0,"discounted_cash":7579.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC TRACHEOSTOMY PLANNED SEPARATE PROCEDURE CDM","code_information":[{"code":"Px00036110749","type":"CDM"},{"code":"31600","type":"HCPCS"}],"standard_charges":[{"gross_charge":12214.0,"discounted_cash":9160.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CENTRAL LINE INSERTION","code_information":[{"code":"Px00036110804","type":"CDM"},{"code":"36556","type":"HCPCS"}],"standard_charges":[{"gross_charge":7070.0,"discounted_cash":5302.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC REMOVAL INDWELL TUNNEL CATHETER","code_information":[{"code":"Px00036110819","type":"CDM"},{"code":"32552","type":"HCPCS"}],"standard_charges":[{"gross_charge":3305.0,"discounted_cash":2478.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":2747.0,"discounted_cash":2060.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ABLTJ PERC CRYOABLTJ IMG GDN NRV PLEX/TRNCL NRV","code_information":[{"code":"Px00036110894","type":"CDM"},{"code":"0442T","type":"HCPCS"}],"standard_charges":[{"gross_charge":27357.0,"discounted_cash":20517.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":30198.0,"discounted_cash":22648.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC TREAT PLEURODESIS W/AGENT","code_information":[{"code":"Px00036110912","type":"CDM"},{"code":"32560","type":"HCPCS"}],"standard_charges":[{"gross_charge":3176.0,"discounted_cash":2382.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC NEEDLE BIOPSY LYMPH NODES","code_information":[{"code":"Px00036110934","type":"CDM"},{"code":"38505","type":"HCPCS"}],"standard_charges":[{"gross_charge":3157.0,"discounted_cash":2367.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC STOMACH SURGERY PROCEDURE","code_information":[{"code":"Px00036110940","type":"CDM"},{"code":"43999","type":"HCPCS"}],"standard_charges":[{"gross_charge":4240.0,"discounted_cash":3180.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC PERC RADIO FREQ ABLATION LIVER TUMOR","code_information":[{"code":"Px00036110946","type":"CDM"},{"code":"47382","type":"HCPCS"}],"standard_charges":[{"gross_charge":14095.0,"discounted_cash":10571.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC THERAPEUTIC APHERESIS PLASMA PHERESIS CDM","code_information":[{"code":"Px00036110977","type":"CDM"},{"code":"36514","type":"HCPCS"}],"standard_charges":[{"gross_charge":7128.0,"discounted_cash":5346.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PERC CRYO ABLATION RENAL TUMOR","code_information":[{"code":"Px00036111014","type":"CDM"},{"code":"50593","type":"HCPCS"}],"standard_charges":[{"gross_charge":17529.0,"discounted_cash":13146.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CHANGE OF URETER TUBE/STENT","code_information":[{"code":"Px00036111015","type":"CDM"},{"code":"50688","type":"HCPCS"}],"standard_charges":[{"gross_charge":8888.0,"discounted_cash":6666.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":7938.0,"discounted_cash":5953.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC TRANSPERINEAL NEEDLE PLACEMENT, PROSTATE","code_information":[{"code":"Px00036111031","type":"CDM"},{"code":"55875","type":"HCPCS"}],"standard_charges":[{"gross_charge":16522.0,"discounted_cash":12391.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD RADIATION ONCOLOGY"}]},{"description":"HC INJECTION INTO BRAIN CANAL FOR DIAGNOSIS/TREATMENT","code_information":[{"code":"Px00036111040","type":"CDM"},{"code":"61026","type":"HCPCS"}],"standard_charges":[{"gross_charge":2184.0,"discounted_cash":1638.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC INJECTION AA&/STRD INTERCOSTAL NRV EA ADDL LVL","code_information":[{"code":"Px00036111071","type":"CDM"},{"code":"64421","type":"HCPCS"}],"standard_charges":[{"gross_charge":2808.0,"discounted_cash":2106.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC INJECTION ANESTHETIC AGENT 1 INTERCOSTAL NERVE CDM","code_information":[{"code":"Px00036111093","type":"CDM"},{"code":"64420","type":"HCPCS"}],"standard_charges":[{"gross_charge":2184.0,"discounted_cash":1638.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC INJECTION TREATMENT OF NERVE CELIAC PLEXUS","code_information":[{"code":"Px00036111095","type":"CDM"},{"code":"64680","type":"HCPCS"}],"standard_charges":[{"gross_charge":4948.0,"discounted_cash":3711.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CHEMICAL CAUTERIZATION OF GRANULATION TISSUE CDM","code_information":[{"code":"Px00036111102","type":"CDM"},{"code":"17250","type":"HCPCS"}],"standard_charges":[{"gross_charge":807.0,"discounted_cash":605.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING","code_information":[{"code":"Px00036111124","type":"CDM"},{"code":"32554","type":"HCPCS"}],"standard_charges":[{"gross_charge":2039.0,"discounted_cash":1529.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING","code_information":[{"code":"Px00036111125","type":"CDM"},{"code":"32555","type":"HCPCS"}],"standard_charges":[{"gross_charge":2039.0,"discounted_cash":1529.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PERQ DRAINAGE PLEURA INSERT CATH W/O IMAGING","code_information":[{"code":"Px00036111126","type":"CDM"},{"code":"32556","type":"HCPCS"}],"standard_charges":[{"gross_charge":7862.0,"discounted_cash":5896.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PERQ DRAINAGE PLEURA INSERT CATH W/IMAGING","code_information":[{"code":"Px00036111127","type":"CDM"},{"code":"32557","type":"HCPCS"}],"standard_charges":[{"gross_charge":9414.0,"discounted_cash":7060.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":9054.0,"discounted_cash":6790.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC NONSLCTV CATH THOR AORTA ANGIO INTR/XTRCRANL ART","code_information":[{"code":"Px00036111129","type":"CDM"},{"code":"36221","type":"HCPCS"}],"standard_charges":[{"gross_charge":9632.0,"discounted_cash":7224.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC SLCTV CATH CAROTID/INNOM ART ANGIO XTRCRANL ART","code_information":[{"code":"Px00036111130","type":"CDM"},{"code":"36222","type":"HCPCS"}],"standard_charges":[{"gross_charge":10232.0,"discounted_cash":7674.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC SLCTV CATH CAROTID/INNOM ART ANGIO INTRCRANL ART","code_information":[{"code":"Px00036111131","type":"CDM"},{"code":"36223","type":"HCPCS"}],"standard_charges":[{"gross_charge":10232.0,"discounted_cash":7674.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC SLCTV CATH INTRNL CAROTID ART ANGIO INTRCRNL ART","code_information":[{"code":"Px00036111132","type":"CDM"},{"code":"36224","type":"HCPCS"}],"standard_charges":[{"gross_charge":20420.0,"discounted_cash":15315.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC SLCTV CATH SUBCLAVIAN ART ANGIO VERTEBRAL ARTERY","code_information":[{"code":"Px00036111133","type":"CDM"},{"code":"36225","type":"HCPCS"}],"standard_charges":[{"gross_charge":11656.0,"discounted_cash":8742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC SLCTV CATH VERTEBRAL ART ANGIO VERTEBRAL ARTERY","code_information":[{"code":"Px00036111134","type":"CDM"},{"code":"36226","type":"HCPCS"}],"standard_charges":[{"gross_charge":20420.0,"discounted_cash":15315.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC SLCTV CATH XTRNL CAROTID ANGIO XTRNL CAROTD CIRC","code_information":[{"code":"Px00036111135","type":"CDM"},{"code":"36227","type":"HCPCS"}],"standard_charges":[{"gross_charge":5578.0,"discounted_cash":4183.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC SLCTV CATH INTRCRNL BRNCH ANGIO INTRL CAROT/VERT","code_information":[{"code":"Px00036111136","type":"CDM"},{"code":"36228","type":"HCPCS"}],"standard_charges":[{"gross_charge":4610.0,"discounted_cash":3457.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC PRQ TRANSCATHETER RTRVL INTRVAS FB WITH IMAGING","code_information":[{"code":"Px00036111137","type":"CDM"},{"code":"37197","type":"HCPCS"}],"standard_charges":[{"gross_charge":10815.0,"discounted_cash":8111.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC THROMBOLYSIS ARTERIAL INFUSION W/IMAGING INIT TX","code_information":[{"code":"Px00036111138","type":"CDM"},{"code":"37211","type":"HCPCS"}],"standard_charges":[{"gross_charge":4651.0,"discounted_cash":3488.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC THROMBOLYSIS VENOUS INFUSION W/IMAGING INIT TX","code_information":[{"code":"Px00036111139","type":"CDM"},{"code":"37212","type":"HCPCS"}],"standard_charges":[{"gross_charge":4385.0,"discounted_cash":3288.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC THROMBOLYSIS ART/VENOUS INFSN W/IMAGE SUBSQ TX","code_information":[{"code":"Px00036111140","type":"CDM"},{"code":"37213","type":"HCPCS"}],"standard_charges":[{"gross_charge":10529.0,"discounted_cash":7896.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":9418.0,"discounted_cash":7063.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CESSATION THROMBOLYTIC THRPY W/CATHETER REMOVAL","code_information":[{"code":"Px00036111141","type":"CDM"},{"code":"37214","type":"HCPCS"}],"standard_charges":[{"gross_charge":10529.0,"discounted_cash":7896.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":9418.0,"discounted_cash":7063.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC NERVE BLOCK INJ PUDENDAL","code_information":[{"code":"Px00036111164","type":"CDM"},{"code":"64430","type":"HCPCS"}],"standard_charges":[{"gross_charge":3019.0,"discounted_cash":2264.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC GUIDE CATH FLUID DRAINAGE SOFT TISSUE","code_information":[{"code":"Px00036111182","type":"CDM"},{"code":"10030","type":"HCPCS"}],"standard_charges":[{"gross_charge":9054.0,"discounted_cash":6790.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BX BREAST 1ST LESION STEREO","code_information":[{"code":"Px00036111183","type":"CDM"},{"code":"19081","type":"HCPCS"}],"standard_charges":[{"gross_charge":7740.0,"discounted_cash":5805.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BX BREAST ADD LESION STEREO","code_information":[{"code":"Px00036111184","type":"CDM"},{"code":"19082","type":"HCPCS"}],"standard_charges":[{"gross_charge":7085.0,"discounted_cash":5313.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BX BREAST 1ST LESION US IMAG","code_information":[{"code":"Px00036111185","type":"CDM"},{"code":"19083","type":"HCPCS"}],"standard_charges":[{"gross_charge":6254.0,"discounted_cash":4690.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BX BREAST ADD LESION US IMAG","code_information":[{"code":"Px00036111186","type":"CDM"},{"code":"19084","type":"HCPCS"}],"standard_charges":[{"gross_charge":6254.0,"discounted_cash":4690.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PERQ DEVICE LOC BREAST EA IMAG","code_information":[{"code":"Px00036111190","type":"CDM"},{"code":"19282","type":"HCPCS"}],"standard_charges":[{"gross_charge":402.0,"discounted_cash":301.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PERQ DEV LOC BREAST 1ST STEREO","code_information":[{"code":"Px00036111191","type":"CDM"},{"code":"19283","type":"HCPCS"}],"standard_charges":[{"gross_charge":1220.0,"discounted_cash":915.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PERQ DEV LOC BREAST ADD STEREO","code_information":[{"code":"Px00036111192","type":"CDM"},{"code":"19284","type":"HCPCS"}],"standard_charges":[{"gross_charge":477.0,"discounted_cash":357.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PERQ DEV LOC BREAST 1ST US IMAG","code_information":[{"code":"Px00036111193","type":"CDM"},{"code":"19285","type":"HCPCS"}],"standard_charges":[{"gross_charge":2498.0,"discounted_cash":1873.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PERQ DEV LOC BREAST ADD US IMAG","code_information":[{"code":"Px00036111194","type":"CDM"},{"code":"19286","type":"HCPCS"}],"standard_charges":[{"gross_charge":477.0,"discounted_cash":357.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC INSERTION INTRA-AORTIC BALLOON ASSIST DEV PERQ CDM","code_information":[{"code":"Px00036111211","type":"CDM"},{"code":"33967","type":"HCPCS"}],"standard_charges":[{"gross_charge":6365.0,"discounted_cash":4773.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC DRAIN/INJ JOINT/BURSA INTERMEDIATE W/US","code_information":[{"code":"Px00036111217","type":"CDM"},{"code":"20606","type":"HCPCS"}],"standard_charges":[{"gross_charge":2191.0,"discounted_cash":1643.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DRAIN/INJ JOINT/BURSA MAJOR W/US","code_information":[{"code":"Px00036111218","type":"CDM"},{"code":"20611","type":"HCPCS"}],"standard_charges":[{"gross_charge":2191.0,"discounted_cash":1643.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ABLATE BONE TUMOR(S) PERQ CRYO","code_information":[{"code":"Px00036111219","type":"CDM"},{"code":"20983","type":"HCPCS"}],"standard_charges":[{"gross_charge":26087.0,"discounted_cash":19565.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PERQ CERVICOTHORACIC INJECT","code_information":[{"code":"Px00036111222","type":"CDM"},{"code":"22510","type":"HCPCS"}],"standard_charges":[{"gross_charge":28197.0,"discounted_cash":21147.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC PERQ LUMBOSACRAL INJECTION","code_information":[{"code":"Px00036111223","type":"CDM"},{"code":"22511","type":"HCPCS"}],"standard_charges":[{"gross_charge":23732.0,"discounted_cash":17799.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC VERTEBROPLASTY ADDL INJECT","code_information":[{"code":"Px00036111224","type":"CDM"},{"code":"22512","type":"HCPCS"}],"standard_charges":[{"gross_charge":23732.0,"discounted_cash":17799.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC STENT PLACEMT ANTEGRADE CAROTID S&I","code_information":[{"code":"Px00036111232","type":"CDM"},{"code":"37218","type":"HCPCS"}],"standard_charges":[{"gross_charge":38361.0,"discounted_cash":28770.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC MYELOGRAPHY LUMBAR INJECTION CERVICAL S&I","code_information":[{"code":"Px00036111234","type":"CDM"},{"code":"62302","type":"HCPCS"}],"standard_charges":[{"gross_charge":4034.0,"discounted_cash":3025.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MYELOGRAPHY LUMBAR INJECTION LUMBOSAC S&I","code_information":[{"code":"Px00036111236","type":"CDM"},{"code":"62304","type":"HCPCS"}],"standard_charges":[{"gross_charge":4509.0,"discounted_cash":3381.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC WOUND NEG PRESSURE TX USING NON-DME GT 50 SQCM","code_information":[{"code":"Px00036111243","type":"CDM"},{"code":"97608","type":"HCPCS"}],"standard_charges":[{"gross_charge":1157.0,"discounted_cash":867.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC TENOTOMY PRQ ACHILLES TENDON SPX LOCAL ANES","code_information":[{"code":"Px00036111250","type":"CDM"},{"code":"27605","type":"HCPCS"}],"standard_charges":[{"gross_charge":8819.0,"discounted_cash":6614.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC NEW REPAIR ELBOW PERCUTANEOUS","code_information":[{"code":"Px00036111251","type":"CDM"},{"code":"24357","type":"HCPCS"}],"standard_charges":[{"gross_charge":14198.0,"discounted_cash":10648.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC TEAEC W/GRAFT SUPERFICIAL FEMORAL ARTERY","code_information":[{"code":"Px00036111261","type":"CDM"},{"code":"35302","type":"HCPCS"}],"standard_charges":[{"gross_charge":28779.0,"discounted_cash":21584.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC INCISION OF TENDON & MUSCLE","code_information":[{"code":"Px00036111263","type":"CDM"},{"code":"23405","type":"HCPCS"}],"standard_charges":[{"gross_charge":24275.0,"discounted_cash":18206.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC RECHANNELING OF ARTERY","code_information":[{"code":"Px00036111271","type":"CDM"},{"code":"35355","type":"HCPCS"}],"standard_charges":[{"gross_charge":20048.0,"discounted_cash":15036.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CVL FEM POP BYPASS","code_information":[{"code":"Px00036111273","type":"CDM"},{"code":"35556","type":"HCPCS"}],"standard_charges":[{"gross_charge":52385.0,"discounted_cash":39288.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC INJECTION FOR WRIST ARTHROGRAPHY","code_information":[{"code":"Px00036112004","type":"CDM"},{"code":"25246","type":"HCPCS"}],"standard_charges":[{"gross_charge":2472.0,"discounted_cash":1854.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC INTRO NEEDLE/CATH DIALYSIS CIR IMAGING","code_information":[{"code":"Px00036114033","type":"CDM"},{"code":"36901","type":"HCPCS"}],"standard_charges":[{"gross_charge":3815.0,"discounted_cash":2861.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC INTRO NEEDLE/CATH DIALYSIS CIRCUIT W/BALLN ANGIO","code_information":[{"code":"Px00036114034","type":"CDM"},{"code":"36902","type":"HCPCS"}],"standard_charges":[{"gross_charge":37286.0,"discounted_cash":27964.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC INTRO NEEDLE/CATH DIALYSIS CIRCUIT W/STENT & ANGIO","code_information":[{"code":"Px00036114035","type":"CDM"},{"code":"36903","type":"HCPCS"}],"standard_charges":[{"gross_charge":47500.0,"discounted_cash":35625.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC ANGIOPLASTY BALLN DIALY CIRC","code_information":[{"code":"Px00036114039","type":"CDM"},{"code":"36907","type":"HCPCS"}],"standard_charges":[{"gross_charge":35016.0,"discounted_cash":26262.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC PLACE STENT DIALY CIRC W/ANGIO","code_information":[{"code":"Px00036114040","type":"CDM"},{"code":"36908","type":"HCPCS"}],"standard_charges":[{"gross_charge":42062.0,"discounted_cash":31546.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC EMBOLIZATION/OCCLU DIALY CIRC","code_information":[{"code":"Px00036114041","type":"CDM"},{"code":"36909","type":"HCPCS"}],"standard_charges":[{"gross_charge":19544.0,"discounted_cash":14658.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC ANGIOPLAST BALLN TRNSL 1ST ART","code_information":[{"code":"Px00036114042","type":"CDM"},{"code":"37246","type":"HCPCS"}],"standard_charges":[{"gross_charge":39816.0,"discounted_cash":29862.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC ANGIOPLAST BLLN TRNSL ADDL ART","code_information":[{"code":"Px00036114043","type":"CDM"},{"code":"37247","type":"HCPCS"}],"standard_charges":[{"gross_charge":13832.0,"discounted_cash":10374.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC ANGIOPLAST BLLN TRNSL 1ST VEIN","code_information":[{"code":"Px00036114044","type":"CDM"},{"code":"37248","type":"HCPCS"}],"standard_charges":[{"gross_charge":33470.0,"discounted_cash":25102.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC ANGIOPLAST BLLN TRNS ADDL VEIN","code_information":[{"code":"Px00036114045","type":"CDM"},{"code":"37249","type":"HCPCS"}],"standard_charges":[{"gross_charge":13832.0,"discounted_cash":10374.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC INJ W/NDL OR CATH PLCMNT EPIDRL L/S  W/IMG","code_information":[{"code":"Px00036114048","type":"CDM"},{"code":"62323","type":"HCPCS"}],"standard_charges":[{"gross_charge":3208.0,"discounted_cash":2406.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC INJ W/NDL OR CATH PLCMNT EPIDRL C/T W/IMG","code_information":[{"code":"Px00036114055","type":"CDM"},{"code":"62321","type":"HCPCS"}],"standard_charges":[{"gross_charge":7761.0,"discounted_cash":5820.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MINOR PROCEDURE","code_information":[{"code":"Px00036119054","type":"CDM"}],"standard_charges":[{"gross_charge":1153.0,"discounted_cash":864.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PERQ DEV SOFT TISS 1ST IMAG","code_information":[{"code":"Px00036119071","type":"CDM"},{"code":"10035","type":"HCPCS"}],"standard_charges":[{"gross_charge":2851.0,"discounted_cash":2138.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC INTRVASC US NONCORONARY 1ST","code_information":[{"code":"Px00036119076","type":"CDM"},{"code":"37252","type":"HCPCS"}],"standard_charges":[{"gross_charge":7288.0,"discounted_cash":5466.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC INTRVASC US NONCORONARY ADDL","code_information":[{"code":"Px00036119077","type":"CDM"},{"code":"37253","type":"HCPCS"}],"standard_charges":[{"gross_charge":6027.0,"discounted_cash":4520.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC INJECTION FOR CHOLANGIOGRAM, EXISTING ACCESS","code_information":[{"code":"Px00036119078","type":"CDM"},{"code":"47531","type":"HCPCS"}],"standard_charges":[{"gross_charge":1762.0,"discounted_cash":1321.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PLMT BILIARY DRAINAGE CATH, EXTERNAL","code_information":[{"code":"Px00036119080","type":"CDM"},{"code":"47533","type":"HCPCS"}],"standard_charges":[{"gross_charge":25517.0,"discounted_cash":19137.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC PLMT BILIARY DRAINAGE CATH, INTERNAL-EXTERNAL","code_information":[{"code":"Px00036119081","type":"CDM"},{"code":"47534","type":"HCPCS"}],"standard_charges":[{"gross_charge":44759.0,"discounted_cash":33569.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":9871.0,"discounted_cash":7403.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CONVERSION EXT BIL DRG CATH","code_information":[{"code":"Px00036119082","type":"CDM"},{"code":"47535","type":"HCPCS"}],"standard_charges":[{"gross_charge":15775.0,"discounted_cash":11831.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC EXCHANGE BILIARY DRG CATH","code_information":[{"code":"Px00036119083","type":"CDM"},{"code":"47536","type":"HCPCS"}],"standard_charges":[{"gross_charge":18742.0,"discounted_cash":14056.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":10890.0,"discounted_cash":8167.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ENDOLUMINAL BX BILIARY TREE, SINGL/MLTP","code_information":[{"code":"Px00036119090","type":"CDM"},{"code":"47543","type":"HCPCS"}],"standard_charges":[{"gross_charge":5195.0,"discounted_cash":3896.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC SCLEROTX FLUID COLLECTION","code_information":[{"code":"Px00036119091","type":"CDM"},{"code":"49185","type":"HCPCS"}],"standard_charges":[{"gross_charge":7121.0,"discounted_cash":5340.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC NJX PX NFROSGRM &/URTRGRM, EXISTING ACCESS","code_information":[{"code":"Px00036119093","type":"CDM"},{"code":"50431","type":"HCPCS"}],"standard_charges":[{"gross_charge":3070.0,"discounted_cash":2302.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PLMT NEPHROSTOMY CATHETER","code_information":[{"code":"Px00036119094","type":"CDM"},{"code":"50432","type":"HCPCS"}],"standard_charges":[{"gross_charge":16403.0,"discounted_cash":12302.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":15773.0,"discounted_cash":11829.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PLMT NEPHROURETERAL CATHETER, NEW ACCESS","code_information":[{"code":"Px00036119095","type":"CDM"},{"code":"50433","type":"HCPCS"}],"standard_charges":[{"gross_charge":21552.0,"discounted_cash":16164.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":9202.0,"discounted_cash":6901.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CONVERT NEPHROSTOMY CATHETER, PRE-EXISTING TRACT","code_information":[{"code":"Px00036119096","type":"CDM"},{"code":"50434","type":"HCPCS"}],"standard_charges":[{"gross_charge":21443.0,"discounted_cash":16082.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC EXCHANGE NEPHROSTOMY CATH","code_information":[{"code":"Px00036119097","type":"CDM"},{"code":"50435","type":"HCPCS"}],"standard_charges":[{"gross_charge":18142.0,"discounted_cash":13606.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":17441.0,"discounted_cash":13080.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ENDOLUMINAL BX URTR RNL PLVS","code_information":[{"code":"Px00036119098","type":"CDM"},{"code":"50606","type":"HCPCS"}],"standard_charges":[{"gross_charge":11858.0,"discounted_cash":8893.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PLMT URETERAL STENT PRQ, PRE-EXISTING TRACT","code_information":[{"code":"Px00036119099","type":"CDM"},{"code":"50693","type":"HCPCS"}],"standard_charges":[{"gross_charge":26671.0,"discounted_cash":20003.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC PLMT URETERAL STENT PRQ, NEW ACCESS","code_information":[{"code":"Px00036119100","type":"CDM"},{"code":"50694","type":"HCPCS"}],"standard_charges":[{"gross_charge":25643.0,"discounted_cash":19232.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PLMT URETERAL STENT PRQ, NEW ACCESS SEP CATH","code_information":[{"code":"Px00036119101","type":"CDM"},{"code":"50695","type":"HCPCS"}],"standard_charges":[{"gross_charge":25643.0,"discounted_cash":19232.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PERQ ART M-THROMBECT &/NFS","code_information":[{"code":"Px00036119104","type":"CDM"},{"code":"61645","type":"HCPCS"}],"standard_charges":[{"gross_charge":15729.0,"discounted_cash":11796.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC VNPNXR 3 YEARS/> PHYS/QHP SKILL- MIDLINE CATHETER INSERTION > 3 YR","code_information":[{"code":"Px00036155555","type":"CDM"},{"code":"36410","type":"HCPCS"}],"standard_charges":[{"gross_charge":5711.0,"discounted_cash":4283.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANESTHESIA GEN 1ST HOUR CDM","code_information":[{"code":"Px00037010121","type":"CDM"}],"standard_charges":[{"gross_charge":2104.0,"discounted_cash":1578.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANESTHESIA GEN 15 MIN CDM","code_information":[{"code":"Px00037010122","type":"CDM"}],"standard_charges":[{"gross_charge":188.0,"discounted_cash":141.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANESTHESIA IV GA 1ST HOUR CDM","code_information":[{"code":"Px00037010123","type":"CDM"}],"standard_charges":[{"gross_charge":2104.0,"discounted_cash":1578.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANESTHESIA IV GA 15 MIN CDM","code_information":[{"code":"Px00037010124","type":"CDM"}],"standard_charges":[{"gross_charge":188.0,"discounted_cash":141.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANESTHESIA MAC 1ST HOUR CDM","code_information":[{"code":"Px00037010125","type":"CDM"}],"standard_charges":[{"gross_charge":2104.0,"discounted_cash":1578.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANESTHESIA MAC 15 MIN CTP CDM","code_information":[{"code":"Px00037010126","type":"CDM"}],"standard_charges":[{"gross_charge":188.0,"discounted_cash":141.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANESTHESIA REGIONAL 1ST HOUR CDM","code_information":[{"code":"Px00037010129","type":"CDM"}],"standard_charges":[{"gross_charge":2104.0,"discounted_cash":1578.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ANESTHESIA REGIONAL 15 MIN CDM","code_information":[{"code":"Px00037010130","type":"CDM"}],"standard_charges":[{"gross_charge":188.0,"discounted_cash":141.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MOD SED SAME PHYS/QHP INITIAL 15 MINS LT/5YRS","code_information":[{"code":"Px00037010151","type":"CDM"},{"code":"99151","type":"HCPCS"}],"standard_charges":[{"gross_charge":724.0,"discounted_cash":543.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MOD SED SAME PHYS/QHP INITIAL 15 MINS GT/5YRS","code_information":[{"code":"Px00037010152","type":"CDM"},{"code":"99152","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":519.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MOD SED SAME PHYS/QHP EACH ADDL 15 MINS","code_information":[{"code":"Px00037010153","type":"CDM"},{"code":"99153","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":153.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MOD SED OTHER PHYS/QHP INITIAL 15 MINS LT/5YRS","code_information":[{"code":"Px00037010154","type":"CDM"},{"code":"99155","type":"HCPCS"}],"standard_charges":[{"gross_charge":722.0,"discounted_cash":541.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MOD SED OTHER PHYS/QHP INITIAL 15MINS GT/5YRS","code_information":[{"code":"Px00037010155","type":"CDM"},{"code":"99156","type":"HCPCS"}],"standard_charges":[{"gross_charge":722.0,"discounted_cash":541.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MOD SED OTHER PHYS/QHP EACH ADDL 15 MINS","code_information":[{"code":"Px00037010156","type":"CDM"},{"code":"99157","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":153.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CRYOPRECIPITATE EACH UNIT","code_information":[{"code":"Px00039010002","type":"CDM"},{"code":"P9012","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":81.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC THERAPEUTIC APHERESIS PLASMA PHERESIS LAB","code_information":[{"code":"Px00039010004","type":"CDM"},{"code":"36514","type":"HCPCS"}],"standard_charges":[{"gross_charge":7128.0,"discounted_cash":5346.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC RBC LEUKOREDUCED","code_information":[{"code":"Px00039010015","type":"CDM"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":536.0,"discounted_cash":402.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC FRESH FROZEN PLASMA EA UNIT FRZ W/IN 8 HR","code_information":[{"code":"Px00039010017","type":"CDM"},{"code":"P9017","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":109.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PLATELET PHERESIS LEUKOREDUCED","code_information":[{"code":"Px00039010031","type":"CDM"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1264.0,"discounted_cash":948.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PLATELET PHERESIS LEUKOREDU IRRAD","code_information":[{"code":"Px00039010033","type":"CDM"},{"code":"P9037","type":"HCPCS"}],"standard_charges":[{"gross_charge":1320.0,"discounted_cash":990.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC FRESH FROZEN PLASMA FRZ BETWEEN 8-24HOUR","code_information":[{"code":"Px00039010045","type":"CDM"},{"code":"P9059","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.0,"discounted_cash":128.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CRYOPRECIPITATE EACH UNIT POOLED","code_information":[{"code":"Px00039010054","type":"CDM"},{"code":"P9012","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.5,"discounted_cash":118.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC RBC LEUKOREDUCED IRRADIATED","code_information":[{"code":"Px00039010055","type":"CDM"},{"code":"P9040","type":"HCPCS"}],"standard_charges":[{"gross_charge":625.0,"discounted_cash":468.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PLATELETS PHERESIS PATH REDU","code_information":[{"code":"Px00039010064","type":"CDM"},{"code":"P9073","type":"HCPCS"}],"standard_charges":[{"gross_charge":900.0,"discounted_cash":675.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PLATELETS LEUKOREDUCED IRRAD","code_information":[{"code":"Px00039010102","type":"CDM"},{"code":"P9033","type":"HCPCS"}],"standard_charges":[{"gross_charge":577.0,"discounted_cash":432.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BLOOD TRANSFUSION EA UNIT CDM","code_information":[{"code":"Px00039110001","type":"CDM"},{"code":"36430","type":"HCPCS"}],"standard_charges":[{"gross_charge":848.0,"discounted_cash":636.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC RBC LEUKOREDUCED IRRADIATED WASHED","code_information":[{"code":"Px00039910006","type":"CDM"},{"code":"P9040","type":"HCPCS"}],"standard_charges":[{"gross_charge":625.0,"discounted_cash":468.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MAMMO DIAG BIL W CAD","code_information":[{"code":"Px00040110004","type":"CDM"},{"code":"77066","type":"HCPCS"}],"standard_charges":[{"gross_charge":507.0,"discounted_cash":380.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MAMMO DIAG UNI W CAD","code_information":[{"code":"Px00040110005","type":"CDM"},{"code":"77065","type":"HCPCS"}],"standard_charges":[{"gross_charge":478.0,"discounted_cash":358.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC SCREENING BREAST TOMOSYNTHESIS BI","code_information":[{"code":"Px00040110020","type":"CDM"},{"code":"77063","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":114.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC TOMOSYNTHESIS MAMMO UNI OR BIL DIAGNOSTIC","code_information":[{"code":"Px00040110021","type":"CDM"},{"code":"G0279","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":114.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC US NRV&ACC STRUX 1 XTR COMPRE W/IMG PR EXTREMITY CDM","code_information":[{"code":"Px00040200005","type":"CDM"},{"code":"76883","type":"HCPCS"}],"standard_charges":[{"gross_charge":480.0,"discounted_cash":360.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ECHO EXAM OF HEAD","code_information":[{"code":"Px00040210001","type":"CDM"},{"code":"76506","type":"HCPCS"}],"standard_charges":[{"gross_charge":609.0,"discounted_cash":456.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC US EXAM OF HEAD AND NECK","code_information":[{"code":"Px00040210004","type":"CDM"},{"code":"76536","type":"HCPCS"}],"standard_charges":[{"gross_charge":1138.0,"discounted_cash":853.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC US EXAM CHEST","code_information":[{"code":"Px00040210005","type":"CDM"},{"code":"76604","type":"HCPCS"}],"standard_charges":[{"gross_charge":762.0,"discounted_cash":571.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC US EXAM ABDOMEN COMPLETE","code_information":[{"code":"Px00040210008","type":"CDM"},{"code":"76700","type":"HCPCS"}],"standard_charges":[{"gross_charge":1374.0,"discounted_cash":1030.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC US EXAM PELVIC LIMITED","code_information":[{"code":"Px00040210009","type":"CDM"},{"code":"76857","type":"HCPCS"}],"standard_charges":[{"gross_charge":480.0,"discounted_cash":360.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC US RETROPERITONEAL COMPLETE","code_information":[{"code":"Px00040210010","type":"CDM"},{"code":"76770","type":"HCPCS"}],"standard_charges":[{"gross_charge":1998.0,"discounted_cash":1498.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC US RETROPERITONEAL LIMITED","code_information":[{"code":"Px00040210011","type":"CDM"},{"code":"76775","type":"HCPCS"}],"standard_charges":[{"gross_charge":1815.0,"discounted_cash":1361.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC US EXAM KIDNEY TRANSPLANT W/DOPPLER","code_information":[{"code":"Px00040210012","type":"CDM"},{"code":"76776","type":"HCPCS"}],"standard_charges":[{"gross_charge":1309.0,"discounted_cash":981.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC US SPINAL CANAL","code_information":[{"code":"Px00040210013","type":"CDM"},{"code":"76800","type":"HCPCS"}],"standard_charges":[{"gross_charge":455.0,"discounted_cash":341.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC US OB LT 14 WKS SINGLE FETUS CDM","code_information":[{"code":"Px00040210014","type":"CDM"},{"code":"76801","type":"HCPCS"}],"standard_charges":[{"gross_charge":670.0,"discounted_cash":502.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC US OB LT 14 WKS ADDL FETUS CDM","code_information":[{"code":"Px00040210015","type":"CDM"},{"code":"76802","type":"HCPCS"}],"standard_charges":[{"gross_charge":384.0,"discounted_cash":288.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC US OB AFTER 1ST TRIMEST 1/1ST FETUS","code_information":[{"code":"Px00040210016","type":"CDM"},{"code":"76805","type":"HCPCS"}],"standard_charges":[{"gross_charge":694.0,"discounted_cash":520.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC US OB AFTER 1ST TRIMESTER ADD FETUS","code_information":[{"code":"Px00040210017","type":"CDM"},{"code":"76810","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":140.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC US OB DETAILED SINGLE FETUS CDM","code_information":[{"code":"Px00040210018","type":"CDM"},{"code":"76811","type":"HCPCS"}],"standard_charges":[{"gross_charge":1431.0,"discounted_cash":1073.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC US OB LIMITED FETUS(S) CDM","code_information":[{"code":"Px00040210022","type":"CDM"},{"code":"76815","type":"HCPCS"}],"standard_charges":[{"gross_charge":1378.0,"discounted_cash":1033.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC US OB FOLLOW-UP PER FETUS CDM","code_information":[{"code":"Px00040210023","type":"CDM"},{"code":"76816","type":"HCPCS"}],"standard_charges":[{"gross_charge":416.0,"discounted_cash":312.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC US OB TRANSVAGINAL CDM","code_information":[{"code":"Px00040210024","type":"CDM"},{"code":"76817","type":"HCPCS"}],"standard_charges":[{"gross_charge":410.0,"discounted_cash":307.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC US FETAL BIOPHYS PROFILE W/NST CDM","code_information":[{"code":"Px00040210025","type":"CDM"},{"code":"76818","type":"HCPCS"}],"standard_charges":[{"gross_charge":1075.0,"discounted_cash":806.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC US FETAL BIOPHYS PROFILE W/O NST CDM","code_information":[{"code":"Px00040210026","type":"CDM"},{"code":"76819","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":732.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC US TRANSVAGINAL NON-OB","code_information":[{"code":"Px00040210033","type":"CDM"},{"code":"76830","type":"HCPCS"}],"standard_charges":[{"gross_charge":635.0,"discounted_cash":476.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ECHO EXAM UTERUS","code_information":[{"code":"Px00040210034","type":"CDM"},{"code":"76831","type":"HCPCS"}],"standard_charges":[{"gross_charge":832.0,"discounted_cash":624.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC US EXAM PELVIC FOLLICLE LIMITED","code_information":[{"code":"Px00040210035","type":"CDM"},{"code":"76857","type":"HCPCS"}],"standard_charges":[{"gross_charge":480.0,"discounted_cash":360.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC US EXAM SCROTUM & CONTENTS","code_information":[{"code":"Px00040210036","type":"CDM"},{"code":"76870","type":"HCPCS"}],"standard_charges":[{"gross_charge":927.0,"discounted_cash":695.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC US JOINT COMPLETE","code_information":[{"code":"Px00040210041","type":"CDM"},{"code":"76881","type":"HCPCS"}],"standard_charges":[{"gross_charge":673.0,"discounted_cash":504.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC US LMTD JT/FCL EVAL NONVASC XTR STRUX R-T W/IMG CDM","code_information":[{"code":"Px00040210043","type":"CDM"},{"code":"76882","type":"HCPCS"}],"standard_charges":[{"gross_charge":437.0,"discounted_cash":327.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC US INFANT HIPS DYNAMIC","code_information":[{"code":"Px00040210045","type":"CDM"},{"code":"76885","type":"HCPCS"}],"standard_charges":[{"gross_charge":470.0,"discounted_cash":352.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC US GUIDE COMPRESSION REPAIR","code_information":[{"code":"Px00040210048","type":"CDM"},{"code":"76936","type":"HCPCS"}],"standard_charges":[{"gross_charge":2372.0,"discounted_cash":1779.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC US GUIDE VASCULAR ACCESS","code_information":[{"code":"Px00040210049","type":"CDM"},{"code":"76937","type":"HCPCS"}],"standard_charges":[{"gross_charge":5653.0,"discounted_cash":4239.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":185.0,"discounted_cash":138.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC US GUIDANCE NEEDLE PLACEMENT IMG S&I CDM","code_information":[{"code":"Px00040210052","type":"CDM"},{"code":"76942","type":"HCPCS"}],"standard_charges":[{"gross_charge":5653.0,"discounted_cash":4239.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":955.0,"discounted_cash":716.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC US GUIDE INTERSTITIAL RADIOTHERAPY","code_information":[{"code":"Px00040210056","type":"CDM"},{"code":"76965","type":"HCPCS"}],"standard_charges":[{"gross_charge":597.0,"discounted_cash":447.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"},{"gross_charge":1628.0,"discounted_cash":1221.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD RADIATION ONCOLOGY"}]},{"description":"HC US GUIDE INTRAOPERATIVE","code_information":[{"code":"Px00040210059","type":"CDM"},{"code":"76998","type":"HCPCS"}],"standard_charges":[{"gross_charge":776.0,"discounted_cash":582.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ECHO EXAMINATION PROCEDURE UNLISTED","code_information":[{"code":"Px00040210061","type":"CDM"},{"code":"76999","type":"HCPCS"}],"standard_charges":[{"gross_charge":486.0,"discounted_cash":364.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC POCUS US GUIDE FOR BIOPSY NEEDLE PLACEMENT","code_information":[{"code":"Px00040210062","type":"CDM"},{"code":"76942","type":"HCPCS"}],"standard_charges":[{"gross_charge":955.0,"discounted_cash":716.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC US PELVIC NON-OB COMPLETE","code_information":[{"code":"Px00040210093","type":"CDM"},{"code":"76856","type":"HCPCS"}],"standard_charges":[{"gross_charge":1058.0,"discounted_cash":793.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC US ABDOMEN LIMITED","code_information":[{"code":"Px00040210104","type":"CDM"},{"code":"76705","type":"HCPCS"}],"standard_charges":[{"gross_charge":525.0,"discounted_cash":393.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC US LMTD JT/FCL EVAL NONVASC XTR STRUX R-T W/IMG CDM","code_information":[{"code":"Px00040210112","type":"CDM"},{"code":"76882","type":"HCPCS"}],"standard_charges":[{"gross_charge":437.0,"discounted_cash":327.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC US GUIDANCE NEEDLE PLACEMENT IMG S&I CDM","code_information":[{"code":"Px00040210113","type":"CDM"},{"code":"76942","type":"HCPCS"}],"standard_charges":[{"gross_charge":5653.0,"discounted_cash":4239.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":955.0,"discounted_cash":716.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC US BREAST UNI COMPLETE","code_information":[{"code":"Px00040210136","type":"CDM"},{"code":"76641","type":"HCPCS"}],"standard_charges":[{"gross_charge":387.0,"discounted_cash":290.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC US BREAST UNI LIMITED","code_information":[{"code":"Px00040210137","type":"CDM"},{"code":"76642","type":"HCPCS"}],"standard_charges":[{"gross_charge":387.0,"discounted_cash":290.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC US ABD AORTA SCRN AAA","code_information":[{"code":"Px00040210142","type":"CDM"},{"code":"76706","type":"HCPCS"}],"standard_charges":[{"gross_charge":1297.0,"discounted_cash":972.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MAMMO SCREEN BIL W CAD","code_information":[{"code":"Px00040310004","type":"CDM"},{"code":"77067","type":"HCPCS"}],"standard_charges":[{"gross_charge":451.0,"discounted_cash":338.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MAMMO SCREEN UNIL/BIL W CAD","code_information":[{"code":"Px00040310005","type":"CDM"},{"code":"77067","type":"HCPCS"}],"standard_charges":[{"gross_charge":451.0,"discounted_cash":338.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC INTUBATION CDM","code_information":[{"code":"Px00041010003","type":"CDM"},{"code":"31500","type":"HCPCS"}],"standard_charges":[{"gross_charge":1745.0,"discounted_cash":1308.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BLOOD SAMPLING CAPILLARY CDM","code_information":[{"code":"Px00041010004","type":"CDM"},{"code":"36416","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":20.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BLOOD DRAW ARTERIAL PUNCTURE CDM","code_information":[{"code":"Px00041010006","type":"CDM"},{"code":"36600","type":"HCPCS"}],"standard_charges":[{"gross_charge":440.0,"discounted_cash":330.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CARDIOPULMONARY RESUSCITATION CDM","code_information":[{"code":"Px00041010007","type":"CDM"},{"code":"92950","type":"HCPCS"}],"standard_charges":[{"gross_charge":946.0,"discounted_cash":709.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PULMONARY MECHANICS (VITAL CAPACITY TOTAL -  SEPARATE PROCEDURE)","code_information":[{"code":"Px00041010008","type":"CDM"},{"code":"94150","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":124.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PULSE OXIMETRY MULT MEASUREMENTS ONCE/DAY CDM","code_information":[{"code":"Px00041010012","type":"CDM"},{"code":"94761","type":"HCPCS"}],"standard_charges":[{"gross_charge":656.0,"discounted_cash":492.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PULSE OXIMETRY OVERNIGHT STUDY CDM","code_information":[{"code":"Px00041010013","type":"CDM"},{"code":"94762","type":"HCPCS"}],"standard_charges":[{"gross_charge":589.0,"discounted_cash":441.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MECHANICAL CHEST WALL OSCILL CDM","code_information":[{"code":"Px00041010023","type":"CDM"},{"code":"94669","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":225.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MANJ CH WALL FACILITATE LNG FUNCJ 1 DEMO&/EVAL CDM","code_information":[{"code":"Px00041010261","type":"CDM"},{"code":"94667","type":"HCPCS"}],"standard_charges":[{"gross_charge":855.0,"discounted_cash":641.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MANJ CHEST WALL FACILITATE LUNG FUNCTION SUBSQ CDM","code_information":[{"code":"Px00041010263","type":"CDM"},{"code":"94668","type":"HCPCS"}],"standard_charges":[{"gross_charge":458.0,"discounted_cash":343.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MECHANICAL VENTILATION FIRST DAY CDM","code_information":[{"code":"Px00041010290","type":"CDM"},{"code":"94002","type":"HCPCS"}],"standard_charges":[{"gross_charge":5060.0,"discounted_cash":3795.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MECHANICAL VENTILATION SUBSEQUENT DAY CDM","code_information":[{"code":"Px00041010296","type":"CDM"},{"code":"94003","type":"HCPCS"}],"standard_charges":[{"gross_charge":3240.0,"discounted_cash":2430.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC NONINVASIVE VENTILATION/CPAP DAILY CDM","code_information":[{"code":"Px00041010325","type":"CDM"},{"code":"94660","type":"HCPCS"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":677.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC NONINVASIVE VENTILATION/CPAP SUBSEQUENT DAY CDM","code_information":[{"code":"Px00041010328","type":"CDM"},{"code":"94660","type":"HCPCS"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":677.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PERCUSSION VIBRATION POSTURAL DRAINAGE 3 POSITIONS OR LESS","code_information":[{"code":"Px00041010338","type":"CDM"},{"code":"94668","type":"HCPCS"}],"standard_charges":[{"gross_charge":458.0,"discounted_cash":343.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PERCUSSION VIBRATPOSTURAL DRAINAGE GT/4 POSITIONS CDM","code_information":[{"code":"Px00041010341","type":"CDM"},{"code":"94668","type":"HCPCS"}],"standard_charges":[{"gross_charge":458.0,"discounted_cash":343.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC INHALATION TREATMENT DAILY","code_information":[{"code":"Px00041210006","type":"CDM"},{"code":"94640","type":"HCPCS"}],"standard_charges":[{"gross_charge":533.0,"discounted_cash":399.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PENTAMIDINE AERSL INHALATION PNEUMOCYSTIS/PROPH","code_information":[{"code":"Px00041210007","type":"CDM"},{"code":"94642","type":"HCPCS"}],"standard_charges":[{"gross_charge":932.0,"discounted_cash":699.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC REMOTE THERAPEUTIC MNTR 1ST SETUP&PT EDUCAJ EQP CDM","code_information":[{"code":"Px00042000005","type":"CDM"},{"code":"98975","type":"HCPCS"}],"standard_charges":[{"gross_charge":516.0,"discounted_cash":387.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC REM THER MNTR DEV SPLY MUSCSKEL SYS EA 30D CDM","code_information":[{"code":"Px00042000007","type":"CDM"},{"code":"98977","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":120.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC REMOTE THER MNTR TX MGMT PHYS/QHP 1ST 20 MIN","code_information":[{"code":"Px00042000050","type":"CDM"},{"code":"98980","type":"HCPCS"}],"standard_charges":[{"gross_charge":653.0,"discounted_cash":489.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC REMOTE THER MNTR TX MGMT PHYS/QHP EA ADDL 20 MIN","code_information":[{"code":"Px00042000051","type":"CDM"},{"code":"98981","type":"HCPCS"}],"standard_charges":[{"gross_charge":639.0,"discounted_cash":479.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ORTHOTIC/PROSTH MGMT & TRAINING SBSQ ENCTR PER 15MIN","code_information":[{"code":"Px00042010003","type":"CDM"},{"code":"97763","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.0,"discounted_cash":99.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BFB TRAING W/EMG AND /MANOMETRY 1ST 15 MIN CNTCT CDM","code_information":[{"code":"Px00042010008","type":"CDM"},{"code":"90912","type":"HCPCS"}],"standard_charges":[{"gross_charge":664.0,"discounted_cash":498.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BFB TRAING W/EMG AND /MANOMETRY EA ADDL 15 MIN CNTCT CDM","code_information":[{"code":"Px00042010009","type":"CDM"},{"code":"90913","type":"HCPCS"}],"standard_charges":[{"gross_charge":332.0,"discounted_cash":249.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES CDM","code_information":[{"code":"Px00042010010","type":"CDM"},{"code":"97130","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":101.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES CDM","code_information":[{"code":"Px00042010011","type":"CDM"},{"code":"97129","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":101.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CRISIS TELEH 97110 THERAPEUTIC EXERCISES EA 15 MIN CDM","code_information":[{"code":"Px00042010014","type":"CDM"},{"code":"97110","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.0,"discounted_cash":104.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CRISIS TELEH 97112 NEUROMUSCUL REEDUCAT EA 15 MIN CDM","code_information":[{"code":"Px00042010015","type":"CDM"},{"code":"97112","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":146.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CRISIS TELEH 97116 GAIT TRAINING THERAPY EA 15 MIN CDM","code_information":[{"code":"Px00042010016","type":"CDM"},{"code":"97116","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.0,"discounted_cash":87.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CRISIS TELEH 97129 THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES CDM","code_information":[{"code":"Px00042010023","type":"CDM"},{"code":"97129","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":101.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CRISIS TELEH 97130 THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES CDM","code_information":[{"code":"Px00042010024","type":"CDM"},{"code":"97130","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":101.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CRISIS TELEH 97530 THERAPEUTIC ACTIVITIES EA 15 MIN","code_information":[{"code":"Px00042010028","type":"CDM"},{"code":"97530","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":90.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC STRAPPING UNNA BOOT","code_information":[{"code":"Px00042010080","type":"CDM"},{"code":"29580","type":"HCPCS"}],"standard_charges":[{"gross_charge":973.0,"discounted_cash":729.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC APPL MLTLAYR COMPRES LEG BELOW KNEE W/ANKLE FOOT BIL","code_information":[{"code":"Px00042010083","type":"CDM"},{"code":"29581","type":"HCPCS"}],"standard_charges":[{"gross_charge":973.0,"discounted_cash":729.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC APPL MLTLAYR COMPRES LEG BELOW KNEE W/ANKLE FOOT","code_information":[{"code":"Px00042010084","type":"CDM"},{"code":"29581","type":"HCPCS"}],"standard_charges":[{"gross_charge":973.0,"discounted_cash":729.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC APPL MLTLAYR COMPRES SYS UPARM LWARM HAND&FING","code_information":[{"code":"Px00042010099","type":"CDM"},{"code":"29584","type":"HCPCS"}],"standard_charges":[{"gross_charge":770.0,"discounted_cash":577.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BIOFEEDBACK TRAIN ANY METH","code_information":[{"code":"Px00042010102","type":"CDM"},{"code":"90901","type":"HCPCS"}],"standard_charges":[{"gross_charge":229.0,"discounted_cash":171.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CANALITH REPOSITIONING PROCEDURE - PER DAY","code_information":[{"code":"Px00042010108","type":"CDM"},{"code":"95992","type":"HCPCS"}],"standard_charges":[{"gross_charge":408.0,"discounted_cash":306.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC APPL MODALITY 1 OR MORE AREAS TRACTION MECHANICAL","code_information":[{"code":"Px00042010110","type":"CDM"},{"code":"97012","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":79.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC APPL MODALITY 1 OR MORE AREAS ELEC STIMJ UNATTENDED","code_information":[{"code":"Px00042010113","type":"CDM"},{"code":"97014","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.0,"discounted_cash":83.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC INFRARED THERAPY","code_information":[{"code":"Px00042010121","type":"CDM"},{"code":"97026","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.0,"discounted_cash":132.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC APPL MODALITY TO ONE OR MORE AREAS - ULTRAVIOLET","code_information":[{"code":"Px00042010123","type":"CDM"},{"code":"97028","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":47.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC APPL MODALITY 1 OR MORE AREAS ATTENDED ESTIM EA 15 MIN","code_information":[{"code":"Px00042010124","type":"CDM"},{"code":"97032","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":108.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC APPL MODALITY 1 OR MORE AREAS CONTRAST BATHS EA 15 MIN","code_information":[{"code":"Px00042010126","type":"CDM"},{"code":"97034","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":72.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC APPL MODALITY 1 OR MORE AREAS ULTRASOUND EA 15 MIN","code_information":[{"code":"Px00042010127","type":"CDM"},{"code":"97035","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.0,"discounted_cash":87.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC THER EXERCISES PX 1 OR MORE AREAS EACH 15 MIN","code_information":[{"code":"Px00042010131","type":"CDM"},{"code":"97110","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.0,"discounted_cash":104.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC NEUROMUSC REEDUCA THER PX 1 OR MORE AREAS EACH 15 MIN","code_information":[{"code":"Px00042010139","type":"CDM"},{"code":"97112","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":146.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC AQUATIC THERAPY/EXERCISES - 15 MIN","code_information":[{"code":"Px00042010141","type":"CDM"},{"code":"97113","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.0,"discounted_cash":141.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC THER PX 1 OR MORE AREAS EA 15 MIN GAIT TRAING W/STAIR","code_information":[{"code":"Px00042010142","type":"CDM"},{"code":"97116","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.0,"discounted_cash":87.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC THER PX 1 OR MORE AREAS EACH 15 MINUTES MASSAGE","code_information":[{"code":"Px00042010144","type":"CDM"},{"code":"97124","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":121.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MANUAL THERAPY TQS 1 OR MORE REGIONS EACH 15 MINUTES","code_information":[{"code":"Px00042010150","type":"CDM"},{"code":"97140","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN","code_information":[{"code":"Px00042010160","type":"CDM"},{"code":"97530","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC WHEELCHAIR MGMT EA 15 MIN","code_information":[{"code":"Px00042010165","type":"CDM"},{"code":"97542","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":99.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC NEG PRESS WOUND TX UTILIZING DME EQUIP LTE/50 SQ CM","code_information":[{"code":"Px00042010188","type":"CDM"},{"code":"97605","type":"HCPCS"}],"standard_charges":[{"gross_charge":638.0,"discounted_cash":478.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC NEG PRESS WOUND TX UTILIZING DME EQUIP GT/50 SQ CM","code_information":[{"code":"Px00042010195","type":"CDM"},{"code":"97606","type":"HCPCS"}],"standard_charges":[{"gross_charge":964.0,"discounted_cash":723.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PHYSICAL PERFORMANCE TEST/MEAS W/REPRT EA 15 MIN","code_information":[{"code":"Px00042010248","type":"CDM"},{"code":"97750","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ORTHOTICS MGMT & TRAING INITIAL ENCTR EA 15 MINS","code_information":[{"code":"Px00042010264","type":"CDM"},{"code":"97760","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":116.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PROSTHETICS TRAINING INITIAL ENCTR EA 15 MINS","code_information":[{"code":"Px00042010265","type":"CDM"},{"code":"97761","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":93.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC VIRTUAL REMOTE THER MNTR TX MGMT PHYS/QHP 1ST 20 MIN","code_information":[{"code":"Px00042050000","type":"CDM"},{"code":"98980","type":"HCPCS"}],"standard_charges":[{"gross_charge":653.0,"discounted_cash":489.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC VIRTUAL REMOTE THER MNTR TX MGMT PHYS/QHP EA ADDL 20 MIN","code_information":[{"code":"Px00042050001","type":"CDM"},{"code":"98981","type":"HCPCS"}],"standard_charges":[{"gross_charge":639.0,"discounted_cash":479.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC VIRTUAL THERAPY SPEECH-HEARING THERAPY INDIV CDM","code_information":[{"code":"Px00042050002","type":"CDM"},{"code":"92507","type":"HCPCS"}],"standard_charges":[{"gross_charge":495.0,"discounted_cash":371.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC VIRTUAL THERAPY EVALUATION OF SPEECH SOUND PRODUCTION ARTICULATE CDM","code_information":[{"code":"Px00042050005","type":"CDM"},{"code":"92522","type":"HCPCS"}],"standard_charges":[{"gross_charge":433.0,"discounted_cash":324.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC VIRTUAL THERAPY SPEECH SOUND LANG COMPREHEN EXTENDED CDM","code_information":[{"code":"Px00042050006","type":"CDM"},{"code":"92523","type":"HCPCS"}],"standard_charges":[{"gross_charge":433.0,"discounted_cash":324.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC VIRTUAL THERAPY BEHAVIORAL & QUALIT ANALYSIS VOICE AND RESONANCE CDM","code_information":[{"code":"Px00042050007","type":"CDM"},{"code":"92524","type":"HCPCS"}],"standard_charges":[{"gross_charge":433.0,"discounted_cash":324.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC VIRTUAL THERAPY STANDARDIZED COGNITIVE PERFORMANCE TESTING PER HOUR CDM","code_information":[{"code":"Px00042050008","type":"CDM"},{"code":"96125","type":"HCPCS"}],"standard_charges":[{"gross_charge":402.0,"discounted_cash":301.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC VIRTUAL THERAPY THER EXERCISES PX 1 OR MORE AREAS EACH 15MINS CDM","code_information":[{"code":"Px00042050009","type":"CDM"},{"code":"97110","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC VIRTUAL THERAPY NEUROMUSC REEDUCA PX 1 OR MORE AREAS EACH 15MINS CDM","code_information":[{"code":"Px00042050010","type":"CDM"},{"code":"97112","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.0,"discounted_cash":132.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC VIRTUAL THERAPY PX 1 OR MORE AREAS EA 15 MIN GAIT TRAING W/STAIR CDM","code_information":[{"code":"Px00042050011","type":"CDM"},{"code":"97116","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":78.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC VIRTUAL THERAPY THER IVNTJ COG FUNCJ CNTCT 1ST 15MINS CDM","code_information":[{"code":"Px00042050012","type":"CDM"},{"code":"97129","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":92.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC VIRTUAL THERAPY THER IVNTJ COG FUNCJ CNTCT EA ADDL 15MINS CDM","code_information":[{"code":"Px00042050013","type":"CDM"},{"code":"97130","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":92.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC VIRTUAL THERAPY PT EVALUATION LOW COMPLEX CDM","code_information":[{"code":"Px00042050014","type":"CDM"},{"code":"97161","type":"HCPCS"}],"standard_charges":[{"gross_charge":361.0,"discounted_cash":270.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC VIRTUAL THERAPY PT EVALUATION MOD COMPLEX CDM","code_information":[{"code":"Px00042050015","type":"CDM"},{"code":"97162","type":"HCPCS"}],"standard_charges":[{"gross_charge":361.0,"discounted_cash":270.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC VIRTUAL THERAPY PT EVALUATION HIGH COMPLEX CDM","code_information":[{"code":"Px00042050016","type":"CDM"},{"code":"97163","type":"HCPCS"}],"standard_charges":[{"gross_charge":361.0,"discounted_cash":270.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC VIRTUAL THERAPY PT RE-EVAL EST PLAN CARE 20MINS CDM","code_information":[{"code":"Px00042050017","type":"CDM"},{"code":"97164","type":"HCPCS"}],"standard_charges":[{"gross_charge":341.0,"discounted_cash":255.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC VIRTUAL THERAPY OT EVALUATION LOW COMPLEX CDM","code_information":[{"code":"Px00042050018","type":"CDM"},{"code":"97165","type":"HCPCS"}],"standard_charges":[{"gross_charge":361.0,"discounted_cash":270.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC VIRTUAL THERAPY OT EVALUATION MOD COMPLEX CDM","code_information":[{"code":"Px00042050019","type":"CDM"},{"code":"97166","type":"HCPCS"}],"standard_charges":[{"gross_charge":361.0,"discounted_cash":270.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC VIRTUAL THERAPY OT EVALUATION HIGH COMPLEX CDM","code_information":[{"code":"Px00042050020","type":"CDM"},{"code":"97167","type":"HCPCS"}],"standard_charges":[{"gross_charge":361.0,"discounted_cash":270.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC VIRTUAL THERAPY OT RE-EVAL EST PLAN CARE 30MINS CDM","code_information":[{"code":"Px00042050021","type":"CDM"},{"code":"97168","type":"HCPCS"}],"standard_charges":[{"gross_charge":341.0,"discounted_cash":255.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC VIRTUAL THERAPY SELF-CARE/HOME MGMT TRAINING EACH 15MINS CDM","code_information":[{"code":"Px00042050022","type":"CDM"},{"code":"97535","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.0,"discounted_cash":99.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC VIRTUAL THERAPY REMOTE THERAPEUTIC MNTR 1ST SETUP&PT EDUCAJ EQP CDM","code_information":[{"code":"Px00042050023","type":"CDM"},{"code":"98975","type":"HCPCS"}],"standard_charges":[{"gross_charge":420.0,"discounted_cash":315.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC VIRTUAL THERAPY REM THER MNTR DEV SUPPLY RESPIR SYS EA 30D CDM","code_information":[{"code":"Px00042050024","type":"CDM"},{"code":"98976","type":"HCPCS"}],"standard_charges":[{"gross_charge":420.0,"discounted_cash":315.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC VIRTUAL THERAPY THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15MINS CDM","code_information":[{"code":"Px00042050025","type":"CDM"},{"code":"97530","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":86.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC VIRTUAL REM THER MNTR DEV SPLY W/REC MUSCSKEL SYS EA 30 DAYS","code_information":[{"code":"Px00042050026","type":"CDM"},{"code":"98977","type":"HCPCS"}],"standard_charges":[{"gross_charge":420.0,"discounted_cash":315.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PT EVALUATION LOW COMPLEX CDM","code_information":[{"code":"Px00042410066","type":"CDM"},{"code":"97161","type":"HCPCS"}],"standard_charges":[{"gross_charge":397.0,"discounted_cash":297.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PT EVALUATION  MOD COMPLEX CDM","code_information":[{"code":"Px00042410067","type":"CDM"},{"code":"97162","type":"HCPCS"}],"standard_charges":[{"gross_charge":397.0,"discounted_cash":297.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PT EVALUATION HIGH COMPLEX","code_information":[{"code":"Px00042410068","type":"CDM"},{"code":"97163","type":"HCPCS"}],"standard_charges":[{"gross_charge":397.0,"discounted_cash":297.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PT RE-EVAL EST PLAN CARE 20 MINS","code_information":[{"code":"Px00042410069","type":"CDM"},{"code":"97164","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":281.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CRISIS TELEH 97161 PT EVALUATION LOW COMPLEX CDM","code_information":[{"code":"Px00042410070","type":"CDM"},{"code":"97161","type":"HCPCS"}],"standard_charges":[{"gross_charge":397.0,"discounted_cash":297.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CRISIS TELEH 97162 PT EVALUATION  MOD COMPLEX CDM","code_information":[{"code":"Px00042410071","type":"CDM"},{"code":"97162","type":"HCPCS"}],"standard_charges":[{"gross_charge":397.0,"discounted_cash":297.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CRISIS TELEH 97163 PT EVALUATION HIGH COMPLEX CDM","code_information":[{"code":"Px00042410072","type":"CDM"},{"code":"97163","type":"HCPCS"}],"standard_charges":[{"gross_charge":397.0,"discounted_cash":297.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CRISIS TELEH 97164 PT RE-EVAL ESTAB PLAN OF CARE CDM","code_information":[{"code":"Px00042410073","type":"CDM"},{"code":"97164","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":281.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CAREGIVER IND FUNCTIONAL TRAINING W/O PATIENT PRESENT 1ST 30 MIN CDM","code_information":[{"code":"Px00043000007","type":"CDM"},{"code":"97550","type":"HCPCS"}],"standard_charges":[{"gross_charge":267.0,"discounted_cash":200.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CAREGIVER IND FUNCTIONAL TRAINING W/O PATIENT PRESENT EA ADD 15 MIN CDM","code_information":[{"code":"Px00043000008","type":"CDM"},{"code":"97551","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":108.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC APPL MODALITY 1 OR MORE AREAS PARAFFIN BATH","code_information":[{"code":"Px00043010004","type":"CDM"},{"code":"97018","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.0,"discounted_cash":82.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CRISIS TELEH 97535 SELF CARE MGMT TRAINING EA 15 MIN CDM","code_information":[{"code":"Px00043010005","type":"CDM"},{"code":"97535","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":109.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC SENSORY INTEGRATIVE TECHNIQUES EACH 15 MINUTES","code_information":[{"code":"Px00043010007","type":"CDM"},{"code":"97533","type":"HCPCS"}],"standard_charges":[{"gross_charge":174.0,"discounted_cash":130.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC SELF-CARE/HOME MGMT TRAINING EACH 15 MINUTES","code_information":[{"code":"Px00043010008","type":"CDM"},{"code":"97535","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":109.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC SELF CARE MNGMENT TRAINING - ADL","code_information":[{"code":"Px00043010013","type":"CDM"},{"code":"97535","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":109.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC COMMUNITY/WORK REINTEGRATION EA 15 MIN","code_information":[{"code":"Px00043010014","type":"CDM"},{"code":"97537","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.0,"discounted_cash":132.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CRISIS TELEH 97755 ASSISTIVE TECHNOLOGY ASSESS CDM","code_information":[{"code":"Px00043010032","type":"CDM"},{"code":"97755","type":"HCPCS"}],"standard_charges":[{"gross_charge":174.0,"discounted_cash":130.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC OT EVALUATION LOW COMPLEX","code_information":[{"code":"Px00043410045","type":"CDM"},{"code":"97165","type":"HCPCS"}],"standard_charges":[{"gross_charge":397.0,"discounted_cash":297.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC OT EVALUATION MOD COMPLEXITY","code_information":[{"code":"Px00043410046","type":"CDM"},{"code":"97166","type":"HCPCS"}],"standard_charges":[{"gross_charge":397.0,"discounted_cash":297.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC OT EVALUATION HIGH COMPLEX","code_information":[{"code":"Px00043410047","type":"CDM"},{"code":"97167","type":"HCPCS"}],"standard_charges":[{"gross_charge":397.0,"discounted_cash":297.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC OT RE-EVALUATION ESTABLISHED PLAN OF CARE","code_information":[{"code":"Px00043410048","type":"CDM"},{"code":"97168","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":281.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CRISIS TELEH 97165 OT EVALUATION LOW COMPLEX CDM","code_information":[{"code":"Px00043410050","type":"CDM"},{"code":"97165","type":"HCPCS"}],"standard_charges":[{"gross_charge":397.0,"discounted_cash":297.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CRISIS TELEH 97166 OT EVALUATION MOD COMPLEXITY CDM","code_information":[{"code":"Px00043410051","type":"CDM"},{"code":"97166","type":"HCPCS"}],"standard_charges":[{"gross_charge":397.0,"discounted_cash":297.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CRISIS TELEH 97167 OT EVALUATION HIGH COMPLEX CDM","code_information":[{"code":"Px00043410052","type":"CDM"},{"code":"97167","type":"HCPCS"}],"standard_charges":[{"gross_charge":397.0,"discounted_cash":297.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC TX SPEECH/LANG/VOICE COMMJ/AUDITORY PROCESS - INDIVIDUAL","code_information":[{"code":"Px00044010016","type":"CDM"},{"code":"92507","type":"HCPCS"}],"standard_charges":[{"gross_charge":495.0,"discounted_cash":371.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC SPEECH LANG VOICE COMMJ AUDITRY - GROUP 2 OR MORE CDM","code_information":[{"code":"Px00044010024","type":"CDM"},{"code":"92508","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":68.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ORAL FUNCTION THERAPY","code_information":[{"code":"Px00044010042","type":"CDM"},{"code":"92526","type":"HCPCS"}],"standard_charges":[{"gross_charge":484.0,"discounted_cash":363.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ORAL SPEECH DEVICE EVAL","code_information":[{"code":"Px00044010050","type":"CDM"},{"code":"92597","type":"HCPCS"}],"standard_charges":[{"gross_charge":561.0,"discounted_cash":420.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC USE OF SPEECH DEVICE SERVICE CDM","code_information":[{"code":"Px00044010068","type":"CDM"},{"code":"92609","type":"HCPCS"}],"standard_charges":[{"gross_charge":499.0,"discounted_cash":374.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC STANDARDIZED COGNITIVE PERFORMANCE TESTING PER HOUR CDM","code_information":[{"code":"Px00044010083","type":"CDM"},{"code":"96125","type":"HCPCS"}],"standard_charges":[{"gross_charge":402.0,"discounted_cash":301.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC EVAL SPEECH SOUND PRODUCT LANGUAGE COMPREHENSION CDM","code_information":[{"code":"Px00044010126","type":"CDM"},{"code":"92523","type":"HCPCS"}],"standard_charges":[{"gross_charge":433.0,"discounted_cash":324.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BEHAVIORAL & QUALIT ANALYSIS VOICE AND RESONANCE CDM","code_information":[{"code":"Px00044010127","type":"CDM"},{"code":"92524","type":"HCPCS"}],"standard_charges":[{"gross_charge":433.0,"discounted_cash":324.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CRISIS TELEH 92507 SPEECH/HEARING THERAPY - INDIV CDM","code_information":[{"code":"Px00044010145","type":"CDM"},{"code":"92507","type":"HCPCS"}],"standard_charges":[{"gross_charge":495.0,"discounted_cash":371.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC EX FOR SPEECH DEVICE RX 1HR","code_information":[{"code":"Px00044410022","type":"CDM"},{"code":"92607","type":"HCPCS"}],"standard_charges":[{"gross_charge":431.0,"discounted_cash":323.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC EX FOR SPEECH DEVICE RX EA ADDL 30 MIN","code_information":[{"code":"Px00044410025","type":"CDM"},{"code":"92608","type":"HCPCS"}],"standard_charges":[{"gross_charge":217.0,"discounted_cash":162.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC EVALUATE SWALLOWING FUNCTION","code_information":[{"code":"Px00044410026","type":"CDM"},{"code":"92610","type":"HCPCS"}],"standard_charges":[{"gross_charge":406.0,"discounted_cash":304.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC EVALUATE SWALLOWING FUNCTION - LTD","code_information":[{"code":"Px00044410040","type":"CDM"},{"code":"92610","type":"HCPCS"}],"standard_charges":[{"gross_charge":406.0,"discounted_cash":304.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MOTION FLUOROSCOPY/SWALLOW","code_information":[{"code":"Px00044410043","type":"CDM"},{"code":"92611","type":"HCPCS"}],"standard_charges":[{"gross_charge":687.0,"discounted_cash":515.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ENDOSCOPY SWALLOW TST (FEES)","code_information":[{"code":"Px00044410054","type":"CDM"},{"code":"92612","type":"HCPCS"}],"standard_charges":[{"gross_charge":695.0,"discounted_cash":521.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC EVALUATION OF SPEECH FLUENCY","code_information":[{"code":"Px00044410063","type":"CDM"},{"code":"92521","type":"HCPCS"}],"standard_charges":[{"gross_charge":433.0,"discounted_cash":324.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC EVALUATION OF SPEECH SOUND PRODUCTION ARTICULATE CDM","code_information":[{"code":"Px00044410064","type":"CDM"},{"code":"92522","type":"HCPCS"}],"standard_charges":[{"gross_charge":433.0,"discounted_cash":324.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CRISIS TELEH 92521 EVALUATION OF SPEECH FLUENCY CDM","code_information":[{"code":"Px00044410070","type":"CDM"},{"code":"92521","type":"HCPCS"}],"standard_charges":[{"gross_charge":433.0,"discounted_cash":324.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CRISIS TELEH 92522 EVALUATE SPEECH PRODUCTION CDM","code_information":[{"code":"Px00044410071","type":"CDM"},{"code":"92522","type":"HCPCS"}],"standard_charges":[{"gross_charge":433.0,"discounted_cash":324.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CRISIS TELEH 92523 SPEECH SOUND LANG COMPREHEN CDM","code_information":[{"code":"Px00044410072","type":"CDM"},{"code":"92523","type":"HCPCS"}],"standard_charges":[{"gross_charge":433.0,"discounted_cash":324.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CRISIS TELEH 92524 BEHAVRAL QUALIT ANALYS VOICE CDM","code_information":[{"code":"Px00044410073","type":"CDM"},{"code":"92524","type":"HCPCS"}],"standard_charges":[{"gross_charge":433.0,"discounted_cash":324.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED OPEN TREATMENT INTERPHALANGEAL JOINT DISLOCATION CDM","code_information":[{"code":"Px00045000001","type":"CDM"},{"code":"28675","type":"HCPCS"}],"standard_charges":[{"gross_charge":9152.0,"discounted_cash":6864.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED MANIPULATION KNEE JOINT UNDER GENERAL ANESTHESIA CDM","code_information":[{"code":"Px00045000002","type":"CDM"},{"code":"27570","type":"HCPCS"}],"standard_charges":[{"gross_charge":5083.0,"discounted_cash":3812.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TAP BLOCK BILATERAL BY INJECTION(S) CDM","code_information":[{"code":"Px00045000003","type":"CDM"},{"code":"64488","type":"HCPCS"}],"standard_charges":[{"gross_charge":3019.0,"discounted_cash":2264.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED HEMORRHOIDECTOMY NTRNL & XTRNL 1 COLUMN/GROUP CDM","code_information":[{"code":"Px00045000005","type":"CDM"},{"code":"46255","type":"HCPCS"}],"standard_charges":[{"gross_charge":9106.0,"discounted_cash":6829.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INJECTION AA&/STRD SCIATIC NERVE W/IMG GDN CDM","code_information":[{"code":"Px00045000006","type":"CDM"},{"code":"64445","type":"HCPCS"}],"standard_charges":[{"gross_charge":2283.0,"discounted_cash":1712.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INJECTION AA&/STRD FEM NRV CONT NFS CATH IMG GDN CDM","code_information":[{"code":"Px00045000007","type":"CDM"},{"code":"64448","type":"HCPCS"}],"standard_charges":[{"gross_charge":3019.0,"discounted_cash":2264.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED I&D VAGINAL HEMATOMA OBSTETRICAL/POSTPARTUM CDM","code_information":[{"code":"Px00045000008","type":"CDM"},{"code":"57022","type":"HCPCS"}],"standard_charges":[{"gross_charge":9154.0,"discounted_cash":6865.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED SIALOT SUBMNDBLR SUBLNGL/PRTD UNCOMP INTRAORAL CDM","code_information":[{"code":"Px00045000009","type":"CDM"},{"code":"42330","type":"HCPCS"}],"standard_charges":[{"gross_charge":10082.0,"discounted_cash":7561.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM CDM","code_information":[{"code":"Px00045000012","type":"CDM"},{"code":"11307","type":"HCPCS"}],"standard_charges":[{"gross_charge":638.0,"discounted_cash":478.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED ASPIRATION AND/OR INJECTION THYROID CYST CDM","code_information":[{"code":"Px00045000013","type":"CDM"},{"code":"60300","type":"HCPCS"}],"standard_charges":[{"gross_charge":2564.0,"discounted_cash":1923.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL TISSUE EXPANDER W/O INSERTION IMPLANT CDM","code_information":[{"code":"Px00045000014","type":"CDM"},{"code":"11971","type":"HCPCS"}],"standard_charges":[{"gross_charge":7942.0,"discounted_cash":5956.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INCISION FLEXOR TENDON SHEATH WRIST CDM","code_information":[{"code":"Px00045000015","type":"CDM"},{"code":"25001","type":"HCPCS"}],"standard_charges":[{"gross_charge":18736.0,"discounted_cash":14052.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TENOTOMY EXTENSOR HAND/FINGER OPEN EACH TENDON CDM","code_information":[{"code":"Px00045000016","type":"CDM"},{"code":"26460","type":"HCPCS"}],"standard_charges":[{"gross_charge":9218.0,"discounted_cash":6913.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TONSIL ASPIRATION CDM","code_information":[{"code":"Px00045000017","type":"CDM"},{"code":"45000017","type":"HCPCS"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":677.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DECOMPRESSION FASCIOTOMY THIGH&/KNEE 1 COMPONENT CDM","code_information":[{"code":"Px00045000019","type":"CDM"},{"code":"27496","type":"HCPCS"}],"standard_charges":[{"gross_charge":10548.0,"discounted_cash":7911.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TAP BLOCK UNILATERAL BY INJECTION(S) CDM","code_information":[{"code":"Px00045000020","type":"CDM"},{"code":"64486","type":"HCPCS"}],"standard_charges":[{"gross_charge":3019.0,"discounted_cash":2264.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INJECTION INTRALESIONAL UP TO AND INCLUD 7 LESIONS CDM","code_information":[{"code":"Px00045000021","type":"CDM"},{"code":"11900","type":"HCPCS"}],"standard_charges":[{"gross_charge":638.0,"discounted_cash":478.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED RECTUM FOREIGN BODY REMOVAL WITH SPECULUM AND/OR FORCEPS CDM","code_information":[{"code":"Px00045000022","type":"CDM"},{"code":"45999","type":"HCPCS"}],"standard_charges":[{"gross_charge":2555.0,"discounted_cash":1916.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INSERTION CERVICAL DILATOR SEPARATE PROCEDURE CDM","code_information":[{"code":"Px00045000023","type":"CDM"},{"code":"59200","type":"HCPCS"}],"standard_charges":[{"gross_charge":1034.0,"discounted_cash":775.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED J TUBE REPLACEMENT CDM","code_information":[{"code":"Px00045000024","type":"CDM"},{"code":"44799","type":"HCPCS"}],"standard_charges":[{"gross_charge":741.0,"discounted_cash":555.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED PRQ SKEL FIXJ FX GRT TOE PHLX/PHLG W/MANJ CDM","code_information":[{"code":"Px00045000025","type":"CDM"},{"code":"28496","type":"HCPCS"}],"standard_charges":[{"gross_charge":10548.0,"discounted_cash":7911.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED HEMORRHOID REDUCTION VIA FORCEP CDM","code_information":[{"code":"Px00045000030","type":"CDM"},{"code":"46999","type":"HCPCS"}],"standard_charges":[{"gross_charge":2555.0,"discounted_cash":1916.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REMOTE THERAPEUTIC MNTR 1ST SETUP&PT EDUCAJ EQP CDM","code_information":[{"code":"Px00045000032","type":"CDM"},{"code":"98975","type":"HCPCS"}],"standard_charges":[{"gross_charge":516.0,"discounted_cash":387.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED LOW COST SKIN SUB APP TO TRUNK/ARMS/LEGS TO 100 SQ CM 1ST 25 SQ CM","code_information":[{"code":"Px00045000051","type":"CDM"},{"code":"C5271","type":"HCPCS"}],"standard_charges":[{"gross_charge":2058.0,"discounted_cash":1543.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED LOW COST SKIN SUB APP TO TRNK/ARMS/LEGS TO 100 SQ CM EA ADD 25 SQ CM","code_information":[{"code":"Px00045000052","type":"CDM"},{"code":"C5272","type":"HCPCS"}],"standard_charges":[{"gross_charge":1029.0,"discounted_cash":771.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED LOW COST SKIN SUB APP TO TRNK/ARMS/LEGS GT/ 100 SQ CM 1ST 100 SQ CM","code_information":[{"code":"Px00045000053","type":"CDM"},{"code":"C5273","type":"HCPCS"}],"standard_charges":[{"gross_charge":6116.0,"discounted_cash":4587.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED LOW COST SKIN SUB APP TO TRNK/ARMS/LEGS GT/100 SQ CM EA ADD 100 SQCM","code_information":[{"code":"Px00045000054","type":"CDM"},{"code":"C5274","type":"HCPCS"}],"standard_charges":[{"gross_charge":3057.0,"discounted_cash":2292.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED LOW COST SKIN SUB APP TO FACE/NECK/HAND/FEET TO 100 SQ CM 1ST 25 SQCM","code_information":[{"code":"Px00045000055","type":"CDM"},{"code":"C5275","type":"HCPCS"}],"standard_charges":[{"gross_charge":2058.0,"discounted_cash":1543.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED LOW COST SKIN SUB APP TO FACE/NECK/HAND/FEET EA ADD 25 SQ CM","code_information":[{"code":"Px00045000056","type":"CDM"},{"code":"C5276","type":"HCPCS"}],"standard_charges":[{"gross_charge":1029.0,"discounted_cash":771.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED LOW COST SKIN SUBST APP TO FACE/NECK/HAND/FEET 1ST 100 SQCM","code_information":[{"code":"Px00045000057","type":"CDM"},{"code":"C5277","type":"HCPCS"}],"standard_charges":[{"gross_charge":2058.0,"discounted_cash":1543.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED LOW COST SKIN SUB APP TO FACE/NECK/HAND/FEET EA ADD 100 SQCM","code_information":[{"code":"Px00045000058","type":"CDM"},{"code":"C5278","type":"HCPCS"}],"standard_charges":[{"gross_charge":1029.0,"discounted_cash":771.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INJECTION AA&/STRD AXILLARY NERVE W/IMG GDN CDM","code_information":[{"code":"Px00045000059","type":"CDM"},{"code":"64417","type":"HCPCS"}],"standard_charges":[{"gross_charge":3019.0,"discounted_cash":2264.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED NJX ANES STELLATE GANGLION CRV SYMPATHETIC CDM","code_information":[{"code":"Px00045000060","type":"CDM"},{"code":"64510","type":"HCPCS"}],"standard_charges":[{"gross_charge":3019.0,"discounted_cash":2264.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED RMVL DEVITAL TISS N-SLCTV DBRDMT W/O ANES 1 SESS CDM","code_information":[{"code":"Px00045000061","type":"CDM"},{"code":"97602","type":"HCPCS"}],"standard_charges":[{"gross_charge":638.0,"discounted_cash":478.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED EXC LESION/TUMOR DENTOALVEOLAR STRUX W/O RPR CDM","code_information":[{"code":"Px00045000062","type":"CDM"},{"code":"41825","type":"HCPCS"}],"standard_charges":[{"gross_charge":10082.0,"discounted_cash":7561.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DSTRJ TRIGEMINAL NRV SUPRAORB INFRAORB BRANCH CDM","code_information":[{"code":"Px00045000063","type":"CDM"},{"code":"64600","type":"HCPCS"}],"standard_charges":[{"gross_charge":3019.0,"discounted_cash":2264.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CORE NEEDLE BX LUNG/MEDIASTINUM PERQ W/IMG CDM","code_information":[{"code":"Px00045000064","type":"CDM"},{"code":"32408","type":"HCPCS"}],"standard_charges":[{"gross_charge":5314.0,"discounted_cash":3985.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INSERT TEMP PROSTATIC URETH STENT W/MEASUREMENT CDM","code_information":[{"code":"Px00045000066","type":"CDM"},{"code":"53855","type":"HCPCS"}],"standard_charges":[{"gross_charge":6572.0,"discounted_cash":4929.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INSERTION TUNNEL INTRAPERITONEAL CATH DIAL OPEN CDM","code_information":[{"code":"Px00045000067","type":"CDM"},{"code":"49421","type":"HCPCS"}],"standard_charges":[{"gross_charge":10890.0,"discounted_cash":8167.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE ABSCESS SUBMAXILLARY INTRAORAL CDM","code_information":[{"code":"Px00045000068","type":"CDM"},{"code":"42320","type":"HCPCS"}],"standard_charges":[{"gross_charge":1618.0,"discounted_cash":1213.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CONV EXT BIL DRG CATH TO INT-EXT BIL DRG CATH CDM","code_information":[{"code":"Px00045000069","type":"CDM"},{"code":"47535","type":"HCPCS"}],"standard_charges":[{"gross_charge":10890.0,"discounted_cash":8167.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED EXCHANGE BILIARY DRG CATHETER PRQ W/IMG GID RS&I CDM","code_information":[{"code":"Px00045000070","type":"CDM"},{"code":"47536","type":"HCPCS"}],"standard_charges":[{"gross_charge":10890.0,"discounted_cash":8167.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED EXCISION PILONIDAL CYST/SINUS COMPLICATED CDM","code_information":[{"code":"Px00045000071","type":"CDM"},{"code":"11772","type":"HCPCS"}],"standard_charges":[{"gross_charge":9154.0,"discounted_cash":6865.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DSTRJ NEUROFIBROMATA XTNSV FACE HEAD NECK GT/50 CDM","code_information":[{"code":"Px00045000072","type":"CDM"},{"code":"0419T","type":"HCPCS"}],"standard_charges":[{"gross_charge":1785.0,"discounted_cash":1338.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DSTRJ NEUROFIBROMATA XTNSV TRUNK EXTGT/100 CDM","code_information":[{"code":"Px00045000073","type":"CDM"},{"code":"0420T","type":"HCPCS"}],"standard_charges":[{"gross_charge":1785.0,"discounted_cash":1338.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INSERTION OF CATHETER VEIN CDM","code_information":[{"code":"Px00045000074","type":"CDM"},{"code":"36481","type":"HCPCS"}],"standard_charges":[{"gross_charge":1624.0,"discounted_cash":1218.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED BIOPSY SOFT TISSUE NECK/THORAX CDM","code_information":[{"code":"Px00045000076","type":"CDM"},{"code":"21550","type":"HCPCS"}],"standard_charges":[{"gross_charge":5314.0,"discounted_cash":3985.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INJECTION AA&/STRD BRACH PLEX CONT NFS CATH IMG CDM","code_information":[{"code":"Px00045000077","type":"CDM"},{"code":"64416","type":"HCPCS"}],"standard_charges":[{"gross_charge":3019.0,"discounted_cash":2264.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL OF SALIVARY STONE CDM","code_information":[{"code":"Px00045000078","type":"CDM"},{"code":"42699","type":"HCPCS"}],"standard_charges":[{"gross_charge":737.0,"discounted_cash":552.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED THRMBC ARTL/VEN GRF XCP HEMO GRF/FSTL W/REVJ GRF CDM","code_information":[{"code":"Px00045000080","type":"CDM"},{"code":"35876","type":"HCPCS"}],"standard_charges":[{"gross_charge":15563.0,"discounted_cash":11672.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED ABDOMINAL WOUND DEHISCENSE TREATMENT CDM","code_information":[{"code":"Px00045000081","type":"CDM"},{"code":"49900","type":"HCPCS"}],"standard_charges":[{"gross_charge":10890.0,"discounted_cash":8167.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED VBAC DELIVERY ONLY CDM","code_information":[{"code":"Px00045000082","type":"CDM"},{"code":"59612","type":"HCPCS"}],"standard_charges":[{"gross_charge":8693.0,"discounted_cash":6519.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED AMPUTATION TOE INTERPHALANGEAL JOINT CDM","code_information":[{"code":"Px00045000083","type":"CDM"},{"code":"28825","type":"HCPCS"}],"standard_charges":[{"gross_charge":10548.0,"discounted_cash":7911.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED URETHRAL FB REMOVAL CDM","code_information":[{"code":"Px00045000084","type":"CDM"},{"code":"53899","type":"HCPCS"}],"standard_charges":[{"gross_charge":660.0,"discounted_cash":495.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED EGD PLACE GASTROSTOMY TUBE CDM","code_information":[{"code":"Px00045000085","type":"CDM"},{"code":"43246","type":"HCPCS"}],"standard_charges":[{"gross_charge":4354.0,"discounted_cash":3265.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED UNLISTED PROCEDURE DENTOALVEOLAR STRUCTURES CDM","code_information":[{"code":"Px00045000086","type":"CDM"},{"code":"41899","type":"HCPCS"}],"standard_charges":[{"gross_charge":639.0,"discounted_cash":479.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL ANAL SETON OTHER MARKER CDM","code_information":[{"code":"Px00045000087","type":"CDM"},{"code":"46030","type":"HCPCS"}],"standard_charges":[{"gross_charge":3837.0,"discounted_cash":2877.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED EXC BARTHOLINS GLAND/CYST CDM","code_information":[{"code":"Px00045000088","type":"CDM"},{"code":"56740","type":"HCPCS"}],"standard_charges":[{"gross_charge":10020.0,"discounted_cash":7515.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED RPR WND EXTRAOCULAR MUSCLE TENDON&/TENON CAPSU CDM","code_information":[{"code":"Px00045000089","type":"CDM"},{"code":"65290","type":"HCPCS"}],"standard_charges":[{"gross_charge":8739.0,"discounted_cash":6554.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED THROMBOLYTIC VENOUS THERAPY CDM","code_information":[{"code":"Px00045000090","type":"CDM"},{"code":"37212","type":"HCPCS"}],"standard_charges":[{"gross_charge":9159.0,"discounted_cash":6869.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED ASPIRATION/RELEASE VITREOUS SUBRETINAL/CHOROIDAL CDM","code_information":[{"code":"Px00045000091","type":"CDM"},{"code":"67015","type":"HCPCS"}],"standard_charges":[{"gross_charge":5399.0,"discounted_cash":4049.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED BRNCHSC RF DSTRJ PULM NRV BI MAINSTEM BRONCHI CDM","code_information":[{"code":"Px00045000092","type":"CDM"},{"code":"0781T","type":"HCPCS"}],"standard_charges":[{"gross_charge":1452.0,"discounted_cash":1089.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED BRNCHSC RF DSTRJ PULM NRV UNI MAINSTEM BRONCHUS CDM","code_information":[{"code":"Px00045000093","type":"CDM"},{"code":"0782T","type":"HCPCS"}],"standard_charges":[{"gross_charge":1452.0,"discounted_cash":1089.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL SUTURES/STAPLES NOT REQUIRING ANESTHESIA CDM","code_information":[{"code":"Px00045000096","type":"CDM"},{"code":"15853","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":50.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL SUTURES&STAPLES NOT REQUIRING ANESTHESIA CDM","code_information":[{"code":"Px00045000097","type":"CDM"},{"code":"15854","type":"HCPCS"}],"standard_charges":[{"gross_charge":3057.0,"discounted_cash":2292.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED SUBCONJUNCTIVAL INJECTION CDM","code_information":[{"code":"Px00045000098","type":"CDM"},{"code":"68200","type":"HCPCS"}],"standard_charges":[{"gross_charge":944.0,"discounted_cash":708.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED SUTURE PHARYNX WOUND/INJURY CDM","code_information":[{"code":"Px00045000100","type":"CDM"},{"code":"42900","type":"HCPCS"}],"standard_charges":[{"gross_charge":4918.0,"discounted_cash":3688.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED BIOPSY OF FLOOR OF MOUTH CDM","code_information":[{"code":"Px00045000107","type":"CDM"},{"code":"41108","type":"HCPCS"}],"standard_charges":[{"gross_charge":5314.0,"discounted_cash":3985.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM OR LESS CDM","code_information":[{"code":"Px00045000108","type":"CDM"},{"code":"11305","type":"HCPCS"}],"standard_charges":[{"gross_charge":638.0,"discounted_cash":478.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED PRTL HYMENECTOMY/REV HYMENAL RING CDM","code_information":[{"code":"Px00045000109","type":"CDM"},{"code":"56700","type":"HCPCS"}],"standard_charges":[{"gross_charge":8693.0,"discounted_cash":6519.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED ADJUSTMENT/REVJ XTRNL FIXATION SYSTEM REQ ANES CDM","code_information":[{"code":"Px00045000110","type":"CDM"},{"code":"20693","type":"HCPCS"}],"standard_charges":[{"gross_charge":20338.0,"discounted_cash":15253.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED BIOPSY VULVA/PERINEUM 1 LESION SPX CDM","code_information":[{"code":"Px00045000121","type":"CDM"},{"code":"56605","type":"HCPCS"}],"standard_charges":[{"gross_charge":2604.0,"discounted_cash":1953.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC ED NEG PRESSURE WOUND THERAPY UTI DISPOSABLE NON-DME LTE 50SQ","code_information":[{"code":"Px00045000122","type":"CDM"},{"code":"97607","type":"HCPCS"}],"standard_charges":[{"gross_charge":1292.0,"discounted_cash":969.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC ED 68020 INCISION CONJUNCTIVA DRAINAGE OF CYST CDM","code_information":[{"code":"Px00045000125","type":"CDM"},{"code":"68020","type":"HCPCS"}],"standard_charges":[{"gross_charge":3123.0,"discounted_cash":2342.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DECOMPRESS FOREARM 1 SPACE CDM","code_information":[{"code":"Px00045000126","type":"CDM"},{"code":"25020","type":"HCPCS"}],"standard_charges":[{"gross_charge":5206.0,"discounted_cash":3904.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED SUTURE QUADRICEPS/HAMSTRING RUPTURE PRIMARY CDM","code_information":[{"code":"Px00045000127","type":"CDM"},{"code":"27385","type":"HCPCS"}],"standard_charges":[{"gross_charge":23171.0,"discounted_cash":17378.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED VENTRICULAR PUNCTURE PREVIOUS BURR HOLE W/O NJX","code_information":[{"code":"Px00045000132","type":"CDM"},{"code":"61020","type":"HCPCS"}],"standard_charges":[{"gross_charge":2812.0,"discounted_cash":2109.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED NEGATIVE PRESSURE WOUND THERAPY DME >50 SQCM CDM","code_information":[{"code":"Px00045000133","type":"CDM"},{"code":"97606","type":"HCPCS"}],"standard_charges":[{"gross_charge":1293.0,"discounted_cash":969.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED NEGATIVE PRESSURE WOUND THERAPY NON-DME >50 SQCM CDM","code_information":[{"code":"Px00045000134","type":"CDM"},{"code":"97608","type":"HCPCS"}],"standard_charges":[{"gross_charge":1293.0,"discounted_cash":969.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DESTRUCTION VAGINAL LESIONS SIMPLE CDM","code_information":[{"code":"Px00045000135","type":"CDM"},{"code":"57061","type":"HCPCS"}],"standard_charges":[{"gross_charge":10294.0,"discounted_cash":7720.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC US ED EXAM CHEST CDM","code_information":[{"code":"Px00045000136","type":"CDM"},{"code":"76604","type":"HCPCS"}],"standard_charges":[{"gross_charge":693.0,"discounted_cash":519.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC US ED LMTD JT/FCL EVAL NONVASC XTR STRUX R-T W/IMG CDM","code_information":[{"code":"Px00045000137","type":"CDM"},{"code":"76882","type":"HCPCS"}],"standard_charges":[{"gross_charge":397.0,"discounted_cash":297.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC US ED GUIDANCE NEEDLE PLACEMENT IMG S&I CDM","code_information":[{"code":"Px00045000138","type":"CDM"},{"code":"76942","type":"HCPCS"}],"standard_charges":[{"gross_charge":868.0,"discounted_cash":651.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC US ED ABDOMEN LIMITED CDM","code_information":[{"code":"Px00045000139","type":"CDM"},{"code":"76705","type":"HCPCS"}],"standard_charges":[{"gross_charge":477.0,"discounted_cash":357.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC US ED ECHO TRANSTHORC R-T 2D W/WO M-MODE REC F-UP/LMTD CDM","code_information":[{"code":"Px00045000140","type":"CDM"},{"code":"93308","type":"HCPCS"}],"standard_charges":[{"gross_charge":553.0,"discounted_cash":414.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC US ED EXAM OF HEAD AND NECK CDM","code_information":[{"code":"Px00045000141","type":"CDM"},{"code":"76536","type":"HCPCS"}],"standard_charges":[{"gross_charge":1035.0,"discounted_cash":776.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC US ED EXAM PELVIC LIMITED CDM","code_information":[{"code":"Px00045000142","type":"CDM"},{"code":"76857","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.0,"discounted_cash":327.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC US ED OB LIMITED FETUS(S) CDM","code_information":[{"code":"Px00045000143","type":"CDM"},{"code":"76815","type":"HCPCS"}],"standard_charges":[{"gross_charge":1253.0,"discounted_cash":939.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC US ED RETROPERITONEAL LIMITED CDM","code_information":[{"code":"Px00045000144","type":"CDM"},{"code":"76775","type":"HCPCS"}],"standard_charges":[{"gross_charge":1650.0,"discounted_cash":1237.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC US ED BREAST UNI LIMITED CDM","code_information":[{"code":"Px00045000145","type":"CDM"},{"code":"76642","type":"HCPCS"}],"standard_charges":[{"gross_charge":352.0,"discounted_cash":264.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TREAT BIG TOE FRACTURE W/O MANIP CDM","code_information":[{"code":"Px00045001299","type":"CDM"},{"code":"28490","type":"HCPCS"}],"standard_charges":[{"gross_charge":1350.0,"discounted_cash":1012.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED ACNE SURGERY CDM","code_information":[{"code":"Px00045001301","type":"CDM"},{"code":"10040","type":"HCPCS"}],"standard_charges":[{"gross_charge":638.0,"discounted_cash":478.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CURETTAGE POSTPARTUM CDM","code_information":[{"code":"Px00045001309","type":"CDM"},{"code":"59160","type":"HCPCS"}],"standard_charges":[{"gross_charge":8693.0,"discounted_cash":6519.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE DRUG IMPLANT DEVICE CDM","code_information":[{"code":"Px00045001312","type":"CDM"},{"code":"11982","type":"HCPCS"}],"standard_charges":[{"gross_charge":780.0,"discounted_cash":585.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DECOMPRESS FASCIOTOMY FINGERS/HAND CDM","code_information":[{"code":"Px00045001313","type":"CDM"},{"code":"26037","type":"HCPCS"}],"standard_charges":[{"gross_charge":9152.0,"discounted_cash":6864.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED LIGATION OF EXTERMITY ARTERY CDM","code_information":[{"code":"Px00045010001","type":"CDM"},{"code":"37618","type":"HCPCS"}],"standard_charges":[{"gross_charge":9020.0,"discounted_cash":6765.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED ADJT TIS REARGMT EYE/NOSE/EAR/LIP 10.1-30.0 SQCM CDM","code_information":[{"code":"Px00045010002","type":"CDM"},{"code":"14061","type":"HCPCS"}],"standard_charges":[{"gross_charge":5306.0,"discounted_cash":3979.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INHALATION TREATMENT CDM","code_information":[{"code":"Px00045010003","type":"CDM"},{"code":"94640","type":"HCPCS"}],"standard_charges":[{"gross_charge":533.0,"discounted_cash":399.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED APPL INTERDENTAL FIXATION DEVICE NON-FX/DISLC CDM","code_information":[{"code":"Px00045010004","type":"CDM"},{"code":"21110","type":"HCPCS"}],"standard_charges":[{"gross_charge":4918.0,"discounted_cash":3688.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED RPR 1ST INGUN HRNA AGE 5 YRS OR MORE REDUCIBLE CDM","code_information":[{"code":"Px00045010005","type":"CDM"},{"code":"49505","type":"HCPCS"}],"standard_charges":[{"gross_charge":12552.0,"discounted_cash":9414.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED PERICARDIOCENTESIS W/IMG GUIDANCE WHEN PERFORMED CDM","code_information":[{"code":"Px00045010006","type":"CDM"},{"code":"33016","type":"HCPCS"}],"standard_charges":[{"gross_charge":7080.0,"discounted_cash":5310.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED PERQ PRCRD DRG GTE 6YR W/O CONGENITAL CAR ANOMALY CDM","code_information":[{"code":"Px00045010007","type":"CDM"},{"code":"33017","type":"HCPCS"}],"standard_charges":[{"gross_charge":4795.0,"discounted_cash":3596.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED PERQ PRCRD DRG 0-5YR/ANY AGE W/CGEN CAR ANOMALY CDM","code_information":[{"code":"Px00045010008","type":"CDM"},{"code":"33018","type":"HCPCS"}],"standard_charges":[{"gross_charge":4795.0,"discounted_cash":3596.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED PERQ PERICARDIAL DRG W/INSJ NDWELLG CATH W/CT CDM","code_information":[{"code":"Px00045010009","type":"CDM"},{"code":"33019","type":"HCPCS"}],"standard_charges":[{"gross_charge":6268.0,"discounted_cash":4701.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED NERVE BLOCK INJ FACIAL CDM","code_information":[{"code":"Px00045010010","type":"CDM"},{"code":"64999","type":"HCPCS"}],"standard_charges":[{"gross_charge":1443.0,"discounted_cash":1082.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT CDM","code_information":[{"code":"Px00045010011","type":"CDM"},{"code":"62328","type":"HCPCS"}],"standard_charges":[{"gross_charge":4007.0,"discounted_cash":3005.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED THERAPEUTIC SPINAL PNXR DRAINAGE CSF W/FLUOR/CT CDM","code_information":[{"code":"Px00045010012","type":"CDM"},{"code":"62329","type":"HCPCS"}],"standard_charges":[{"gross_charge":4007.0,"discounted_cash":3005.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INJECTION AA&/STRD NERVES NRVTG SI JOINT W/IMG CDM","code_information":[{"code":"Px00045010013","type":"CDM"},{"code":"64451","type":"HCPCS"}],"standard_charges":[{"gross_charge":4007.0,"discounted_cash":3005.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP LXTR CDM","code_information":[{"code":"Px00045010014","type":"CDM"},{"code":"15738","type":"HCPCS"}],"standard_charges":[{"gross_charge":10002.0,"discounted_cash":7501.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED ADJNT TIS TRNSFR/REARGMT ANY AREA 30.1-60 SQ CM CDM","code_information":[{"code":"Px00045010015","type":"CDM"},{"code":"14301","type":"HCPCS"}],"standard_charges":[{"gross_charge":10002.0,"discounted_cash":7501.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED ADJT TIS TRNSFR/REARGMT DEFEC EA ADDL 30 SQCM CDM","code_information":[{"code":"Px00045010016","type":"CDM"},{"code":"14302","type":"HCPCS"}],"standard_charges":[{"gross_charge":5000.0,"discounted_cash":3750.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IMG CDM","code_information":[{"code":"Px00045010017","type":"CDM"},{"code":"64454","type":"HCPCS"}],"standard_charges":[{"gross_charge":4007.0,"discounted_cash":3005.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED NEEDLE INSERTION W/O INJECTION 1 OR 2 MUSCLES CDM","code_information":[{"code":"Px00045010018","type":"CDM"},{"code":"20560","type":"HCPCS"}],"standard_charges":[{"gross_charge":7953.0,"discounted_cash":5964.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INDUCTION OF VOMITING CDM","code_information":[{"code":"Px00045010019","type":"CDM"},{"code":"99175","type":"HCPCS"}],"standard_charges":[{"gross_charge":560.0,"discounted_cash":420.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED NEEDLE INSERTION W/O INJECTION 3 OR MORE MUSCLES CDM","code_information":[{"code":"Px00045010020","type":"CDM"},{"code":"20561","type":"HCPCS"}],"standard_charges":[{"gross_charge":15906.0,"discounted_cash":11929.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL FOREIGN BODY INTRANASAL GENERAL ANES CDM","code_information":[{"code":"Px00045010021","type":"CDM"},{"code":"30310","type":"HCPCS"}],"standard_charges":[{"gross_charge":10082.0,"discounted_cash":7561.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF NOSE LESION CDM","code_information":[{"code":"Px00045010023","type":"CDM"},{"code":"30000","type":"HCPCS"}],"standard_charges":[{"gross_charge":737.0,"discounted_cash":552.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF NASAL SEPTUM ABSCESS/HEMATOMA CDM","code_information":[{"code":"Px00045010024","type":"CDM"},{"code":"30020","type":"HCPCS"}],"standard_charges":[{"gross_charge":1618.0,"discounted_cash":1213.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE NASAL FOREIGN BODY CDM","code_information":[{"code":"Px00045010025","type":"CDM"},{"code":"30300","type":"HCPCS"}],"standard_charges":[{"gross_charge":293.0,"discounted_cash":219.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED ABLATE INF TURBINATE SUPERFICIAL CDM","code_information":[{"code":"Px00045010027","type":"CDM"},{"code":"30801","type":"HCPCS"}],"standard_charges":[{"gross_charge":4918.0,"discounted_cash":3688.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CONTROL OF NOSEBLEED SIMPLE CDM","code_information":[{"code":"Px00045010028","type":"CDM"},{"code":"30901","type":"HCPCS"}],"standard_charges":[{"gross_charge":827.0,"discounted_cash":620.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CONTROL OF NOSEBLEED COMPLEX CDM","code_information":[{"code":"Px00045010030","type":"CDM"},{"code":"30903","type":"HCPCS"}],"standard_charges":[{"gross_charge":1884.0,"discounted_cash":1413.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST CDM","code_information":[{"code":"Px00045010031","type":"CDM"},{"code":"10160","type":"HCPCS"}],"standard_charges":[{"gross_charge":957.0,"discounted_cash":717.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1 CDM","code_information":[{"code":"Px00045010032","type":"CDM"},{"code":"11055","type":"HCPCS"}],"standard_charges":[{"gross_charge":638.0,"discounted_cash":478.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4 CDM","code_information":[{"code":"Px00045010033","type":"CDM"},{"code":"11056","type":"HCPCS"}],"standard_charges":[{"gross_charge":638.0,"discounted_cash":478.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED PARING/CUTTING BENIGN HYPERKERATOTIC LESION GT/4 CDM","code_information":[{"code":"Px00045010034","type":"CDM"},{"code":"11057","type":"HCPCS"}],"standard_charges":[{"gross_charge":638.0,"discounted_cash":478.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM OR LESS CDM","code_information":[{"code":"Px00045010035","type":"CDM"},{"code":"11400","type":"HCPCS"}],"standard_charges":[{"gross_charge":2298.0,"discounted_cash":1723.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED EXC B9 LESION MRGN XCP SK TG T/A/L 1.1-2.0 CM CDM","code_information":[{"code":"Px00045010036","type":"CDM"},{"code":"11402","type":"HCPCS"}],"standard_charges":[{"gross_charge":2298.0,"discounted_cash":1723.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED EXC B9 LESION MRGN XCP SK TG T/A/L 2.1-3.0 CM CDM","code_information":[{"code":"Px00045010037","type":"CDM"},{"code":"11403","type":"HCPCS"}],"standard_charges":[{"gross_charge":2298.0,"discounted_cash":1723.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED EXC B9 LESION MRGN XCP SK TG T/A/L GT/4.0 CM CDM","code_information":[{"code":"Px00045010038","type":"CDM"},{"code":"11406","type":"HCPCS"}],"standard_charges":[{"gross_charge":5314.0,"discounted_cash":3985.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED EXC B9 LESION MRGN XCP SK TG S/N/H/F/G GT/4.0CM CDM","code_information":[{"code":"Px00045010039","type":"CDM"},{"code":"11426","type":"HCPCS"}],"standard_charges":[{"gross_charge":9154.0,"discounted_cash":6865.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM CDM","code_information":[{"code":"Px00045010040","type":"CDM"},{"code":"11442","type":"HCPCS"}],"standard_charges":[{"gross_charge":2298.0,"discounted_cash":1723.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM CDM","code_information":[{"code":"Px00045010041","type":"CDM"},{"code":"11443","type":"HCPCS"}],"standard_charges":[{"gross_charge":5314.0,"discounted_cash":3985.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TRIMMING NONDYSTROPHIC NAILS ANY NUMBER CDM","code_information":[{"code":"Px00045010042","type":"CDM"},{"code":"11719","type":"HCPCS"}],"standard_charges":[{"gross_charge":363.0,"discounted_cash":272.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED PREP SITE TRUNK/ARM/LEG 1ST 100 SQ CM/1PCT CDM","code_information":[{"code":"Px00045010043","type":"CDM"},{"code":"15002","type":"HCPCS"}],"standard_charges":[{"gross_charge":5306.0,"discounted_cash":3979.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED PREP SITE TRUNK/ARM/LEG ADDL 100 SQ CM/1PCT CDM","code_information":[{"code":"Px00045010044","type":"CDM"},{"code":"15003","type":"HCPCS"}],"standard_charges":[{"gross_charge":2652.0,"discounted_cash":1989.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED PREP SITE F/S/N/H/F/G/M/D GT 1ST 100 SQ CM/1PCT CDM","code_information":[{"code":"Px00045010045","type":"CDM"},{"code":"15004","type":"HCPCS"}],"standard_charges":[{"gross_charge":1785.0,"discounted_cash":1338.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED PREP SITE F/S/N/H/F/G/M/D GT ADDL 100 SQ CM/1PCT CDM","code_information":[{"code":"Px00045010046","type":"CDM"},{"code":"15005","type":"HCPCS"}],"standard_charges":[{"gross_charge":892.0,"discounted_cash":669.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DESTRUCTION BENIGN LESIONS UP TO 14 CDM","code_information":[{"code":"Px00045010047","type":"CDM"},{"code":"17110","type":"HCPCS"}],"standard_charges":[{"gross_charge":638.0,"discounted_cash":478.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INJECTION SINGLE TENDON ORIGIN/INSERTION CDM","code_information":[{"code":"Px00045010048","type":"CDM"},{"code":"20551","type":"HCPCS"}],"standard_charges":[{"gross_charge":1461.0,"discounted_cash":1095.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US CDM","code_information":[{"code":"Px00045010049","type":"CDM"},{"code":"20600","type":"HCPCS"}],"standard_charges":[{"gross_charge":965.0,"discounted_cash":723.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US CDM","code_information":[{"code":"Px00045010050","type":"CDM"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":1752.0,"discounted_cash":1314.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED ASPIRATION&/INJECTION GANGLION CYST ANY LOCATJ CDM","code_information":[{"code":"Px00045010051","type":"CDM"},{"code":"20612","type":"HCPCS"}],"standard_charges":[{"gross_charge":945.0,"discounted_cash":708.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TX MANDIBULAR FX W/INTERDENTAL FIXATION CDM","code_information":[{"code":"Px00045010052","type":"CDM"},{"code":"21453","type":"HCPCS"}],"standard_charges":[{"gross_charge":18922.0,"discounted_cash":14191.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED OPTX DSTL RADL I-ARTIC FX/EPIPHYSL SEP 2 FRAG CDM","code_information":[{"code":"Px00045010053","type":"CDM"},{"code":"25608","type":"HCPCS"}],"standard_charges":[{"gross_charge":20338.0,"discounted_cash":15253.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED OPTX DSTL RADL I-ARTIC FX/EPIPHYSL SEP 3 FRAG CDM","code_information":[{"code":"Px00045010054","type":"CDM"},{"code":"25609","type":"HCPCS"}],"standard_charges":[{"gross_charge":20338.0,"discounted_cash":15253.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INSERT CATH ARTERY CUTDOWN CDM","code_information":[{"code":"Px00045010055","type":"CDM"},{"code":"36625","type":"HCPCS"}],"standard_charges":[{"gross_charge":961.0,"discounted_cash":720.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED ARTHRT EXPL DRG/RMVL LOOSE/FB IPHAL JT EA CDM","code_information":[{"code":"Px00045010056","type":"CDM"},{"code":"26080","type":"HCPCS"}],"standard_charges":[{"gross_charge":5083.0,"discounted_cash":3812.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED PARTIAL EXCISION PROXIMAL/MIDDLE PHALANX FINGER CDM","code_information":[{"code":"Px00045010057","type":"CDM"},{"code":"26235","type":"HCPCS"}],"standard_charges":[{"gross_charge":5083.0,"discounted_cash":3812.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED OSTEOTOMY PHALANX FINGER EACH CDM","code_information":[{"code":"Px00045010058","type":"CDM"},{"code":"26567","type":"HCPCS"}],"standard_charges":[{"gross_charge":10548.0,"discounted_cash":7911.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CLTX METACARPAL FX W/MANJ W/XTRNL FIXJ EA BONE CDM","code_information":[{"code":"Px00045010059","type":"CDM"},{"code":"26607","type":"HCPCS"}],"standard_charges":[{"gross_charge":10548.0,"discounted_cash":7911.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED SUTURE INFRAPATELLAR TENDON PRIMARY CDM","code_information":[{"code":"Px00045010063","type":"CDM"},{"code":"27380","type":"HCPCS"}],"standard_charges":[{"gross_charge":23440.0,"discounted_cash":17580.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED OPEN TX FRACTURE PHALANX/PHALANGES NOT GREAT TOE CDM","code_information":[{"code":"Px00045010064","type":"CDM"},{"code":"28525","type":"HCPCS"}],"standard_charges":[{"gross_charge":10548.0,"discounted_cash":7911.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED STRAPPING HIP CDM","code_information":[{"code":"Px00045010065","type":"CDM"},{"code":"29520","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":308.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INTUBATION ENDOTRACHEAL EMERGENCY PROCEDURE CDM","code_information":[{"code":"Px00045010066","type":"CDM"},{"code":"31500","type":"HCPCS"}],"standard_charges":[{"gross_charge":1745.0,"discounted_cash":1308.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CATHETER ASPIRATION NASOTRACHEAL SPX CDM","code_information":[{"code":"Px00045010067","type":"CDM"},{"code":"31720","type":"HCPCS"}],"standard_charges":[{"gross_charge":678.0,"discounted_cash":508.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING CDM","code_information":[{"code":"Px00045010068","type":"CDM"},{"code":"32554","type":"HCPCS"}],"standard_charges":[{"gross_charge":2039.0,"discounted_cash":1529.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INSJ/RPLCMT TEMP TRANSVNS 1CHMBR ELTRD/PM CATH CDM","code_information":[{"code":"Px00045010071","type":"CDM"},{"code":"33210","type":"HCPCS"}],"standard_charges":[{"gross_charge":19251.0,"discounted_cash":14438.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED RPR BLOOD VESSEL DIRECT LOWER EXTREMITY CDM","code_information":[{"code":"Px00045010073","type":"CDM"},{"code":"35226","type":"HCPCS"}],"standard_charges":[{"gross_charge":1964.0,"discounted_cash":1473.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INTRODUCTION NEEDLE/INTRACATHETER VEIN CDM","code_information":[{"code":"Px00045010074","type":"CDM"},{"code":"36000","type":"HCPCS"}],"standard_charges":[{"gross_charge":1751.0,"discounted_cash":1313.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INJECTION PX PRQ TX EXTREMITY PSEUDOANEURYSM CDM","code_information":[{"code":"Px00045010076","type":"CDM"},{"code":"36002","type":"HCPCS"}],"standard_charges":[{"gross_charge":2347.0,"discounted_cash":1760.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE 5 YRS OR MORE CDM","code_information":[{"code":"Px00045010077","type":"CDM"},{"code":"36556","type":"HCPCS"}],"standard_charges":[{"gross_charge":7070.0,"discounted_cash":5302.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INSJ TUNNELED CVC W/O SUBQ PORT/PMP AGE 5 YRS OR MORE CDM","code_information":[{"code":"Px00045010078","type":"CDM"},{"code":"36558","type":"HCPCS"}],"standard_charges":[{"gross_charge":13487.0,"discounted_cash":10115.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INSJ PRPH CVC W/O SUBQ PORT/PMP UNDER 5 YR CDM","code_information":[{"code":"Px00045010079","type":"CDM"},{"code":"36568","type":"HCPCS"}],"standard_charges":[{"gross_charge":5273.0,"discounted_cash":3954.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INSJ PRPH CVC W/O SUBQ PORT/PMP AGE 5 YRS OR MORE CDM","code_information":[{"code":"Px00045010080","type":"CDM"},{"code":"36569","type":"HCPCS"}],"standard_charges":[{"gross_charge":5740.0,"discounted_cash":4305.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED COLLECT BLOOD FROM IMPLANT VENOUS ACCESS DEVICE CDM","code_information":[{"code":"Px00045010081","type":"CDM"},{"code":"36591","type":"HCPCS"}],"standard_charges":[{"gross_charge":278.0,"discounted_cash":208.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DECLOT BY THROMBOLYTIC AGENT IMPLANT DEVICE/CATH CDM","code_information":[{"code":"Px00045010082","type":"CDM"},{"code":"36593","type":"HCPCS"}],"standard_charges":[{"gross_charge":1124.0,"discounted_cash":843.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED ARTERIAL PUNCTURE WITHDRAWAL BLOOD DX CDM","code_information":[{"code":"Px00045010083","type":"CDM"},{"code":"36600","type":"HCPCS"}],"standard_charges":[{"gross_charge":440.0,"discounted_cash":330.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED THROMBOLYSIS CEREBRAL IV INFUSION CDM","code_information":[{"code":"Px00045010084","type":"CDM"},{"code":"37195","type":"HCPCS"}],"standard_charges":[{"gross_charge":614.0,"discounted_cash":460.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INTRAORAL I&D TONGUE/FLOOR SUBMENTAL SPACE CDM","code_information":[{"code":"Px00045010086","type":"CDM"},{"code":"41007","type":"HCPCS"}],"standard_charges":[{"gross_charge":4918.0,"discounted_cash":3688.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBMNDB CDM","code_information":[{"code":"Px00045010087","type":"CDM"},{"code":"41017","type":"HCPCS"}],"standard_charges":[{"gross_charge":10082.0,"discounted_cash":7561.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED EGD TRANSORAL BIOPSY SINGLE/MULTIPLE CDM","code_information":[{"code":"Px00045010088","type":"CDM"},{"code":"43239","type":"HCPCS"}],"standard_charges":[{"gross_charge":2064.0,"discounted_cash":1548.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED THROMBOLYSIS CORONARY INTRAVENOUS INFUSION CDM","code_information":[{"code":"Px00045010089","type":"CDM"},{"code":"92977","type":"HCPCS"}],"standard_charges":[{"gross_charge":731.0,"discounted_cash":548.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED EGD FLEXIBLE FOREIGN BODY REMOVAL CDM","code_information":[{"code":"Px00045010090","type":"CDM"},{"code":"43247","type":"HCPCS"}],"standard_charges":[{"gross_charge":2064.0,"discounted_cash":1548.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE CDM","code_information":[{"code":"Px00045010091","type":"CDM"},{"code":"43752","type":"HCPCS"}],"standard_charges":[{"gross_charge":953.0,"discounted_cash":714.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REPOS NASO/ORO GASTRIC FEEDING TUBE THRU DUO CDM","code_information":[{"code":"Px00045010092","type":"CDM"},{"code":"43761","type":"HCPCS"}],"standard_charges":[{"gross_charge":3374.0,"discounted_cash":2530.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INTRODUCTION LONG GI TUBE SEPARATE PROCEDURE CDM","code_information":[{"code":"Px00045010093","type":"CDM"},{"code":"44500","type":"HCPCS"}],"standard_charges":[{"gross_charge":2925.0,"discounted_cash":2193.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CRITICAL CARE FIRST HOUR CDM","code_information":[{"code":"Px00045010094","type":"CDM"},{"code":"99291","type":"HCPCS"}],"standard_charges":[{"gross_charge":7021.0,"discounted_cash":5265.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED SIGMOIDOSCOPY FLX CONTROL BLEEDING CDM","code_information":[{"code":"Px00045010095","type":"CDM"},{"code":"45334","type":"HCPCS"}],"standard_charges":[{"gross_charge":2707.0,"discounted_cash":2030.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF RECTAL ABSCESS CDM","code_information":[{"code":"Px00045010097","type":"CDM"},{"code":"45005","type":"HCPCS"}],"standard_charges":[{"gross_charge":3837.0,"discounted_cash":2877.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED PROCTOSIGMOIDOSCOPY DX CDM","code_information":[{"code":"Px00045010098","type":"CDM"},{"code":"45300","type":"HCPCS"}],"standard_charges":[{"gross_charge":808.0,"discounted_cash":606.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED PROCTOSIGMOIDOSCOPY FB CDM","code_information":[{"code":"Px00045010099","type":"CDM"},{"code":"45307","type":"HCPCS"}],"standard_charges":[{"gross_charge":6424.0,"discounted_cash":4818.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REDUCTION OF RECTAL PROLAPSE CDM","code_information":[{"code":"Px00045010100","type":"CDM"},{"code":"45900","type":"HCPCS"}],"standard_charges":[{"gross_charge":2945.0,"discounted_cash":2208.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD CDM","code_information":[{"code":"Px00045010101","type":"CDM"},{"code":"45378","type":"HCPCS"}],"standard_charges":[{"gross_charge":2078.0,"discounted_cash":1558.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED COLSC FLEXIBLE W/CONTROL BLEEDING ANY METHOD CDM","code_information":[{"code":"Px00045010102","type":"CDM"},{"code":"45382","type":"HCPCS"}],"standard_charges":[{"gross_charge":2707.0,"discounted_cash":2030.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CYSTO W/SIMPLE REMOVAL STONE & STENT CDM","code_information":[{"code":"Px00045010103","type":"CDM"},{"code":"52310","type":"HCPCS"}],"standard_charges":[{"gross_charge":5719.0,"discounted_cash":4289.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CORPORA CAVERNOSA-GLANS PENIS FSTLJ PRIAPISM CDM","code_information":[{"code":"Px00045010104","type":"CDM"},{"code":"54435","type":"HCPCS"}],"standard_charges":[{"gross_charge":9854.0,"discounted_cash":7390.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED PUNCTURE SHUNT TUBE/RESERVOIR ASPIRATION/INJ PX CDM","code_information":[{"code":"Px00045010105","type":"CDM"},{"code":"61070","type":"HCPCS"}],"standard_charges":[{"gross_charge":1766.0,"discounted_cash":1324.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TWIST DRILL HOLE EVAC&/DRG SUBDURAL HEMATOMA CDM","code_information":[{"code":"Px00045010106","type":"CDM"},{"code":"61108","type":"HCPCS"}],"standard_charges":[{"gross_charge":1981.0,"discounted_cash":1485.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED SPINAL PUNCTURE LUMBAR DIAGNOSTIC CDM","code_information":[{"code":"Px00045010107","type":"CDM"},{"code":"62270","type":"HCPCS"}],"standard_charges":[{"gross_charge":1960.0,"discounted_cash":1470.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED SPINAL PUNCTURE THER DRAIN CEREBROSPINAL FLUID CDM","code_information":[{"code":"Px00045010108","type":"CDM"},{"code":"62272","type":"HCPCS"}],"standard_charges":[{"gross_charge":2293.0,"discounted_cash":1719.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED MANIPULATE ELBOW W/ANESTH CDM","code_information":[{"code":"Px00045010109","type":"CDM"},{"code":"24300","type":"HCPCS"}],"standard_charges":[{"gross_charge":5083.0,"discounted_cash":3812.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED ALCOHOL/DRUG SCREEN/INTERVENTION 15-30 MIN CDM","code_information":[{"code":"Px00045010110","type":"CDM"},{"code":"99408","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":122.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED ALCOHOL/DRUG SCREEN/INTERVENTION GT/30 MIN CDM","code_information":[{"code":"Px00045010111","type":"CDM"},{"code":"99409","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":243.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED NASOPHARYNGOSCOPY CDM","code_information":[{"code":"Px00045010113","type":"CDM"},{"code":"92511","type":"HCPCS"}],"standard_charges":[{"gross_charge":216.0,"discounted_cash":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"},{"gross_charge":448.0,"discounted_cash":336.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD RADIATION ONCOLOGY"}]},{"description":"HC ED TREATMENT OF MISCARRIAGE CDM","code_information":[{"code":"Px00045010115","type":"CDM"},{"code":"59812","type":"HCPCS"}],"standard_charges":[{"gross_charge":10020.0,"discounted_cash":7515.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED EPISIOTOMY OR VAGINAL REPAIR CDM","code_information":[{"code":"Px00045010117","type":"CDM"},{"code":"59300","type":"HCPCS"}],"standard_charges":[{"gross_charge":10106.0,"discounted_cash":7579.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED VAGINAL DELIVERY ONLY CDM","code_information":[{"code":"Px00045010118","type":"CDM"},{"code":"59409","type":"HCPCS"}],"standard_charges":[{"gross_charge":8768.0,"discounted_cash":6576.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DELIVER PLACENTA CDM","code_information":[{"code":"Px00045010119","type":"CDM"},{"code":"59414","type":"HCPCS"}],"standard_charges":[{"gross_charge":12499.0,"discounted_cash":9374.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED SPONTANEOUS ABORTION FAC CDM","code_information":[{"code":"Px00045010121","type":"CDM"},{"code":"59820","type":"HCPCS"}],"standard_charges":[{"gross_charge":10020.0,"discounted_cash":7515.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TEMP TRANSCUTANEOUS EXT PACING CDM","code_information":[{"code":"Px00045010123","type":"CDM"},{"code":"92953","type":"HCPCS"}],"standard_charges":[{"gross_charge":2788.0,"discounted_cash":2091.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":3043.0,"discounted_cash":2282.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED SEXUAL ASSAULT EXAM CDM","code_information":[{"code":"Px00045010130","type":"CDM"},{"code":"99284","type":"HCPCS"}],"standard_charges":[{"gross_charge":2238.0,"discounted_cash":1678.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS CDM","code_information":[{"code":"Px00045010132","type":"CDM"},{"code":"46221","type":"HCPCS"}],"standard_charges":[{"gross_charge":2945.0,"discounted_cash":2208.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED EXCISION MULTIPLE EXTERNAL PAPILLAE/TAGS ANUS CDM","code_information":[{"code":"Px00045010134","type":"CDM"},{"code":"46230","type":"HCPCS"}],"standard_charges":[{"gross_charge":9106.0,"discounted_cash":6829.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DISTAL RADIAL FRACTURE CDM","code_information":[{"code":"Px00045010138","type":"CDM"},{"code":"25606","type":"HCPCS"}],"standard_charges":[{"gross_charge":10548.0,"discounted_cash":7911.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TX PELVIC FX W/O MANIP CDM","code_information":[{"code":"Px00045010139","type":"CDM"},{"code":"27197","type":"HCPCS"}],"standard_charges":[{"gross_charge":1448.0,"discounted_cash":1086.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CLSD TX PELVIC FX W/MANIP CDM","code_information":[{"code":"Px00045010140","type":"CDM"},{"code":"27198","type":"HCPCS"}],"standard_charges":[{"gross_charge":1448.0,"discounted_cash":1086.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED BLOOD DRAW LT 3 YRS FEM/JUGULAR CDM","code_information":[{"code":"Px00045010143","type":"CDM"},{"code":"36400","type":"HCPCS"}],"standard_charges":[{"gross_charge":2050.0,"discounted_cash":1537.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED BLOOD DRAW LT 3 YRS SCALP VEIN CDM","code_information":[{"code":"Px00045010144","type":"CDM"},{"code":"36405","type":"HCPCS"}],"standard_charges":[{"gross_charge":2050.0,"discounted_cash":1537.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED BLOOD DRAW LT 3 YRS OTHER VEIN CDM","code_information":[{"code":"Px00045010145","type":"CDM"},{"code":"36406","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":38.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED NON-ROUTINE BL DRAW GT/3 YRS CDM","code_information":[{"code":"Px00045010146","type":"CDM"},{"code":"36410","type":"HCPCS"}],"standard_charges":[{"gross_charge":5711.0,"discounted_cash":4283.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED VEIN ACCESS CUTDOWN LT/1 YR CDM","code_information":[{"code":"Px00045010148","type":"CDM"},{"code":"36420","type":"HCPCS"}],"standard_charges":[{"gross_charge":1577.0,"discounted_cash":1182.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED VEIN ACCESS CUTDOWN GT/1 YR CDM","code_information":[{"code":"Px00045010149","type":"CDM"},{"code":"36425","type":"HCPCS"}],"standard_charges":[{"gross_charge":1338.0,"discounted_cash":1003.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT CLSD CLAVICLE FRACTURE W/O MANIP CDM","code_information":[{"code":"Px00045010152","type":"CDM"},{"code":"23500","type":"HCPCS"}],"standard_charges":[{"gross_charge":986.0,"discounted_cash":739.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CORRECT HALLUX VALGUS SESAMOID CDM","code_information":[{"code":"Px00045010154","type":"CDM"},{"code":"28295","type":"HCPCS"}],"standard_charges":[{"gross_charge":10548.0,"discounted_cash":7911.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE WRIST TENDON LESION CDM","code_information":[{"code":"Px00045010156","type":"CDM"},{"code":"25111","type":"HCPCS"}],"standard_charges":[{"gross_charge":5083.0,"discounted_cash":3812.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT THIGH FX GROWTH PLATE CDM","code_information":[{"code":"Px00045010157","type":"CDM"},{"code":"27516","type":"HCPCS"}],"standard_charges":[{"gross_charge":734.0,"discounted_cash":550.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT KNEE FRACTURE(S) TUBEROSITY CDM","code_information":[{"code":"Px00045010158","type":"CDM"},{"code":"27538","type":"HCPCS"}],"standard_charges":[{"gross_charge":734.0,"discounted_cash":550.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT KNEE DISLOCATION CDM","code_information":[{"code":"Px00045010159","type":"CDM"},{"code":"27550","type":"HCPCS"}],"standard_charges":[{"gross_charge":1124.0,"discounted_cash":843.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TREAT KNEE DISLOCATION W/ANESTH CDM","code_information":[{"code":"Px00045010163","type":"CDM"},{"code":"27552","type":"HCPCS"}],"standard_charges":[{"gross_charge":6433.0,"discounted_cash":4824.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TREAT KNEE DISLOCATION W/O ANESTH CDM","code_information":[{"code":"Px00045010165","type":"CDM"},{"code":"27560","type":"HCPCS"}],"standard_charges":[{"gross_charge":845.0,"discounted_cash":633.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TREAT PATELLA DISLOCATION W/ANSETH CDM","code_information":[{"code":"Px00045010168","type":"CDM"},{"code":"27562","type":"HCPCS"}],"standard_charges":[{"gross_charge":7678.0,"discounted_cash":5758.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DRAIN LOWER LEG LESION DEEP CDM","code_information":[{"code":"Px00045010171","type":"CDM"},{"code":"27603","type":"HCPCS"}],"standard_charges":[{"gross_charge":8448.0,"discounted_cash":6336.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DRAIN LOWER LEG BURSA CDM","code_information":[{"code":"Px00045010172","type":"CDM"},{"code":"27604","type":"HCPCS"}],"standard_charges":[{"gross_charge":9152.0,"discounted_cash":6864.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR ACHILLES TENDON CDM","code_information":[{"code":"Px00045010173","type":"CDM"},{"code":"27650","type":"HCPCS"}],"standard_charges":[{"gross_charge":15941.0,"discounted_cash":11955.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR OF LEG TENDON EACH CDM","code_information":[{"code":"Px00045010174","type":"CDM"},{"code":"27664","type":"HCPCS"}],"standard_charges":[{"gross_charge":23440.0,"discounted_cash":17580.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TREAT TIB SHAFT FRACTURE W/O MANIP CDM","code_information":[{"code":"Px00045010176","type":"CDM"},{"code":"27750","type":"HCPCS"}],"standard_charges":[{"gross_charge":734.0,"discounted_cash":550.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TREAT TIBIAL FRACTURE W/MANIPULATION CDM","code_information":[{"code":"Px00045010179","type":"CDM"},{"code":"27752","type":"HCPCS"}],"standard_charges":[{"gross_charge":8296.0,"discounted_cash":6222.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TX OF MEDIAL MALLEOLUS FRACTURE W/O MANIP CDM","code_information":[{"code":"Px00045010182","type":"CDM"},{"code":"27760","type":"HCPCS"}],"standard_charges":[{"gross_charge":1402.0,"discounted_cash":1051.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TX OF MEDIAL MALLEOLUS FRACTURE W/MANIP CDM","code_information":[{"code":"Px00045010185","type":"CDM"},{"code":"27762","type":"HCPCS"}],"standard_charges":[{"gross_charge":8296.0,"discounted_cash":6222.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE INT DWELL URETERAL STENT TRANSURETHRAL CDM","code_information":[{"code":"Px00045010186","type":"CDM"},{"code":"50386","type":"HCPCS"}],"standard_charges":[{"gross_charge":5702.0,"discounted_cash":4276.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED OPEN TREATMENT OF MEDIAL MALLEOLUS FRACTURE CDM","code_information":[{"code":"Px00045010187","type":"CDM"},{"code":"27766","type":"HCPCS"}],"standard_charges":[{"gross_charge":23440.0,"discounted_cash":17580.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CLTX POST ANKLE FX W/O MANIP CDM","code_information":[{"code":"Px00045010189","type":"CDM"},{"code":"27767","type":"HCPCS"}],"standard_charges":[{"gross_charge":734.0,"discounted_cash":550.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CLTX POST ANKLE FX W/MANIPULATION CDM","code_information":[{"code":"Px00045010190","type":"CDM"},{"code":"27768","type":"HCPCS"}],"standard_charges":[{"gross_charge":5083.0,"discounted_cash":3812.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED PARTIAL EXCISION BONE PHALANX TOE CDM","code_information":[{"code":"Px00045010191","type":"CDM"},{"code":"28124","type":"HCPCS"}],"standard_charges":[{"gross_charge":9152.0,"discounted_cash":6864.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TX OF FIBULA FRACTURE PROX W/O MANIP CDM","code_information":[{"code":"Px00045010192","type":"CDM"},{"code":"27780","type":"HCPCS"}],"standard_charges":[{"gross_charge":1277.0,"discounted_cash":957.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TX OF FIBULA FRACTURE PROX W/MANIP CDM","code_information":[{"code":"Px00045010195","type":"CDM"},{"code":"27781","type":"HCPCS"}],"standard_charges":[{"gross_charge":8296.0,"discounted_cash":6222.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED PARTIAL REMOVAL OF TOE-HEMIPHALANGECTOMY OR INTERPHALANGEA CDM","code_information":[{"code":"Px00045010196","type":"CDM"},{"code":"28160","type":"HCPCS"}],"standard_charges":[{"gross_charge":10548.0,"discounted_cash":7911.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED OPEN TREATMENT PROXIMAL FIBULA/SHAFT FRACTURE CDM","code_information":[{"code":"Px00045010197","type":"CDM"},{"code":"27784","type":"HCPCS"}],"standard_charges":[{"gross_charge":23440.0,"discounted_cash":17580.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TREATMENT OF ANKLE FRACTURE W/O MANIP CDM","code_information":[{"code":"Px00045010198","type":"CDM"},{"code":"27786","type":"HCPCS"}],"standard_charges":[{"gross_charge":845.0,"discounted_cash":633.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CYSTOTOMY W/INSJ URETERAL CATH/STENT SPX CDM","code_information":[{"code":"Px00045010200","type":"CDM"},{"code":"51045","type":"HCPCS"}],"standard_charges":[{"gross_charge":5702.0,"discounted_cash":4276.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED RMVL SPINAL NSTIM ELTRD PRQ ARRAY INCL FLUOR CDM","code_information":[{"code":"Px00045010201","type":"CDM"},{"code":"63661","type":"HCPCS"}],"standard_charges":[{"gross_charge":5526.0,"discounted_cash":4144.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED FAC E&M VISIT LEVEL 1 CDM","code_information":[{"code":"Px00045010204","type":"CDM"},{"code":"99281","type":"HCPCS"}],"standard_charges":[{"gross_charge":450.0,"discounted_cash":337.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED FAC E&M VISIT LEVEL 2 CDM","code_information":[{"code":"Px00045010207","type":"CDM"},{"code":"99282","type":"HCPCS"}],"standard_charges":[{"gross_charge":908.0,"discounted_cash":681.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED FAC E&M VISIT LEVEL 3 CDM","code_information":[{"code":"Px00045010210","type":"CDM"},{"code":"99283","type":"HCPCS"}],"standard_charges":[{"gross_charge":1327.0,"discounted_cash":995.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED FAC E&M VISIT LEVEL 4 CDM","code_information":[{"code":"Px00045010213","type":"CDM"},{"code":"99284","type":"HCPCS"}],"standard_charges":[{"gross_charge":1943.0,"discounted_cash":1457.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED FAC E&M VISIT LEVEL 5 CDM","code_information":[{"code":"Px00045010216","type":"CDM"},{"code":"99285","type":"HCPCS"}],"standard_charges":[{"gross_charge":3092.0,"discounted_cash":2319.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INSJ NON-NDWELLG BLADDER CATHETER CDM","code_information":[{"code":"Px00045010219","type":"CDM"},{"code":"51701","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.0,"discounted_cash":184.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CRITICAL CARE ADDL 30 MIN CDM","code_information":[{"code":"Px00045010221","type":"CDM"},{"code":"99292","type":"HCPCS"}],"standard_charges":[{"gross_charge":611.0,"discounted_cash":458.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INSJ TEMP NDWELLG BLADDER CATHETER SIMPLE CDM","code_information":[{"code":"Px00045010223","type":"CDM"},{"code":"51702","type":"HCPCS"}],"standard_charges":[{"gross_charge":626.0,"discounted_cash":469.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CHANGE CYSTOSTOMY TUBE SIMPLE CDM","code_information":[{"code":"Px00045010227","type":"CDM"},{"code":"51705","type":"HCPCS"}],"standard_charges":[{"gross_charge":1447.0,"discounted_cash":1085.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CHANGE CYSTOSTOMY TUBE COMPLICATED CDM","code_information":[{"code":"Px00045010228","type":"CDM"},{"code":"51710","type":"HCPCS"}],"standard_charges":[{"gross_charge":3330.0,"discounted_cash":2497.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED MEAS POST-VOIDING RESIDUAL URINE&/BLADDER CAP CDM","code_information":[{"code":"Px00045010229","type":"CDM"},{"code":"51798","type":"HCPCS"}],"standard_charges":[{"gross_charge":369.0,"discounted_cash":276.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CYSTOURETHROSCOPY CDM","code_information":[{"code":"Px00045010230","type":"CDM"},{"code":"52000","type":"HCPCS"}],"standard_charges":[{"gross_charge":1563.0,"discounted_cash":1172.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED OPEN TX FINGER DISLOCATION CDM","code_information":[{"code":"Px00045010231","type":"CDM"},{"code":"26785","type":"HCPCS"}],"standard_charges":[{"gross_charge":10548.0,"discounted_cash":7911.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED OPEN TX METATARSAL FXW W/O CDM","code_information":[{"code":"Px00045010232","type":"CDM"},{"code":"28485","type":"HCPCS"}],"standard_charges":[{"gross_charge":23440.0,"discounted_cash":17580.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED I&D FOREARM&/WRIST DEEP ABSCESS/HEMATOMA CDM","code_information":[{"code":"Px00045010233","type":"CDM"},{"code":"25028","type":"HCPCS"}],"standard_charges":[{"gross_charge":10548.0,"discounted_cash":7911.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CYSTO BLADDER W/URETERAL CATHETERIZATION CDM","code_information":[{"code":"Px00045010234","type":"CDM"},{"code":"52005","type":"HCPCS"}],"standard_charges":[{"gross_charge":4637.0,"discounted_cash":3477.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT METACARPAL FRACTURE W/INTERNAL FIXATION CDM","code_information":[{"code":"Px00045010235","type":"CDM"},{"code":"26615","type":"HCPCS"}],"standard_charges":[{"gross_charge":9152.0,"discounted_cash":6864.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INJECTION ANES AGENT SPHENOPALATINE GANGLION CDM","code_information":[{"code":"Px00045010236","type":"CDM"},{"code":"64505","type":"HCPCS"}],"standard_charges":[{"gross_charge":964.0,"discounted_cash":723.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED FUSION OF FINGER JOINT CDM","code_information":[{"code":"Px00045010238","type":"CDM"},{"code":"26860","type":"HCPCS"}],"standard_charges":[{"gross_charge":10548.0,"discounted_cash":7911.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED AMPUTATE FINGER/THUMB SINGLE W/DIRECT CLOSURE CDM","code_information":[{"code":"Px00045010239","type":"CDM"},{"code":"26951","type":"HCPCS"}],"standard_charges":[{"gross_charge":10548.0,"discounted_cash":7911.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DILAT URETHRAL STRIX DILATOR MALE 1ST","code_information":[{"code":"Px00045010240","type":"CDM"},{"code":"53600","type":"HCPCS"}],"standard_charges":[{"gross_charge":760.0,"discounted_cash":570.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED LEV 1 HOSP TYPE B ED VISIT CDM","code_information":[{"code":"Px00045010241","type":"CDM"},{"code":"G0380","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":144.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED SKIN FULL GRAFT EEN & LIPS 20 SQ CM OR LESS CDM","code_information":[{"code":"Px00045010242","type":"CDM"},{"code":"15260","type":"HCPCS"}],"standard_charges":[{"gross_charge":5306.0,"discounted_cash":3979.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED LEV 2 HOSP TYPE B ED VISIT CDM","code_information":[{"code":"Px00045010243","type":"CDM"},{"code":"G0381","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INTRAORAL I&D TONGUE/FLOOR SUBMNDBLR SPACE","code_information":[{"code":"Px00045010244","type":"CDM"},{"code":"41008","type":"HCPCS"}],"standard_charges":[{"gross_charge":10082.0,"discounted_cash":7561.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED PERQ REPLACEMENT GTUBE NOT REQ REVJ GSTRST TRC CDM","code_information":[{"code":"Px00045010245","type":"CDM"},{"code":"43762","type":"HCPCS"}],"standard_charges":[{"gross_charge":1467.0,"discounted_cash":1100.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED PERQ DILATION XST TRC ENDOUROLOGIC PX W/O IMG CDM","code_information":[{"code":"Px00045010246","type":"CDM"},{"code":"43763","type":"HCPCS"}],"standard_charges":[{"gross_charge":1467.0,"discounted_cash":1100.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED LEV 3 HOSP TYPE B ED VISIT CDM","code_information":[{"code":"Px00045010249","type":"CDM"},{"code":"G0382","type":"HCPCS"}],"standard_charges":[{"gross_charge":613.0,"discounted_cash":459.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED AMPUTATE FINGER/THUMB SINGLE W/LOCAL ADV FLAPS CDM","code_information":[{"code":"Px00045010250","type":"CDM"},{"code":"26952","type":"HCPCS"}],"standard_charges":[{"gross_charge":10548.0,"discounted_cash":7911.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REAPPROXIMATING OF DISTAL FINGERTIP CDM","code_information":[{"code":"Px00045010251","type":"CDM"},{"code":"26989","type":"HCPCS"}],"standard_charges":[{"gross_charge":518.0,"discounted_cash":388.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF PELVIS LESION CDM","code_information":[{"code":"Px00045010252","type":"CDM"},{"code":"26990","type":"HCPCS"}],"standard_charges":[{"gross_charge":10548.0,"discounted_cash":7911.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE HIP FOREIGN BODY CDM","code_information":[{"code":"Px00045010254","type":"CDM"},{"code":"27087","type":"HCPCS"}],"standard_charges":[{"gross_charge":11256.0,"discounted_cash":8442.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TREATMENT COCCYGEAL FRACTURE CDM","code_information":[{"code":"Px00045010255","type":"CDM"},{"code":"27200","type":"HCPCS"}],"standard_charges":[{"gross_charge":1135.0,"discounted_cash":851.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT HIP SOCKET FRACTURE CDM","code_information":[{"code":"Px00045010256","type":"CDM"},{"code":"27220","type":"HCPCS"}],"standard_charges":[{"gross_charge":1023.0,"discounted_cash":767.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TX THIGH FRACTURE PROX END NECK W/O MANIP CDM","code_information":[{"code":"Px00045010257","type":"CDM"},{"code":"27230","type":"HCPCS"}],"standard_charges":[{"gross_charge":734.0,"discounted_cash":550.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CLTX INTER/PERI/SUBTROCHANTERIC FEM FX W/O MANJ CDM","code_information":[{"code":"Px00045010258","type":"CDM"},{"code":"27238","type":"HCPCS"}],"standard_charges":[{"gross_charge":5083.0,"discounted_cash":3812.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CLTX GREATER TROCHANTERIC FX W/O MANJ CDM","code_information":[{"code":"Px00045010259","type":"CDM"},{"code":"27246","type":"HCPCS"}],"standard_charges":[{"gross_charge":734.0,"discounted_cash":550.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED LEV 4 HOSP TYPE B ED VISIT CDM","code_information":[{"code":"Px00045010261","type":"CDM"},{"code":"G0383","type":"HCPCS"}],"standard_charges":[{"gross_charge":880.0,"discounted_cash":660.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TX HIP DISLOCATION W/O ANESTH CDM","code_information":[{"code":"Px00045010263","type":"CDM"},{"code":"27250","type":"HCPCS"}],"standard_charges":[{"gross_charge":734.0,"discounted_cash":550.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED LEV 5 HOSP TYPE B ED VISIT CDM","code_information":[{"code":"Px00045010265","type":"CDM"},{"code":"G0384","type":"HCPCS"}],"standard_charges":[{"gross_charge":1087.0,"discounted_cash":815.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TX HIP DISLOCATION W/ANESTH CDM","code_information":[{"code":"Px00045010267","type":"CDM"},{"code":"27252","type":"HCPCS"}],"standard_charges":[{"gross_charge":7285.0,"discounted_cash":5463.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TX SPONTANEOUS HIP DISLOCATION BY ABDUCTION W/O ANESTH W/O MANIP CDM","code_information":[{"code":"Px00045010269","type":"CDM"},{"code":"27256","type":"HCPCS"}],"standard_charges":[{"gross_charge":734.0,"discounted_cash":550.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TX POST HIP ARTHROPLASTY DISLOCATION W/O ANESTH CDM","code_information":[{"code":"Px00045010271","type":"CDM"},{"code":"27265","type":"HCPCS"}],"standard_charges":[{"gross_charge":1072.0,"discounted_cash":804.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TX POST HIP ARTHROPLASTY DISLOCATION W/ANESTH CDM","code_information":[{"code":"Px00045010275","type":"CDM"},{"code":"27266","type":"HCPCS"}],"standard_charges":[{"gross_charge":9196.0,"discounted_cash":6897.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL OF FOREIGN BODY DEEP CDM","code_information":[{"code":"Px00045010276","type":"CDM"},{"code":"27086","type":"HCPCS"}],"standard_charges":[{"gross_charge":9154.0,"discounted_cash":6865.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TX THIGH FRACTURE W/MANIP CDM","code_information":[{"code":"Px00045010278","type":"CDM"},{"code":"27240","type":"HCPCS"}],"standard_charges":[{"gross_charge":7041.0,"discounted_cash":5280.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED NEG PRESSURE WOUND THERAPY UTILIZING DME 50 SQ CM OR LESS CDM","code_information":[{"code":"Px00045010279","type":"CDM"},{"code":"97605","type":"HCPCS"}],"standard_charges":[{"gross_charge":638.0,"discounted_cash":478.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INSERTION WIRE/PIN W/APPL SKELETAL TRACTION SPX CDM","code_information":[{"code":"Px00045010280","type":"CDM"},{"code":"20650","type":"HCPCS"}],"standard_charges":[{"gross_charge":10548.0,"discounted_cash":7911.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED RX ACETABULAR FX MANIPULATION CDM","code_information":[{"code":"Px00045010281","type":"CDM"},{"code":"27222","type":"HCPCS"}],"standard_charges":[{"gross_charge":1023.0,"discounted_cash":767.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REPRGRMG PROGRAMMABLE CEREBROSPINAL SHUNT CDM","code_information":[{"code":"Px00045010282","type":"CDM"},{"code":"62252","type":"HCPCS"}],"standard_charges":[{"gross_charge":850.0,"discounted_cash":637.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE TENDON SHEATH DIGIT&/PALM EACH CDM","code_information":[{"code":"Px00045010283","type":"CDM"},{"code":"26020","type":"HCPCS"}],"standard_charges":[{"gross_charge":10548.0,"discounted_cash":7911.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TX FINGER FRACTURE W/PERC FIXATION W/MANIP EACH CDM","code_information":[{"code":"Px00045010284","type":"CDM"},{"code":"26727","type":"HCPCS"}],"standard_charges":[{"gross_charge":10548.0,"discounted_cash":7911.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED I&D DEEP ABSC BURSA/HEMATOMA THIGH/KNEE REGION CDM","code_information":[{"code":"Px00045010285","type":"CDM"},{"code":"27301","type":"HCPCS"}],"standard_charges":[{"gross_charge":8448.0,"discounted_cash":6336.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL FOREIGN BODY DEEP THIGH/KNEE CDM","code_information":[{"code":"Px00045010286","type":"CDM"},{"code":"27372","type":"HCPCS"}],"standard_charges":[{"gross_charge":9154.0,"discounted_cash":6865.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TREAT FEMORAL SHAFT FRACTURE W/O MANIP CDM","code_information":[{"code":"Px00045010289","type":"CDM"},{"code":"27500","type":"HCPCS"}],"standard_charges":[{"gross_charge":734.0,"discounted_cash":550.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CORPORA CAVERNOSA-CORPUS SPONGIOSUM SHUNT UNI/BI CDM","code_information":[{"code":"Px00045010290","type":"CDM"},{"code":"54430","type":"HCPCS"}],"standard_charges":[{"gross_charge":4610.0,"discounted_cash":3457.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED OPEN TX OF LUNATE DISLOCATION CDM","code_information":[{"code":"Px00045010291","type":"CDM"},{"code":"25695","type":"HCPCS"}],"standard_charges":[{"gross_charge":23440.0,"discounted_cash":17580.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREATMENT OF THIGH FRACTURE SUPRACNDLR W/O MANIP CDM","code_information":[{"code":"Px00045010292","type":"CDM"},{"code":"27501","type":"HCPCS"}],"standard_charges":[{"gross_charge":637.0,"discounted_cash":477.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREATMENT OF THIGH FRACTURE W/MANIPULATION CDM","code_information":[{"code":"Px00045010294","type":"CDM"},{"code":"27502","type":"HCPCS"}],"standard_charges":[{"gross_charge":7804.0,"discounted_cash":5853.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":4410.0,"discounted_cash":3307.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREATMENT OF THIGH FRACTURE W/WO TRACTION CDM","code_information":[{"code":"Px00045010295","type":"CDM"},{"code":"27503","type":"HCPCS"}],"standard_charges":[{"gross_charge":4410.0,"discounted_cash":3307.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT FEMORAL FRACTURE W/O MANIPULATION CDM","code_information":[{"code":"Px00045010297","type":"CDM"},{"code":"27508","type":"HCPCS"}],"standard_charges":[{"gross_charge":786.0,"discounted_cash":589.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT KNEE FRACTURE PROXIMAL TIBIAL W/MANIP CDM","code_information":[{"code":"Px00045010299","type":"CDM"},{"code":"27532","type":"HCPCS"}],"standard_charges":[{"gross_charge":10548.0,"discounted_cash":7911.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED NEUROPLASTY MEDIAN NERVE AT CARP TUNNEL CDM","code_information":[{"code":"Px00045010300","type":"CDM"},{"code":"64721","type":"HCPCS"}],"standard_charges":[{"gross_charge":6369.0,"discounted_cash":4776.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED PLACEMENT SETON CDM","code_information":[{"code":"Px00045010301","type":"CDM"},{"code":"46020","type":"HCPCS"}],"standard_charges":[{"gross_charge":9106.0,"discounted_cash":6829.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REM PILONIDAL CYST EXTENSIVE CDM","code_information":[{"code":"Px00045010302","type":"CDM"},{"code":"11771","type":"HCPCS"}],"standard_charges":[{"gross_charge":9154.0,"discounted_cash":6865.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED ADJ TISS TRS S/A/L DEF 10SQCM CDM","code_information":[{"code":"Px00045010303","type":"CDM"},{"code":"14020","type":"HCPCS"}],"standard_charges":[{"gross_charge":6116.0,"discounted_cash":4587.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED APL SKIN SUB HI TAL 1ST 25CM CDM","code_information":[{"code":"Px00045010304","type":"CDM"},{"code":"15271","type":"HCPCS"}],"standard_charges":[{"gross_charge":5306.0,"discounted_cash":3979.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED APL SKIN SUB HI TAL PED ADL100 CDM","code_information":[{"code":"Px00045010305","type":"CDM"},{"code":"15274","type":"HCPCS"}],"standard_charges":[{"gross_charge":5306.0,"discounted_cash":3979.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED PEDICLE FLAP EL NOSE EAR LIPS CDM","code_information":[{"code":"Px00045010306","type":"CDM"},{"code":"15576","type":"HCPCS"}],"standard_charges":[{"gross_charge":5306.0,"discounted_cash":3979.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INSERT NON-TUNNEL CV CATH LT/5 YR CDM","code_information":[{"code":"Px00045010307","type":"CDM"},{"code":"36555","type":"HCPCS"}],"standard_charges":[{"gross_charge":6696.0,"discounted_cash":5022.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INSERT NEEDLE BONE CAVITY CDM","code_information":[{"code":"Px00045010308","type":"CDM"},{"code":"36680","type":"HCPCS"}],"standard_charges":[{"gross_charge":1577.0,"discounted_cash":1182.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF SKIN ABSCESS SIMPLE OR SINGLE CDM","code_information":[{"code":"Px00045010309","type":"CDM"},{"code":"10060","type":"HCPCS"}],"standard_charges":[{"gross_charge":1191.0,"discounted_cash":893.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":1143.0,"discounted_cash":857.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF SKIN ABSCESS COMPLICATED OR MULTIPLE CDM","code_information":[{"code":"Px00045010310","type":"CDM"},{"code":"10061","type":"HCPCS"}],"standard_charges":[{"gross_charge":1248.0,"discounted_cash":936.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF PILONIDAL CYST SIMPLE CDM","code_information":[{"code":"Px00045010311","type":"CDM"},{"code":"10080","type":"HCPCS"}],"standard_charges":[{"gross_charge":1067.0,"discounted_cash":800.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF PILONIDAL CYST COMPLICATED CDM","code_information":[{"code":"Px00045010312","type":"CDM"},{"code":"10081","type":"HCPCS"}],"standard_charges":[{"gross_charge":5906.0,"discounted_cash":4429.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE FOREIGN BODY SIMPLE CDM","code_information":[{"code":"Px00045010313","type":"CDM"},{"code":"10120","type":"HCPCS"}],"standard_charges":[{"gross_charge":1224.0,"discounted_cash":918.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE FOREIGN BODY COMPLICATED CDM","code_information":[{"code":"Px00045010314","type":"CDM"},{"code":"10121","type":"HCPCS"}],"standard_charges":[{"gross_charge":6638.0,"discounted_cash":4978.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED FOREHEAD FLAP W VASC PEDICLE CDM","code_information":[{"code":"Px00045010315","type":"CDM"},{"code":"15731","type":"HCPCS"}],"standard_charges":[{"gross_charge":10002.0,"discounted_cash":7501.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF HEMA/FLUID CDM","code_information":[{"code":"Px00045010316","type":"CDM"},{"code":"10140","type":"HCPCS"}],"standard_charges":[{"gross_charge":7981.0,"discounted_cash":5985.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED COMPLEX DRAINAGE WOUND - CMPLX CDM","code_information":[{"code":"Px00045010317","type":"CDM"},{"code":"10180","type":"HCPCS"}],"standard_charges":[{"gross_charge":9154.0,"discounted_cash":6865.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DEBRIDE INFECTED SKIN CDM","code_information":[{"code":"Px00045010318","type":"CDM"},{"code":"11000","type":"HCPCS"}],"standard_charges":[{"gross_charge":2058.0,"discounted_cash":1543.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DEBRIDE INFECTED SKIN ADD-ON CDM","code_information":[{"code":"Px00045010319","type":"CDM"},{"code":"11001","type":"HCPCS"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":240.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DEBRIDE SKIN AT FX SITE CDM","code_information":[{"code":"Px00045010320","type":"CDM"},{"code":"11010","type":"HCPCS"}],"standard_charges":[{"gross_charge":2298.0,"discounted_cash":1723.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DEB SKIN BONE AT FX SITE CDM","code_information":[{"code":"Px00045010321","type":"CDM"},{"code":"11012","type":"HCPCS"}],"standard_charges":[{"gross_charge":6271.0,"discounted_cash":4703.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DEB SUBQ TISSUE 20 SQ CM OR LESS - DEBRIDE SKIN CDM","code_information":[{"code":"Px00045010324","type":"CDM"},{"code":"11042","type":"HCPCS"}],"standard_charges":[{"gross_charge":1083.0,"discounted_cash":812.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DEB MUSC/FASCIA 20 SQ CM OR LESS CDM","code_information":[{"code":"Px00045010325","type":"CDM"},{"code":"11043","type":"HCPCS"}],"standard_charges":[{"gross_charge":1293.0,"discounted_cash":969.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TRACHEOSTOMY PLANNED SEPARATE PROCEDURE CDM","code_information":[{"code":"Px00045010326","type":"CDM"},{"code":"31600","type":"HCPCS"}],"standard_charges":[{"gross_charge":12214.0,"discounted_cash":9160.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DEB BONE 20 SQ CM OR LESS CDM","code_information":[{"code":"Px00045010327","type":"CDM"},{"code":"11044","type":"HCPCS"}],"standard_charges":[{"gross_charge":2799.0,"discounted_cash":2099.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TREATMENT NASAL SEPTAL FRACTURE CDM","code_information":[{"code":"Px00045010328","type":"CDM"},{"code":"21337","type":"HCPCS"}],"standard_charges":[{"gross_charge":10082.0,"discounted_cash":7561.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DEB MUSC/FASCIA ADD-ON CDM","code_information":[{"code":"Px00045010329","type":"CDM"},{"code":"11046","type":"HCPCS"}],"standard_charges":[{"gross_charge":1029.0,"discounted_cash":771.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DEBRIDEMENT BONE EACH ADDL 20 SQ CM","code_information":[{"code":"Px00045010330","type":"CDM"},{"code":"11047","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.0,"discounted_cash":120.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL OF SKIN TAGS CDM","code_information":[{"code":"Px00045010331","type":"CDM"},{"code":"11200","type":"HCPCS"}],"standard_charges":[{"gross_charge":1111.0,"discounted_cash":833.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE SKIN TAGS ADD-ON CDM","code_information":[{"code":"Px00045010332","type":"CDM"},{"code":"11201","type":"HCPCS"}],"standard_charges":[{"gross_charge":514.0,"discounted_cash":385.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED SHAVE SKIN LESION 0.5 CM OR LESS TRNK ARM LEG CDM","code_information":[{"code":"Px00045010333","type":"CDM"},{"code":"11300","type":"HCPCS"}],"standard_charges":[{"gross_charge":382.0,"discounted_cash":286.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED EXC B9 LESION MRGN XCP SK TG T/A/L 0.6-1.0 CM CDM","code_information":[{"code":"Px00045010334","type":"CDM"},{"code":"11401","type":"HCPCS"}],"standard_charges":[{"gross_charge":2298.0,"discounted_cash":1723.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED EXC B9 LESION MRGN XCP SK TG T/A/L 3.1-4.0 CM CDM","code_information":[{"code":"Px00045010335","type":"CDM"},{"code":"11404","type":"HCPCS"}],"standard_charges":[{"gross_charge":5314.0,"discounted_cash":3985.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM OR LESS CDM","code_information":[{"code":"Px00045010336","type":"CDM"},{"code":"11420","type":"HCPCS"}],"standard_charges":[{"gross_charge":5314.0,"discounted_cash":3985.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM CDM","code_information":[{"code":"Px00045010337","type":"CDM"},{"code":"11421","type":"HCPCS"}],"standard_charges":[{"gross_charge":5314.0,"discounted_cash":3985.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM CDM","code_information":[{"code":"Px00045010338","type":"CDM"},{"code":"11422","type":"HCPCS"}],"standard_charges":[{"gross_charge":5314.0,"discounted_cash":3985.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM CDM","code_information":[{"code":"Px00045010344","type":"CDM"},{"code":"11423","type":"HCPCS"}],"standard_charges":[{"gross_charge":5314.0,"discounted_cash":3985.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM CDM","code_information":[{"code":"Px00045010345","type":"CDM"},{"code":"11424","type":"HCPCS"}],"standard_charges":[{"gross_charge":5314.0,"discounted_cash":3985.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DEBRIDE NAIL 1-5 CDM","code_information":[{"code":"Px00045010346","type":"CDM"},{"code":"11720","type":"HCPCS"}],"standard_charges":[{"gross_charge":324.0,"discounted_cash":243.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DEBRIDE NAIL 6 OR MORE CDM","code_information":[{"code":"Px00045010347","type":"CDM"},{"code":"11721","type":"HCPCS"}],"standard_charges":[{"gross_charge":324.0,"discounted_cash":243.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL OF NAIL PLATE CDM","code_information":[{"code":"Px00045010348","type":"CDM"},{"code":"11730","type":"HCPCS"}],"standard_charges":[{"gross_charge":845.0,"discounted_cash":633.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE NAIL PLATE ADD-ON CDM","code_information":[{"code":"Px00045010349","type":"CDM"},{"code":"11732","type":"HCPCS"}],"standard_charges":[{"gross_charge":381.0,"discounted_cash":285.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL OF NAIL BED CDM","code_information":[{"code":"Px00045010351","type":"CDM"},{"code":"11750","type":"HCPCS"}],"standard_charges":[{"gross_charge":2216.0,"discounted_cash":1662.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR OF NAIL BED CDM","code_information":[{"code":"Px00045010353","type":"CDM"},{"code":"11760","type":"HCPCS"}],"standard_charges":[{"gross_charge":1099.0,"discounted_cash":824.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED EXCISION OF NAIL FOLD TOE CDM","code_information":[{"code":"Px00045010354","type":"CDM"},{"code":"11765","type":"HCPCS"}],"standard_charges":[{"gross_charge":762.0,"discounted_cash":571.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR SUPERFIC WOUND(S)LT/2.5CM SLP NK AX EXGEN TRNK EXTR HND FT CDM","code_information":[{"code":"Px00045010355","type":"CDM"},{"code":"12001","type":"HCPCS"}],"standard_charges":[{"gross_charge":928.0,"discounted_cash":696.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR SUPERFICIAL WND(S) 2.6-7.5CM SLP NK AX EXGEN TRNK E CDM","code_information":[{"code":"Px00045010356","type":"CDM"},{"code":"12002","type":"HCPCS"}],"standard_charges":[{"gross_charge":1297.0,"discounted_cash":972.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM CDM","code_information":[{"code":"Px00045010357","type":"CDM"},{"code":"12004","type":"HCPCS"}],"standard_charges":[{"gross_charge":1665.0,"discounted_cash":1248.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR SPRFCL WOUND(S)12.6 TO 20.0CM SLP NK AX EXGEN TRNK EXTR H CDM","code_information":[{"code":"Px00045010358","type":"CDM"},{"code":"12005","type":"HCPCS"}],"standard_charges":[{"gross_charge":2070.0,"discounted_cash":1552.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR SPRFCL WOUND(S) 20.1-30.0CM SLP NK AX EXGEN TRNK EXTR HND CDM","code_information":[{"code":"Px00045010359","type":"CDM"},{"code":"12006","type":"HCPCS"}],"standard_charges":[{"gross_charge":2736.0,"discounted_cash":2052.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR SUPERFICIAL WOUND(S)GT/30CM SLP NK AX EXGEN TRNK EXTR CDM","code_information":[{"code":"Px00045010360","type":"CDM"},{"code":"12007","type":"HCPCS"}],"standard_charges":[{"gross_charge":2736.0,"discounted_cash":2052.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR SUPERFICIAL WOUND(S) LT/2.5 FACE ERS EYLD NSE LPS MUC CDM","code_information":[{"code":"Px00045010361","type":"CDM"},{"code":"12011","type":"HCPCS"}],"standard_charges":[{"gross_charge":908.0,"discounted_cash":681.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR SUPERFICIAL WOUND(S) 2.6-5.0CM FACE ERS EYLD NSE LP CDM","code_information":[{"code":"Px00045010362","type":"CDM"},{"code":"12013","type":"HCPCS"}],"standard_charges":[{"gross_charge":1064.0,"discounted_cash":798.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR SUPERFICIAL WOUND(S) 5.1-7.5CM FACE ERS EYLD NSE LP CDM","code_information":[{"code":"Px00045010363","type":"CDM"},{"code":"12014","type":"HCPCS"}],"standard_charges":[{"gross_charge":1221.0,"discounted_cash":915.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR SUPERFICIAL WOUND(S) 7.6-12.5CM FACE ERS EYLD NSE LPS MUC CDM","code_information":[{"code":"Px00045010364","type":"CDM"},{"code":"12015","type":"HCPCS"}],"standard_charges":[{"gross_charge":1479.0,"discounted_cash":1109.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR SUPERFICIAL WOUND(S) 12.6-20.0CM FACE ERS EYLD NSE LPS MUC CDM","code_information":[{"code":"Px00045010365","type":"CDM"},{"code":"12016","type":"HCPCS"}],"standard_charges":[{"gross_charge":1663.0,"discounted_cash":1247.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED EXCISE EXCESSIVE SKN TISS OTHR CDM","code_information":[{"code":"Px00045010366","type":"CDM"},{"code":"15839","type":"HCPCS"}],"standard_charges":[{"gross_charge":7942.0,"discounted_cash":5956.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR SUPERFICIAL WOUND(S) 20.1-30.0CM FACE ERS EYLD NSE LPS MUC CDM","code_information":[{"code":"Px00045010367","type":"CDM"},{"code":"12017","type":"HCPCS"}],"standard_charges":[{"gross_charge":1847.0,"discounted_cash":1385.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR SUPERFICIAL WOUND(S) GT/30.0 CM FACE ERS EYLD NSE LPS MUC CDM","code_information":[{"code":"Px00045010369","type":"CDM"},{"code":"12018","type":"HCPCS"}],"standard_charges":[{"gross_charge":1847.0,"discounted_cash":1385.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CLOSURE OF SPLIT WOUND SIMPLE CLOSURE CDM","code_information":[{"code":"Px00045010370","type":"CDM"},{"code":"12020","type":"HCPCS"}],"standard_charges":[{"gross_charge":1843.0,"discounted_cash":1382.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CLOSURE OF SPLIT WOUND W/PACKNG CDM","code_information":[{"code":"Px00045010371","type":"CDM"},{"code":"12021","type":"HCPCS"}],"standard_charges":[{"gross_charge":1600.0,"discounted_cash":1200.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INTMD WND REPAIR S/TR/EXT UP TO 2.5CM CDM","code_information":[{"code":"Px00045010372","type":"CDM"},{"code":"12031","type":"HCPCS"}],"standard_charges":[{"gross_charge":1605.0,"discounted_cash":1203.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INTMD WND REPAIR S/TR/EXT 2.6 TO 7.5CM CDM","code_information":[{"code":"Px00045010373","type":"CDM"},{"code":"12032","type":"HCPCS"}],"standard_charges":[{"gross_charge":1758.0,"discounted_cash":1318.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INTMD WND REPAIR S/TR/EXT 7.6 TO 12.5CM CDM","code_information":[{"code":"Px00045010374","type":"CDM"},{"code":"12034","type":"HCPCS"}],"standard_charges":[{"gross_charge":1847.0,"discounted_cash":1385.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INTMD WND REPAIR S/TR/EXT 12.6 TO 20.0CM CDM","code_information":[{"code":"Px00045010375","type":"CDM"},{"code":"12035","type":"HCPCS"}],"standard_charges":[{"gross_charge":2051.0,"discounted_cash":1538.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INTMD WND REPAIR S/TR/EXT 20.1 TO 30.0CM CDM","code_information":[{"code":"Px00045010376","type":"CDM"},{"code":"12036","type":"HCPCS"}],"standard_charges":[{"gross_charge":2590.0,"discounted_cash":1942.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INTMD WND REPAIR S/TR/EXT GT/30 CM CDM","code_information":[{"code":"Px00045010377","type":"CDM"},{"code":"12037","type":"HCPCS"}],"standard_charges":[{"gross_charge":9186.0,"discounted_cash":6889.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INTMD WND REPAIR N-HF/GENIT UP TO 2.5CM CDM","code_information":[{"code":"Px00045010378","type":"CDM"},{"code":"12041","type":"HCPCS"}],"standard_charges":[{"gross_charge":1111.0,"discounted_cash":833.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REM FIX DEV ANOTHER PHYSICIAN CDM","code_information":[{"code":"Px00045010379","type":"CDM"},{"code":"20665","type":"HCPCS"}],"standard_charges":[{"gross_charge":1338.0,"discounted_cash":1003.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INTMD WND REPAIR N-HG/GENIT 2.6 TO 7.5CM CDM","code_information":[{"code":"Px00045010380","type":"CDM"},{"code":"12042","type":"HCPCS"}],"standard_charges":[{"gross_charge":1399.0,"discounted_cash":1049.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INTMD WND REPAIR N-HG/GENIT 7.6 TO 12.5CM CDM","code_information":[{"code":"Px00045010381","type":"CDM"},{"code":"12044","type":"HCPCS"}],"standard_charges":[{"gross_charge":1706.0,"discounted_cash":1279.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INTMD WND REPAIR N-HG/GENIT 12.6 TO 20.0CM CDM","code_information":[{"code":"Px00045010382","type":"CDM"},{"code":"12045","type":"HCPCS"}],"standard_charges":[{"gross_charge":2058.0,"discounted_cash":1543.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INTMD WND REPAIR N-HG/GENIT 20.1-30.0CM CDM","code_information":[{"code":"Px00045010383","type":"CDM"},{"code":"12046","type":"HCPCS"}],"standard_charges":[{"gross_charge":3501.0,"discounted_cash":2625.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INTMD WND REPAIR N-HG/GENIT GT/30.0CM CDM","code_information":[{"code":"Px00045010384","type":"CDM"},{"code":"12047","type":"HCPCS"}],"standard_charges":[{"gross_charge":6116.0,"discounted_cash":4587.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INTMD WND REPAIR FACE/MM LT/2.5 CM CDM","code_information":[{"code":"Px00045010385","type":"CDM"},{"code":"12051","type":"HCPCS"}],"standard_charges":[{"gross_charge":2059.0,"discounted_cash":1544.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INTMD WND REPAIR FACE/MM 2.6 TO 5.0CM CDM","code_information":[{"code":"Px00045010386","type":"CDM"},{"code":"12052","type":"HCPCS"}],"standard_charges":[{"gross_charge":2139.0,"discounted_cash":1604.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INTMD WND REPAIR FACE/MM 5.1 TO 7.5CM CDM","code_information":[{"code":"Px00045010387","type":"CDM"},{"code":"12053","type":"HCPCS"}],"standard_charges":[{"gross_charge":2287.0,"discounted_cash":1715.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INTMD WND REPAIR FACE/MM 7.5 TO 12.5CM CDM","code_information":[{"code":"Px00045010388","type":"CDM"},{"code":"12054","type":"HCPCS"}],"standard_charges":[{"gross_charge":2350.0,"discounted_cash":1762.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INTMD WND REPAIR FACE/MM 12.6 TO 20.0CM CDM","code_information":[{"code":"Px00045010389","type":"CDM"},{"code":"12055","type":"HCPCS"}],"standard_charges":[{"gross_charge":2948.0,"discounted_cash":2211.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INTMD WND REPAIR FACE/MM 20.1 TO 30.0CM CDM","code_information":[{"code":"Px00045010390","type":"CDM"},{"code":"12056","type":"HCPCS"}],"standard_charges":[{"gross_charge":2948.0,"discounted_cash":2211.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INTMD WND REPAIR FACE/MM GT/30CM CDM","code_information":[{"code":"Px00045010391","type":"CDM"},{"code":"12057","type":"HCPCS"}],"standard_charges":[{"gross_charge":2948.0,"discounted_cash":2211.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR OF WOUND OR LESION 1.1 TO 2.5CM COMPLEX TRUNK CDM","code_information":[{"code":"Px00045010392","type":"CDM"},{"code":"13100","type":"HCPCS"}],"standard_charges":[{"gross_charge":3615.0,"discounted_cash":2711.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR OF WOUND OR LESION 2.6 TO 7.5CM COMPLEX TRUNK CDM","code_information":[{"code":"Px00045010393","type":"CDM"},{"code":"13101","type":"HCPCS"}],"standard_charges":[{"gross_charge":3615.0,"discounted_cash":2711.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR WOUND/LESION ADD-ON EA ADD 5CM COMPLEX TRUNK CDM","code_information":[{"code":"Px00045010394","type":"CDM"},{"code":"13102","type":"HCPCS"}],"standard_charges":[{"gross_charge":1029.0,"discounted_cash":771.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR OF WOUND OR LESION 1.1 TO 2.5CM COMPLEX SCLP ARM LEG CDM","code_information":[{"code":"Px00045010395","type":"CDM"},{"code":"13120","type":"HCPCS"}],"standard_charges":[{"gross_charge":2147.0,"discounted_cash":1610.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR OF WOUND OR LESION 2.6 TO 7.5CM COMPLEX SCLP ARM LEG CDM","code_information":[{"code":"Px00045010396","type":"CDM"},{"code":"13121","type":"HCPCS"}],"standard_charges":[{"gross_charge":3164.0,"discounted_cash":2373.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REM EXTNL FIX DEV W ANES CDM","code_information":[{"code":"Px00045010397","type":"CDM"},{"code":"20694","type":"HCPCS"}],"standard_charges":[{"gross_charge":5083.0,"discounted_cash":3812.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR WOUND/LESION ADD-ON 5CM OR LESS COMPLEX SCLP ARM LEG CDM","code_information":[{"code":"Px00045010398","type":"CDM"},{"code":"13122","type":"HCPCS"}],"standard_charges":[{"gross_charge":1779.0,"discounted_cash":1334.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 1.1-2.5 CM CDM","code_information":[{"code":"Px00045010399","type":"CDM"},{"code":"13131","type":"HCPCS"}],"standard_charges":[{"gross_charge":2350.0,"discounted_cash":1762.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED NJX C/P/A CAVERNOSA W/PHARMACOLOGIC AGT CDM","code_information":[{"code":"Px00045010401","type":"CDM"},{"code":"54235","type":"HCPCS"}],"standard_charges":[{"gross_charge":1679.0,"discounted_cash":1259.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED SERIAL TONOMETRY EXAM(S) CDM","code_information":[{"code":"Px00045010402","type":"CDM"},{"code":"92100","type":"HCPCS"}],"standard_charges":[{"gross_charge":551.0,"discounted_cash":413.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED PERICARDIOTOMY REMOVAL CLOT/FOREIGN BODY PRIMARY CDM","code_information":[{"code":"Px00045010404","type":"CDM"},{"code":"33020","type":"HCPCS"}],"standard_charges":[{"gross_charge":4840.0,"discounted_cash":3630.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE RECTAL OBSTRUCTION W GEN ANESTH CDM","code_information":[{"code":"Px00045010405","type":"CDM"},{"code":"45915","type":"HCPCS"}],"standard_charges":[{"gross_charge":3837.0,"discounted_cash":2877.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED I&D ISCHIORECTAL&/PERIRECTAL ABSCESS SPX CDM","code_information":[{"code":"Px00045010407","type":"CDM"},{"code":"46040","type":"HCPCS"}],"standard_charges":[{"gross_charge":18555.0,"discounted_cash":13916.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INCISION OF ANAL ABSCESS CDM","code_information":[{"code":"Px00045010409","type":"CDM"},{"code":"46050","type":"HCPCS"}],"standard_charges":[{"gross_charge":4442.0,"discounted_cash":3331.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INCISE EXTERNAL HEMORRHOID CDM","code_information":[{"code":"Px00045010410","type":"CDM"},{"code":"46083","type":"HCPCS"}],"standard_charges":[{"gross_charge":986.0,"discounted_cash":739.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE EXT HEM GROUPS 2 OR MORE CDM","code_information":[{"code":"Px00045010412","type":"CDM"},{"code":"46250","type":"HCPCS"}],"standard_charges":[{"gross_charge":9255.0,"discounted_cash":6941.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL OF HEMORRHOID CLOT CDM","code_information":[{"code":"Px00045010413","type":"CDM"},{"code":"46320","type":"HCPCS"}],"standard_charges":[{"gross_charge":3837.0,"discounted_cash":2877.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DIAGNOSTIC ANOSCOPY CDM","code_information":[{"code":"Px00045010414","type":"CDM"},{"code":"46600","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.0,"discounted_cash":141.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED ANOSCOPY REMOVE FOR BODY CDM","code_information":[{"code":"Px00045010415","type":"CDM"},{"code":"46608","type":"HCPCS"}],"standard_charges":[{"gross_charge":2078.0,"discounted_cash":1558.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED ANOSCOPY CONTROL BLEEDING CDM","code_information":[{"code":"Px00045010416","type":"CDM"},{"code":"46614","type":"HCPCS"}],"standard_charges":[{"gross_charge":2707.0,"discounted_cash":2030.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE BY LIGAT INT HEM GRP CDM","code_information":[{"code":"Px00045010417","type":"CDM"},{"code":"46945","type":"HCPCS"}],"standard_charges":[{"gross_charge":9106.0,"discounted_cash":6829.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CYSTOSTOMY CYSTOTOMY W DRAINAGE CDM","code_information":[{"code":"Px00045010419","type":"CDM"},{"code":"51040","type":"HCPCS"}],"standard_charges":[{"gross_charge":9801.0,"discounted_cash":7350.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DRAIN BLADDER BY NEEDLE CDM","code_information":[{"code":"Px00045010420","type":"CDM"},{"code":"51100","type":"HCPCS"}],"standard_charges":[{"gross_charge":760.0,"discounted_cash":570.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DRAIN BLADDER BY TROCAR/CATH CDM","code_information":[{"code":"Px00045010421","type":"CDM"},{"code":"51101","type":"HCPCS"}],"standard_charges":[{"gross_charge":3311.0,"discounted_cash":2483.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REV EYELID LAT CDM","code_information":[{"code":"Px00045010422","type":"CDM"},{"code":"21282","type":"HCPCS"}],"standard_charges":[{"gross_charge":8747.0,"discounted_cash":6560.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED IRRIGATION OF BLADDER CDM","code_information":[{"code":"Px00045010423","type":"CDM"},{"code":"51700","type":"HCPCS"}],"standard_charges":[{"gross_charge":827.0,"discounted_cash":620.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INSERT BLADDER CATH COMPLEX CDM","code_information":[{"code":"Px00045010424","type":"CDM"},{"code":"51703","type":"HCPCS"}],"standard_charges":[{"gross_charge":1438.0,"discounted_cash":1078.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":1021.0,"discounted_cash":765.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TX FX ORBIT CLSD W MANIP CDM","code_information":[{"code":"Px00045010425","type":"CDM"},{"code":"21401","type":"HCPCS"}],"standard_charges":[{"gross_charge":4918.0,"discounted_cash":3688.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CYSTOSCOPY AND TREATMENT STRICTURE/DILATION CDM","code_information":[{"code":"Px00045010426","type":"CDM"},{"code":"52281","type":"HCPCS"}],"standard_charges":[{"gross_charge":3487.0,"discounted_cash":2615.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INCISION OF URETHRA CDM","code_information":[{"code":"Px00045010427","type":"CDM"},{"code":"53020","type":"HCPCS"}],"standard_charges":[{"gross_charge":6572.0,"discounted_cash":4929.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF URETHRA ABSCESS CDM","code_information":[{"code":"Px00045010428","type":"CDM"},{"code":"53060","type":"HCPCS"}],"standard_charges":[{"gross_charge":6572.0,"discounted_cash":4929.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CL TX PALTL/MAXLRY FX WID WFIX CDM","code_information":[{"code":"Px00045010429","type":"CDM"},{"code":"21421","type":"HCPCS"}],"standard_charges":[{"gross_charge":8747.0,"discounted_cash":6560.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DILATE URETHRA STRICTURE W/ FILIFORM MALE INITIAL CDM","code_information":[{"code":"Px00045010430","type":"CDM"},{"code":"53620","type":"HCPCS"}],"standard_charges":[{"gross_charge":2216.0,"discounted_cash":1662.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DILATION OF URETHRA FEMALE INITIAL CDM","code_information":[{"code":"Px00045010431","type":"CDM"},{"code":"53660","type":"HCPCS"}],"standard_charges":[{"gross_charge":516.0,"discounted_cash":387.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED SLITTING OF PREPUCE EXCEPT NEWBORN CDM","code_information":[{"code":"Px00045010432","type":"CDM"},{"code":"54001","type":"HCPCS"}],"standard_charges":[{"gross_charge":6572.0,"discounted_cash":4929.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED IRRIGATION OF CORPORA CAVERNOSA FOR PRIAPISM CDM","code_information":[{"code":"Px00045010433","type":"CDM"},{"code":"54220","type":"HCPCS"}],"standard_charges":[{"gross_charge":1288.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED PREPUTIAL STRETCHING CDM","code_information":[{"code":"Px00045010434","type":"CDM"},{"code":"54450","type":"HCPCS"}],"standard_charges":[{"gross_charge":1402.0,"discounted_cash":1051.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REDUCE TESTIS TORSION CDM","code_information":[{"code":"Px00045010435","type":"CDM"},{"code":"54600","type":"HCPCS"}],"standard_charges":[{"gross_charge":9854.0,"discounted_cash":7390.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF SCROTUM CDM","code_information":[{"code":"Px00045010436","type":"CDM"},{"code":"54700","type":"HCPCS"}],"standard_charges":[{"gross_charge":6572.0,"discounted_cash":4929.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF SCROTUM ABSCESS CDM","code_information":[{"code":"Px00045010437","type":"CDM"},{"code":"55100","type":"HCPCS"}],"standard_charges":[{"gross_charge":8956.0,"discounted_cash":6717.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL OF SCROTUM LESION CDM","code_information":[{"code":"Px00045010438","type":"CDM"},{"code":"55120","type":"HCPCS"}],"standard_charges":[{"gross_charge":6572.0,"discounted_cash":4929.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED I & D OF VULVA/PERINEUM CDM","code_information":[{"code":"Px00045010440","type":"CDM"},{"code":"56405","type":"HCPCS"}],"standard_charges":[{"gross_charge":1322.0,"discounted_cash":991.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF GLAND ABSCESS CDM","code_information":[{"code":"Px00045010441","type":"CDM"},{"code":"56420","type":"HCPCS"}],"standard_charges":[{"gross_charge":795.0,"discounted_cash":596.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED SURGERY FOR VULVA LESION CDM","code_information":[{"code":"Px00045010442","type":"CDM"},{"code":"56440","type":"HCPCS"}],"standard_charges":[{"gross_charge":10020.0,"discounted_cash":7515.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF PELVIC FLUID CDM","code_information":[{"code":"Px00045010443","type":"CDM"},{"code":"57020","type":"HCPCS"}],"standard_charges":[{"gross_charge":16425.0,"discounted_cash":12318.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT VAGINAL BLEEDING CDM","code_information":[{"code":"Px00045010444","type":"CDM"},{"code":"57180","type":"HCPCS"}],"standard_charges":[{"gross_charge":817.0,"discounted_cash":612.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR OF VAGINA SUTURE CDM","code_information":[{"code":"Px00045010445","type":"CDM"},{"code":"57200","type":"HCPCS"}],"standard_charges":[{"gross_charge":13499.0,"discounted_cash":10124.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR VAGINA/PERINEUM CDM","code_information":[{"code":"Px00045010446","type":"CDM"},{"code":"57210","type":"HCPCS"}],"standard_charges":[{"gross_charge":8693.0,"discounted_cash":6519.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED PELVIC EXAMINATION CDM","code_information":[{"code":"Px00045010447","type":"CDM"},{"code":"57410","type":"HCPCS"}],"standard_charges":[{"gross_charge":10020.0,"discounted_cash":7515.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE VAGINAL FOREIGN BODY CDM","code_information":[{"code":"Px00045010448","type":"CDM"},{"code":"57415","type":"HCPCS"}],"standard_charges":[{"gross_charge":8693.0,"discounted_cash":6519.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INCISION OF EARDRUM W/O GENERAL ANESTHESIA CDM","code_information":[{"code":"Px00045010450","type":"CDM"},{"code":"69420","type":"HCPCS"}],"standard_charges":[{"gross_charge":737.0,"discounted_cash":552.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED BIOPSY OF CERVIX CDM","code_information":[{"code":"Px00045010451","type":"CDM"},{"code":"57500","type":"HCPCS"}],"standard_charges":[{"gross_charge":2493.0,"discounted_cash":1869.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CAUTERIZATION OF CERVIX CDM","code_information":[{"code":"Px00045010452","type":"CDM"},{"code":"57510","type":"HCPCS"}],"standard_charges":[{"gross_charge":7742.0,"discounted_cash":5806.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INCSN EXTNSOR TNDN SHEATH WRST CDM","code_information":[{"code":"Px00045010453","type":"CDM"},{"code":"25000","type":"HCPCS"}],"standard_charges":[{"gross_charge":5083.0,"discounted_cash":3812.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DILATION AND CURETTAGE CDM","code_information":[{"code":"Px00045010454","type":"CDM"},{"code":"58120","type":"HCPCS"}],"standard_charges":[{"gross_charge":10020.0,"discounted_cash":7515.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE INTRAUTERINE DEVICE CDM","code_information":[{"code":"Px00045010455","type":"CDM"},{"code":"58301","type":"HCPCS"}],"standard_charges":[{"gross_charge":1322.0,"discounted_cash":991.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DRILL SKULL FOR IMPLANTATION CDM","code_information":[{"code":"Px00045010456","type":"CDM"},{"code":"61107","type":"HCPCS"}],"standard_charges":[{"gross_charge":1981.0,"discounted_cash":1485.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED PIERCE SKULL & REMOVE CLOT CDM","code_information":[{"code":"Px00045010457","type":"CDM"},{"code":"61154","type":"HCPCS"}],"standard_charges":[{"gross_charge":8693.0,"discounted_cash":6519.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED PIERCE SKULL IMPLANT DEVICE CDM","code_information":[{"code":"Px00045010458","type":"CDM"},{"code":"61210","type":"HCPCS"}],"standard_charges":[{"gross_charge":8693.0,"discounted_cash":6519.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED NERVE BLOCK INJ TRIGEMINAL CDM","code_information":[{"code":"Px00045010459","type":"CDM"},{"code":"64400","type":"HCPCS"}],"standard_charges":[{"gross_charge":1731.0,"discounted_cash":1298.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED NERVE BLOCK INJ OCCIPITAL CDM","code_information":[{"code":"Px00045010461","type":"CDM"},{"code":"64405","type":"HCPCS"}],"standard_charges":[{"gross_charge":1677.0,"discounted_cash":1257.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED NERVE BLOCK INJ INTERCOSTAL SINGLE CDM","code_information":[{"code":"Px00045010462","type":"CDM"},{"code":"64420","type":"HCPCS"}],"standard_charges":[{"gross_charge":2524.0,"discounted_cash":1893.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REV FNGR JNT EA CDM","code_information":[{"code":"Px00045010463","type":"CDM"},{"code":"26140","type":"HCPCS"}],"standard_charges":[{"gross_charge":5083.0,"discounted_cash":3812.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REM IMPLANT FINGER OR HAND CDM","code_information":[{"code":"Px00045010464","type":"CDM"},{"code":"26320","type":"HCPCS"}],"standard_charges":[{"gross_charge":5314.0,"discounted_cash":3985.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED NERVE BLOCK INJ PLANTAR DIGIT CDM","code_information":[{"code":"Px00045010465","type":"CDM"},{"code":"64455","type":"HCPCS"}],"standard_charges":[{"gross_charge":964.0,"discounted_cash":723.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR OF DIGIT NERVE CDM","code_information":[{"code":"Px00045010466","type":"CDM"},{"code":"64831","type":"HCPCS"}],"standard_charges":[{"gross_charge":6369.0,"discounted_cash":4776.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE FOREIGN BODY FROM EYE SUPERFICIAL CDM","code_information":[{"code":"Px00045010467","type":"CDM"},{"code":"65205","type":"HCPCS"}],"standard_charges":[{"gross_charge":293.0,"discounted_cash":219.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE FOREIGN BODY FROM EYE EMBEDDED CDM","code_information":[{"code":"Px00045010469","type":"CDM"},{"code":"65210","type":"HCPCS"}],"standard_charges":[{"gross_charge":360.0,"discounted_cash":270.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE FOREIGN BODY FROM EYE CORNEAL W/O SLIT LAMP CDM","code_information":[{"code":"Px00045010471","type":"CDM"},{"code":"65220","type":"HCPCS"}],"standard_charges":[{"gross_charge":268.0,"discounted_cash":201.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR OF EYE WOUND CDM","code_information":[{"code":"Px00045010474","type":"CDM"},{"code":"65270","type":"HCPCS"}],"standard_charges":[{"gross_charge":5286.0,"discounted_cash":3964.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CURETTE/TREAT CORNEA CDM","code_information":[{"code":"Px00045010475","type":"CDM"},{"code":"65435","type":"HCPCS"}],"standard_charges":[{"gross_charge":2182.0,"discounted_cash":1636.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CURETTE/TREAT CORNEA W/ APPLICATION OF CHELATING AGENT CDM","code_information":[{"code":"Px00045010477","type":"CDM"},{"code":"65436","type":"HCPCS"}],"standard_charges":[{"gross_charge":5286.0,"discounted_cash":3964.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REVISION OF CORNEA CDM","code_information":[{"code":"Px00045010479","type":"CDM"},{"code":"65600","type":"HCPCS"}],"standard_charges":[{"gross_charge":4304.0,"discounted_cash":3228.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REVISE EYE SOCKET IMPLANT CDM","code_information":[{"code":"Px00045010480","type":"CDM"},{"code":"67560","type":"HCPCS"}],"standard_charges":[{"gross_charge":8739.0,"discounted_cash":6554.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF EYELID ABSCESS CDM","code_information":[{"code":"Px00045010482","type":"CDM"},{"code":"67700","type":"HCPCS"}],"standard_charges":[{"gross_charge":1674.0,"discounted_cash":1255.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INCISION OF EYELID FOLD CDM","code_information":[{"code":"Px00045010483","type":"CDM"},{"code":"67715","type":"HCPCS"}],"standard_charges":[{"gross_charge":5286.0,"discounted_cash":3964.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE EYELID FOREIGN BODY CDM","code_information":[{"code":"Px00045010484","type":"CDM"},{"code":"67938","type":"HCPCS"}],"standard_charges":[{"gross_charge":465.0,"discounted_cash":348.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DRAIN EXTERNAL EAR LESION SIMPLE CDM","code_information":[{"code":"Px00045010485","type":"CDM"},{"code":"69000","type":"HCPCS"}],"standard_charges":[{"gross_charge":815.0,"discounted_cash":611.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DRAIN EXTERNAL EAR LESION COMPLICATED CDM","code_information":[{"code":"Px00045010487","type":"CDM"},{"code":"69005","type":"HCPCS"}],"standard_charges":[{"gross_charge":5314.0,"discounted_cash":3985.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CLEAR OUTER EAR CANAL W/O GENERAL ANESTHESIA CDM","code_information":[{"code":"Px00045010489","type":"CDM"},{"code":"69200","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":225.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT CDM","code_information":[{"code":"Px00045010491","type":"CDM"},{"code":"69210","type":"HCPCS"}],"standard_charges":[{"gross_charge":662.0,"discounted_cash":496.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF GUM LESION CDM","code_information":[{"code":"Px00045010492","type":"CDM"},{"code":"41800","type":"HCPCS"}],"standard_charges":[{"gross_charge":946.0,"discounted_cash":709.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED PERCUTANEOUS FIXATION FEMORAL CDM","code_information":[{"code":"Px00045010493","type":"CDM"},{"code":"27509","type":"HCPCS"}],"standard_charges":[{"gross_charge":20338.0,"discounted_cash":15253.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TREATMENT OF DISTAL END FEMOR FRACTURE CDM","code_information":[{"code":"Px00045010494","type":"CDM"},{"code":"27510","type":"HCPCS"}],"standard_charges":[{"gross_charge":4410.0,"discounted_cash":3307.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TREAT PATELLAR FRACTURE W/O MANIPULATION CDM","code_information":[{"code":"Px00045010496","type":"CDM"},{"code":"27520","type":"HCPCS"}],"standard_charges":[{"gross_charge":734.0,"discounted_cash":550.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REP ET HAND W FG EA TENDON CDM","code_information":[{"code":"Px00045010497","type":"CDM"},{"code":"26412","type":"HCPCS"}],"standard_charges":[{"gross_charge":10548.0,"discounted_cash":7911.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DECOMP ANT LAT LEG ONLY CDM","code_information":[{"code":"Px00045010498","type":"CDM"},{"code":"27600","type":"HCPCS"}],"standard_charges":[{"gross_charge":10548.0,"discounted_cash":7911.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TREAT TIBIAL FRACTURE PROXIMAL W/O MANIP CDM","code_information":[{"code":"Px00045010499","type":"CDM"},{"code":"27530","type":"HCPCS"}],"standard_charges":[{"gross_charge":816.0,"discounted_cash":612.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR OF WOUND/LESION 2.6-7.5CM CMPLX FRHD CKS SHN MTH NK AX CDM","code_information":[{"code":"Px00045010501","type":"CDM"},{"code":"13132","type":"HCPCS"}],"standard_charges":[{"gross_charge":3615.0,"discounted_cash":2711.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR WND/LESION ADD-ON 5CM CMPLX FRHD CKS SHN MTH NK AX GEN HND CDM","code_information":[{"code":"Px00045010502","type":"CDM"},{"code":"13133","type":"HCPCS"}],"standard_charges":[{"gross_charge":1029.0,"discounted_cash":771.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR OF WOUND OR LESION 1.1 TO 2.5CM CMPLX EYLD NS ERS LIP CDM","code_information":[{"code":"Px00045010504","type":"CDM"},{"code":"13151","type":"HCPCS"}],"standard_charges":[{"gross_charge":2338.0,"discounted_cash":1753.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR OF WOUND OR LESION 2.6 TO 7.5CM CMPLX EYLD NS ERS LIP CDM","code_information":[{"code":"Px00045010505","type":"CDM"},{"code":"13152","type":"HCPCS"}],"standard_charges":[{"gross_charge":2338.0,"discounted_cash":1753.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR WOUND/LESION ADD-ON 5CM CMPLX EYLD NS ERS LIP CDM","code_information":[{"code":"Px00045010506","type":"CDM"},{"code":"13153","type":"HCPCS"}],"standard_charges":[{"gross_charge":4555.0,"discounted_cash":3416.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED LATE CLOSURE OF WOUND EXTENSIVE OR COMPLICATED CDM","code_information":[{"code":"Px00045010507","type":"CDM"},{"code":"13160","type":"HCPCS"}],"standard_charges":[{"gross_charge":6116.0,"discounted_cash":4587.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INTRAVITREAL NJX PHARMACOLOGIC AGT SPX CDM","code_information":[{"code":"Px00045010508","type":"CDM"},{"code":"67028","type":"HCPCS"}],"standard_charges":[{"gross_charge":832.0,"discounted_cash":624.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED ADJT TIS TRNS/REARGMT F/C/C/M/N/A/G/H/F 10SQCM OR LESS CDM","code_information":[{"code":"Px00045010509","type":"CDM"},{"code":"14040","type":"HCPCS"}],"standard_charges":[{"gross_charge":5306.0,"discounted_cash":3979.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED SKIN TISSUE REARRANGEMENT 10 SQ CM OR LESS EYLDS NS ERS LIP CDM","code_information":[{"code":"Px00045010510","type":"CDM"},{"code":"14060","type":"HCPCS"}],"standard_charges":[{"gross_charge":5306.0,"discounted_cash":3979.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED FILLETED FINGER/TOE FLAP CDM","code_information":[{"code":"Px00045010511","type":"CDM"},{"code":"14350","type":"HCPCS"}],"standard_charges":[{"gross_charge":6116.0,"discounted_cash":4587.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED SKIN PINCH GRAFT 2 CM DIAMETER CDM","code_information":[{"code":"Px00045010512","type":"CDM"},{"code":"15050","type":"HCPCS"}],"standard_charges":[{"gross_charge":2058.0,"discounted_cash":1543.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED SKN SPLT A-GRFT FAC/NCK/HF/G 1ST 100 SQ CM CDM","code_information":[{"code":"Px00045010513","type":"CDM"},{"code":"15120","type":"HCPCS"}],"standard_charges":[{"gross_charge":10002.0,"discounted_cash":7501.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED SKIN FULL GRFT FACE/GENIT/HF 20 SQ CM OR LESS CDM","code_information":[{"code":"Px00045010514","type":"CDM"},{"code":"15240","type":"HCPCS"}],"standard_charges":[{"gross_charge":5306.0,"discounted_cash":3979.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED COMPOSITE SKIN GRAFT EAR NASAL ALA CDM","code_information":[{"code":"Px00045010515","type":"CDM"},{"code":"15760","type":"HCPCS"}],"standard_charges":[{"gross_charge":5306.0,"discounted_cash":3979.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DERMA-FAT-FASCIA GRAFT CDM","code_information":[{"code":"Px00045010516","type":"CDM"},{"code":"15770","type":"HCPCS"}],"standard_charges":[{"gross_charge":10002.0,"discounted_cash":7501.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED BIOPSY BONE OPEN SUPERFICIAL CDM","code_information":[{"code":"Px00045010517","type":"CDM"},{"code":"20240","type":"HCPCS"}],"standard_charges":[{"gross_charge":11171.0,"discounted_cash":8378.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INITIAL TREATMENT OF BURN(S) 1ST DEG LOCAL TX CDM","code_information":[{"code":"Px00045010518","type":"CDM"},{"code":"16000","type":"HCPCS"}],"standard_charges":[{"gross_charge":463.0,"discounted_cash":347.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DRESS/DEBRID P-THICK BURN S LT/5% TBSA CDM","code_information":[{"code":"Px00045010519","type":"CDM"},{"code":"16020","type":"HCPCS"}],"standard_charges":[{"gross_charge":531.0,"discounted_cash":398.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DRESS/DEBRID P-THICK BURN M 5-10% TBSA CDM","code_information":[{"code":"Px00045010520","type":"CDM"},{"code":"16025","type":"HCPCS"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":840.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DRESS/DEBRID P-THICK BURN L GT/10% TBSA CDM","code_information":[{"code":"Px00045010521","type":"CDM"},{"code":"16030","type":"HCPCS"}],"standard_charges":[{"gross_charge":1420.0,"discounted_cash":1065.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INCISION OF BURN SCAB INITI CDM","code_information":[{"code":"Px00045010522","type":"CDM"},{"code":"16035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1322.0,"discounted_cash":991.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DRESSING CHANGE UNDER ANESTHESIA CDM","code_information":[{"code":"Px00045010523","type":"CDM"},{"code":"15852","type":"HCPCS"}],"standard_charges":[{"gross_charge":2058.0,"discounted_cash":1543.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DESTRUCTION OF SKIN LESIONS LESS THAN 10 SQ CM CDM","code_information":[{"code":"Px00045010524","type":"CDM"},{"code":"17106","type":"HCPCS"}],"standard_charges":[{"gross_charge":1322.0,"discounted_cash":991.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CHEMICAL CAUTERY TISSUE CDM","code_information":[{"code":"Px00045010525","type":"CDM"},{"code":"17250","type":"HCPCS"}],"standard_charges":[{"gross_charge":807.0,"discounted_cash":605.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INCISION OF BREAST LESION CDM","code_information":[{"code":"Px00045010527","type":"CDM"},{"code":"19020","type":"HCPCS"}],"standard_charges":[{"gross_charge":10688.0,"discounted_cash":8016.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":5314.0,"discounted_cash":3985.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED EXPLORE WOUND NECK CDM","code_information":[{"code":"Px00045010530","type":"CDM"},{"code":"20100","type":"HCPCS"}],"standard_charges":[{"gross_charge":3918.0,"discounted_cash":2938.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED EXPLORE WOUND CHEST CDM","code_information":[{"code":"Px00045010531","type":"CDM"},{"code":"20101","type":"HCPCS"}],"standard_charges":[{"gross_charge":8218.0,"discounted_cash":6163.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED EXPLORE WOUND ABDOMEN CDM","code_information":[{"code":"Px00045010532","type":"CDM"},{"code":"20102","type":"HCPCS"}],"standard_charges":[{"gross_charge":8218.0,"discounted_cash":6163.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED EXPLORE WOUND EXTREMITY CDM","code_information":[{"code":"Px00045010533","type":"CDM"},{"code":"20103","type":"HCPCS"}],"standard_charges":[{"gross_charge":3918.0,"discounted_cash":2938.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL OF FOREIGN BODY MUSC SIMP CDM","code_information":[{"code":"Px00045010534","type":"CDM"},{"code":"20520","type":"HCPCS"}],"standard_charges":[{"gross_charge":5314.0,"discounted_cash":3985.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL OF FOREIGN BODY COMPLEX CDM","code_information":[{"code":"Px00045010535","type":"CDM"},{"code":"20525","type":"HCPCS"}],"standard_charges":[{"gross_charge":9154.0,"discounted_cash":6865.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED THER INJECTION CARP TUNNEL CDM","code_information":[{"code":"Px00045010536","type":"CDM"},{"code":"20526","type":"HCPCS"}],"standard_charges":[{"gross_charge":964.0,"discounted_cash":723.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INJ TENDON SHEATH/LIGAMENT CDM","code_information":[{"code":"Px00045010538","type":"CDM"},{"code":"20550","type":"HCPCS"}],"standard_charges":[{"gross_charge":1298.0,"discounted_cash":973.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INJ TRIGGER POINT 1/2 MUSCL CDM","code_information":[{"code":"Px00045010539","type":"CDM"},{"code":"20552","type":"HCPCS"}],"standard_charges":[{"gross_charge":1461.0,"discounted_cash":1095.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INJECTION SINGLE/MLT TRIGGER POINT 3/GT MUSCLES CDM","code_information":[{"code":"Px00045010540","type":"CDM"},{"code":"20553","type":"HCPCS"}],"standard_charges":[{"gross_charge":1461.0,"discounted_cash":1095.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED APPLY/REMOVE FIXATION DEVICE CRANIAL CDM","code_information":[{"code":"Px00045010541","type":"CDM"},{"code":"20660","type":"HCPCS"}],"standard_charges":[{"gross_charge":5083.0,"discounted_cash":3812.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED APPLICATION OF HEAD BRACE CDM","code_information":[{"code":"Px00045010542","type":"CDM"},{"code":"20661","type":"HCPCS"}],"standard_charges":[{"gross_charge":2204.0,"discounted_cash":1653.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL OF SUPPORT IMPLANT CDM","code_information":[{"code":"Px00045010543","type":"CDM"},{"code":"20670","type":"HCPCS"}],"standard_charges":[{"gross_charge":6550.0,"discounted_cash":4912.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED FLUID PRESSURE MUSCLE CDM","code_information":[{"code":"Px00045010544","type":"CDM"},{"code":"20950","type":"HCPCS"}],"standard_charges":[{"gross_charge":3131.0,"discounted_cash":2348.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE SHOULDER FOREIGN BODY CDM","code_information":[{"code":"Px00045010546","type":"CDM"},{"code":"23330","type":"HCPCS"}],"standard_charges":[{"gross_charge":5314.0,"discounted_cash":3985.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREATMENT OF NOSE FRACTURE W/ STABILIZATION CDM","code_information":[{"code":"Px00045010547","type":"CDM"},{"code":"21320","type":"HCPCS"}],"standard_charges":[{"gross_charge":10082.0,"discounted_cash":7561.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED OPEN TREATMENT OF NOSE FRACTURE W/O MANIPULATION CDM","code_information":[{"code":"Px00045010548","type":"CDM"},{"code":"21325","type":"HCPCS"}],"standard_charges":[{"gross_charge":10082.0,"discounted_cash":7561.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED OPEN TREATMENT NASAL SEPTAL FRACTURE W/WO STABILIZATION CDM","code_information":[{"code":"Px00045010549","type":"CDM"},{"code":"21336","type":"HCPCS"}],"standard_charges":[{"gross_charge":9152.0,"discounted_cash":6864.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CLSD TX FX ORBIT EXCEPT BLOWOUT W/O MANIPULATION CDM","code_information":[{"code":"Px00045010550","type":"CDM"},{"code":"21400","type":"HCPCS"}],"standard_charges":[{"gross_charge":1618.0,"discounted_cash":1213.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TREATMENT DENTAL RIDGE FRACTURE CDM","code_information":[{"code":"Px00045010552","type":"CDM"},{"code":"21440","type":"HCPCS"}],"standard_charges":[{"gross_charge":8747.0,"discounted_cash":6560.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED OPEN TREATMENT DENTAL RIDGE FRACTURE CDM","code_information":[{"code":"Px00045010553","type":"CDM"},{"code":"21445","type":"HCPCS"}],"standard_charges":[{"gross_charge":16416.0,"discounted_cash":12312.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT LOWER JAW FRACTURE W/O MANIPULATION CDM","code_information":[{"code":"Px00045010554","type":"CDM"},{"code":"21450","type":"HCPCS"}],"standard_charges":[{"gross_charge":1618.0,"discounted_cash":1213.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT LOWER JAW FRACTURE W/ MANIPULATION CDM","code_information":[{"code":"Px00045010555","type":"CDM"},{"code":"21451","type":"HCPCS"}],"standard_charges":[{"gross_charge":4918.0,"discounted_cash":3688.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED RESET DISLOCATED JAW UNCOMPLICATED CDM","code_information":[{"code":"Px00045010556","type":"CDM"},{"code":"21480","type":"HCPCS"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":1035.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DRAIN NECK/CHEST LESION - LESION DRAIN CDM","code_information":[{"code":"Px00045010557","type":"CDM"},{"code":"21501","type":"HCPCS"}],"standard_charges":[{"gross_charge":9154.0,"discounted_cash":6865.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT STERNUM FRACTURE CDM","code_information":[{"code":"Px00045010560","type":"CDM"},{"code":"21820","type":"HCPCS"}],"standard_charges":[{"gross_charge":922.0,"discounted_cash":691.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT SPINE FRACTURE CDM","code_information":[{"code":"Px00045010562","type":"CDM"},{"code":"22310","type":"HCPCS"}],"standard_charges":[{"gross_charge":637.0,"discounted_cash":477.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DRAIN SHOULDER LESION CDM","code_information":[{"code":"Px00045010563","type":"CDM"},{"code":"23030","type":"HCPCS"}],"standard_charges":[{"gross_charge":9154.0,"discounted_cash":6865.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DBRDMT W/RMVL FM FX&/DISLC SKN SUBQ T/M/F MUSC CDM","code_information":[{"code":"Px00045010564","type":"CDM"},{"code":"11011","type":"HCPCS"}],"standard_charges":[{"gross_charge":2298.0,"discounted_cash":1723.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CLSD TX CLAVICULAR FRACTURE W/O MANIPULATION CDM","code_information":[{"code":"Px00045010566","type":"CDM"},{"code":"23500","type":"HCPCS"}],"standard_charges":[{"gross_charge":986.0,"discounted_cash":739.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM CDM","code_information":[{"code":"Px00045010568","type":"CDM"},{"code":"11045","type":"HCPCS"}],"standard_charges":[{"gross_charge":1149.0,"discounted_cash":861.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CLSD TX CLAVICULAR FRACTURE W/MANIPULATION CDM","code_information":[{"code":"Px00045010569","type":"CDM"},{"code":"23505","type":"HCPCS"}],"standard_charges":[{"gross_charge":8296.0,"discounted_cash":6222.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TANGENTIAL BIOPSY SKIN SINGLE LESION CDM","code_information":[{"code":"Px00045010571","type":"CDM"},{"code":"11102","type":"HCPCS"}],"standard_charges":[{"gross_charge":638.0,"discounted_cash":478.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT CLAVICLE DISLOCATION W/O MANI CDM","code_information":[{"code":"Px00045010572","type":"CDM"},{"code":"23520","type":"HCPCS"}],"standard_charges":[{"gross_charge":5083.0,"discounted_cash":3812.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT CLAVICLE DISLOCATION W/MANIP CDM","code_information":[{"code":"Px00045010574","type":"CDM"},{"code":"23525","type":"HCPCS"}],"standard_charges":[{"gross_charge":734.0,"discounted_cash":550.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT CLAVICLE DISLOCATIONAC JT DISLO W/O MAN CDM","code_information":[{"code":"Px00045010576","type":"CDM"},{"code":"23540","type":"HCPCS"}],"standard_charges":[{"gross_charge":1362.0,"discounted_cash":1021.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TANGENTIAL BIOPSY SKIN EA SEP/ADDITIONAL LESION CDM","code_information":[{"code":"Px00045010578","type":"CDM"},{"code":"11103","type":"HCPCS"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":240.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT CLAVICLE DISLOCATION AC JT DISLO W/MAN CDM","code_information":[{"code":"Px00045010579","type":"CDM"},{"code":"23545","type":"HCPCS"}],"standard_charges":[{"gross_charge":1362.0,"discounted_cash":1021.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT SHOULDER BLADE FX W/O MANIP CDM","code_information":[{"code":"Px00045010581","type":"CDM"},{"code":"23570","type":"HCPCS"}],"standard_charges":[{"gross_charge":734.0,"discounted_cash":550.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT SHOULDER BLADE FX W/MANIP CDM","code_information":[{"code":"Px00045010583","type":"CDM"},{"code":"23575","type":"HCPCS"}],"standard_charges":[{"gross_charge":5083.0,"discounted_cash":3812.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT HUMERUS FRACTURE W/O MANIP CDM","code_information":[{"code":"Px00045010585","type":"CDM"},{"code":"23600","type":"HCPCS"}],"standard_charges":[{"gross_charge":946.0,"discounted_cash":709.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED PUNCH BIOPSY SKIN SINGLE LESION CDM","code_information":[{"code":"Px00045010587","type":"CDM"},{"code":"11104","type":"HCPCS"}],"standard_charges":[{"gross_charge":1026.0,"discounted_cash":769.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT HUMERUS FRACTURE W/MANIP CDM","code_information":[{"code":"Px00045010588","type":"CDM"},{"code":"23605","type":"HCPCS"}],"standard_charges":[{"gross_charge":8296.0,"discounted_cash":6222.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT HUMERUS FRACTURE TUBEROSITY W/O MAN CDM","code_information":[{"code":"Px00045010590","type":"CDM"},{"code":"23620","type":"HCPCS"}],"standard_charges":[{"gross_charge":1299.0,"discounted_cash":974.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT HUMERUS FRACTURE TUBEROSITY W/MAN CDM","code_information":[{"code":"Px00045010592","type":"CDM"},{"code":"23625","type":"HCPCS"}],"standard_charges":[{"gross_charge":4559.0,"discounted_cash":3419.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT SHOULDER DISLOCATION W/MANIP CDM","code_information":[{"code":"Px00045010594","type":"CDM"},{"code":"23650","type":"HCPCS"}],"standard_charges":[{"gross_charge":817.0,"discounted_cash":612.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT SHOULDER DISLOCATION W/MANIP & ANNES CDM","code_information":[{"code":"Px00045010596","type":"CDM"},{"code":"23655","type":"HCPCS"}],"standard_charges":[{"gross_charge":11014.0,"discounted_cash":8260.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CLTX SHOULDER DISLC W/FX HUMERAL TUBRST W/MANJ CDM","code_information":[{"code":"Px00045010598","type":"CDM"},{"code":"23665","type":"HCPCS"}],"standard_charges":[{"gross_charge":5083.0,"discounted_cash":3812.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT DISLOCATION/FRACTURE W/SURG NK FX CDM","code_information":[{"code":"Px00045010600","type":"CDM"},{"code":"23675","type":"HCPCS"}],"standard_charges":[{"gross_charge":5083.0,"discounted_cash":3812.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED SHOULDER SURGERY PROCEDURE CDM","code_information":[{"code":"Px00045010601","type":"CDM"},{"code":"23929","type":"HCPCS"}],"standard_charges":[{"gross_charge":850.0,"discounted_cash":637.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF ARM LESION CDM","code_information":[{"code":"Px00045010602","type":"CDM"},{"code":"23930","type":"HCPCS"}],"standard_charges":[{"gross_charge":9154.0,"discounted_cash":6865.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF ARM BURSA CDM","code_information":[{"code":"Px00045010604","type":"CDM"},{"code":"23931","type":"HCPCS"}],"standard_charges":[{"gross_charge":4610.0,"discounted_cash":3457.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL OF ARM FOREIGN BODY CDM","code_information":[{"code":"Px00045010606","type":"CDM"},{"code":"24200","type":"HCPCS"}],"standard_charges":[{"gross_charge":1752.0,"discounted_cash":1314.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DESTRUCT PREMALG LESION FIRST LESION CDM","code_information":[{"code":"Px00045010608","type":"CDM"},{"code":"17000","type":"HCPCS"}],"standard_charges":[{"gross_charge":638.0,"discounted_cash":478.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DRAIN BLOOD FROM UNDER NAIL CDM","code_information":[{"code":"Px00045010609","type":"CDM"},{"code":"11740","type":"HCPCS"}],"standard_charges":[{"gross_charge":694.0,"discounted_cash":520.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL OF BREAST IMPLANT CDM","code_information":[{"code":"Px00045010610","type":"CDM"},{"code":"19328","type":"HCPCS"}],"standard_charges":[{"gross_charge":10570.0,"discounted_cash":7927.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED PUNCH BIOPSY SKIN EA SEP/ADDITIONAL LESION CDM","code_information":[{"code":"Px00045010611","type":"CDM"},{"code":"11105","type":"HCPCS"}],"standard_charges":[{"gross_charge":660.0,"discounted_cash":495.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREATMENT OF NOSE FRACTURE W/O STABILIZATION CDM","code_information":[{"code":"Px00045010612","type":"CDM"},{"code":"21315","type":"HCPCS"}],"standard_charges":[{"gross_charge":8576.0,"discounted_cash":6432.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED NERVE BLOCK INJ ILIOINGUINAL CDM","code_information":[{"code":"Px00045010617","type":"CDM"},{"code":"64425","type":"HCPCS"}],"standard_charges":[{"gross_charge":3812.0,"discounted_cash":2859.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL OF CONTRACEPTIVE CAP CDM","code_information":[{"code":"Px00045010618","type":"CDM"},{"code":"11976","type":"HCPCS"}],"standard_charges":[{"gross_charge":3160.0,"discounted_cash":2370.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":2298.0,"discounted_cash":1723.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL OF SUPPORT IMPLANT CDM","code_information":[{"code":"Px00045010619","type":"CDM"},{"code":"20680","type":"HCPCS"}],"standard_charges":[{"gross_charge":9154.0,"discounted_cash":6865.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR MUSCLES OF HAND CDM","code_information":[{"code":"Px00045010620","type":"CDM"},{"code":"26591","type":"HCPCS"}],"standard_charges":[{"gross_charge":9152.0,"discounted_cash":6864.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT KNUCKLE DISLOCATION CDM","code_information":[{"code":"Px00045010621","type":"CDM"},{"code":"26705","type":"HCPCS"}],"standard_charges":[{"gross_charge":5083.0,"discounted_cash":3812.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT HIP DISLOCATION W/ANESTH CDM","code_information":[{"code":"Px00045010622","type":"CDM"},{"code":"27257","type":"HCPCS"}],"standard_charges":[{"gross_charge":5083.0,"discounted_cash":3812.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED EXPLORATION OF KNEE JOINT CDM","code_information":[{"code":"Px00045010623","type":"CDM"},{"code":"27310","type":"HCPCS"}],"standard_charges":[{"gross_charge":10548.0,"discounted_cash":7911.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED APPLICATION OF FIGURE EIGHT CDM","code_information":[{"code":"Px00045010624","type":"CDM"},{"code":"29049","type":"HCPCS"}],"standard_charges":[{"gross_charge":850.0,"discounted_cash":637.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR BLOOD VESSEL LESION CDM","code_information":[{"code":"Px00045010626","type":"CDM"},{"code":"35188","type":"HCPCS"}],"standard_charges":[{"gross_charge":15563.0,"discounted_cash":11672.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR EYELID WOUND CDM","code_information":[{"code":"Px00045010627","type":"CDM"},{"code":"67930","type":"HCPCS"}],"standard_charges":[{"gross_charge":5286.0,"discounted_cash":3964.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INJECTION EPIDURAL BLOOD/CLOT PATCH CDM","code_information":[{"code":"Px00045010629","type":"CDM"},{"code":"62273","type":"HCPCS"}],"standard_charges":[{"gross_charge":1960.0,"discounted_cash":1470.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED MULTIPLE NERVE BLOCK INJECTIONS RIB NERVES CDM","code_information":[{"code":"Px00045010631","type":"CDM"},{"code":"64421","type":"HCPCS"}],"standard_charges":[{"gross_charge":4550.0,"discounted_cash":3412.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT HUMERUS FRACTURE CDM","code_information":[{"code":"Px00045010632","type":"CDM"},{"code":"23615","type":"HCPCS"}],"standard_charges":[{"gross_charge":40117.0,"discounted_cash":30087.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT ELBOW FRACTURE CDM","code_information":[{"code":"Px00045010633","type":"CDM"},{"code":"24635","type":"HCPCS"}],"standard_charges":[{"gross_charge":20338.0,"discounted_cash":15253.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT FRACTURE OF ULNA CDM","code_information":[{"code":"Px00045010634","type":"CDM"},{"code":"25545","type":"HCPCS"}],"standard_charges":[{"gross_charge":23440.0,"discounted_cash":17580.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT FX RAD EXTRA-ARTICUL CDM","code_information":[{"code":"Px00045010635","type":"CDM"},{"code":"25607","type":"HCPCS"}],"standard_charges":[{"gross_charge":23440.0,"discounted_cash":17580.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR FINGER/HAND TENDON CDM","code_information":[{"code":"Px00045010636","type":"CDM"},{"code":"26350","type":"HCPCS"}],"standard_charges":[{"gross_charge":10548.0,"discounted_cash":7911.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED HAND TENDON RECONSTRUCTION CDM","code_information":[{"code":"Px00045010637","type":"CDM"},{"code":"26502","type":"HCPCS"}],"standard_charges":[{"gross_charge":10548.0,"discounted_cash":7911.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED OPEN TX DISTAL FIBULAR FRACTURE LAT MALLEOLUS CDM","code_information":[{"code":"Px00045010638","type":"CDM"},{"code":"27792","type":"HCPCS"}],"standard_charges":[{"gross_charge":23440.0,"discounted_cash":17580.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED OPEN TX BIMALLEOLAR ANKLE FRACTURE CDM","code_information":[{"code":"Px00045010639","type":"CDM"},{"code":"27814","type":"HCPCS"}],"standard_charges":[{"gross_charge":20338.0,"discounted_cash":15253.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED OPEN TX TRIMALLEOLAR ANKLE FX WO FIX PST LIP CDM","code_information":[{"code":"Px00045010640","type":"CDM"},{"code":"27822","type":"HCPCS"}],"standard_charges":[{"gross_charge":20338.0,"discounted_cash":15253.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CORRECTION OF BUNION CDM","code_information":[{"code":"Px00045010641","type":"CDM"},{"code":"28296","type":"HCPCS"}],"standard_charges":[{"gross_charge":10548.0,"discounted_cash":7911.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CONTROL THROAT BLEEDING CDM","code_information":[{"code":"Px00045010642","type":"CDM"},{"code":"42962","type":"HCPCS"}],"standard_charges":[{"gross_charge":8747.0,"discounted_cash":6560.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE ANAL FIST INTER CDM","code_information":[{"code":"Px00045010644","type":"CDM"},{"code":"46275","type":"HCPCS"}],"standard_charges":[{"gross_charge":9106.0,"discounted_cash":6829.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED HEMORRHOIDOPEXY BY STAPLING CDM","code_information":[{"code":"Px00045010645","type":"CDM"},{"code":"46947","type":"HCPCS"}],"standard_charges":[{"gross_charge":9106.0,"discounted_cash":6829.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED LAPARO CHOLECYSTECTOMY/GRAPH CDM","code_information":[{"code":"Px00045010647","type":"CDM"},{"code":"47563","type":"HCPCS"}],"standard_charges":[{"gross_charge":16025.0,"discounted_cash":12018.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CYSTOSCOPY REMOVAL OF CLOTS CDM","code_information":[{"code":"Px00045010648","type":"CDM"},{"code":"52001","type":"HCPCS"}],"standard_charges":[{"gross_charge":8013.0,"discounted_cash":6009.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CYSTOSCOPY AND TREATMENT CDM","code_information":[{"code":"Px00045010649","type":"CDM"},{"code":"52214","type":"HCPCS"}],"standard_charges":[{"gross_charge":8013.0,"discounted_cash":6009.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REVISION OF CERVIX 57720 CDM","code_information":[{"code":"Px00045010650","type":"CDM"},{"code":"57720","type":"HCPCS"}],"standard_charges":[{"gross_charge":10020.0,"discounted_cash":7515.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE SHOULDER FB DEEP CDM","code_information":[{"code":"Px00045010656","type":"CDM"},{"code":"23333","type":"HCPCS"}],"standard_charges":[{"gross_charge":9154.0,"discounted_cash":6865.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR OF NASAL SEPTUM CDM","code_information":[{"code":"Px00045010659","type":"CDM"},{"code":"30520","type":"HCPCS"}],"standard_charges":[{"gross_charge":10082.0,"discounted_cash":7561.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL SUTURES/STAPLES REQUIRING ANESTHESIA CDM","code_information":[{"code":"Px00045010660","type":"CDM"},{"code":"15851","type":"HCPCS"}],"standard_charges":[{"gross_charge":6116.0,"discounted_cash":4587.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR ARM/LEG NERVE CDM","code_information":[{"code":"Px00045010661","type":"CDM"},{"code":"64857","type":"HCPCS"}],"standard_charges":[{"gross_charge":18997.0,"discounted_cash":14247.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE FOREIGN BODY FROM EYE CDM","code_information":[{"code":"Px00045010662","type":"CDM"},{"code":"65235","type":"HCPCS"}],"standard_charges":[{"gross_charge":5399.0,"discounted_cash":4049.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF EYE CDM","code_information":[{"code":"Px00045010663","type":"CDM"},{"code":"65800","type":"HCPCS"}],"standard_charges":[{"gross_charge":5399.0,"discounted_cash":4049.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED EYE EXAM NEW PATIENT CDM","code_information":[{"code":"Px00045010664","type":"CDM"},{"code":"92002","type":"HCPCS"}],"standard_charges":[{"gross_charge":347.0,"discounted_cash":260.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED HYMENOTOMY SIMPLE INCISION CDM","code_information":[{"code":"Px00045010665","type":"CDM"},{"code":"56442","type":"HCPCS"}],"standard_charges":[{"gross_charge":8693.0,"discounted_cash":6519.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED RECONSTRUCTION OF NAIL BED W/GRAFT CDM","code_information":[{"code":"Px00045010667","type":"CDM"},{"code":"11762","type":"HCPCS"}],"standard_charges":[{"gross_charge":6116.0,"discounted_cash":4587.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE ANAL FIST SUBQ CDM","code_information":[{"code":"Px00045010668","type":"CDM"},{"code":"46270","type":"HCPCS"}],"standard_charges":[{"gross_charge":9106.0,"discounted_cash":6829.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREATMENT OF TIBIA FRACTURE CDM","code_information":[{"code":"Px00045010669","type":"CDM"},{"code":"27756","type":"HCPCS"}],"standard_charges":[{"gross_charge":20338.0,"discounted_cash":15253.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED MNPJ OF TMJ W/ANESTH CDM","code_information":[{"code":"Px00045010670","type":"CDM"},{"code":"21073","type":"HCPCS"}],"standard_charges":[{"gross_charge":4267.0,"discounted_cash":3200.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TX VERT FX W/MANJ CDM","code_information":[{"code":"Px00045010671","type":"CDM"},{"code":"22315","type":"HCPCS"}],"standard_charges":[{"gross_charge":9152.0,"discounted_cash":6864.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INJECTION AA&/STRD FEMORAL NERVE W/IMG GDN CDM","code_information":[{"code":"Px00045010673","type":"CDM"},{"code":"64447","type":"HCPCS"}],"standard_charges":[{"gross_charge":2283.0,"discounted_cash":1712.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR FOREARM TENDON/MUSCLE SECONDARY CDM","code_information":[{"code":"Px00045010674","type":"CDM"},{"code":"25263","type":"HCPCS"}],"standard_charges":[{"gross_charge":15592.0,"discounted_cash":11694.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REPLANTATION DIGIT COMPLETE CDM","code_information":[{"code":"Px00045010675","type":"CDM"},{"code":"20822","type":"HCPCS"}],"standard_charges":[{"gross_charge":4410.0,"discounted_cash":3307.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED HYPOTHERMIA ILL NEONATE CDM","code_information":[{"code":"Px00045010676","type":"CDM"},{"code":"99184","type":"HCPCS"}],"standard_charges":[{"gross_charge":4603.0,"discounted_cash":3452.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR EYELID WOUND FULL THICKNESS CDM","code_information":[{"code":"Px00045010677","type":"CDM"},{"code":"67935","type":"HCPCS"}],"standard_charges":[{"gross_charge":5286.0,"discounted_cash":3964.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE IMPACTED EAR WAX UNI CDM","code_information":[{"code":"Px00045010678","type":"CDM"},{"code":"69209","type":"HCPCS"}],"standard_charges":[{"gross_charge":382.0,"discounted_cash":286.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED APPLICATION OF SHOULDER CAST-PLASTER CDM","code_information":[{"code":"Px00045010679","type":"CDM"},{"code":"29058","type":"HCPCS"}],"standard_charges":[{"gross_charge":850.0,"discounted_cash":637.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED BLOOD PUSH TRANSFUSE LT 2 YR CDM","code_information":[{"code":"Px00045010680","type":"CDM"},{"code":"36440","type":"HCPCS"}],"standard_charges":[{"gross_charge":1444.0,"discounted_cash":1083.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TX FEMORAL FRACTURE PROX HEAD W/O MANI CDM","code_information":[{"code":"Px00045010681","type":"CDM"},{"code":"27267","type":"HCPCS"}],"standard_charges":[{"gross_charge":9152.0,"discounted_cash":6864.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF MOUTH LESION CDM","code_information":[{"code":"Px00045010682","type":"CDM"},{"code":"41015","type":"HCPCS"}],"standard_charges":[{"gross_charge":1618.0,"discounted_cash":1213.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DX LARYNGOSCOPY W/OPER SCOPE CDM","code_information":[{"code":"Px00045010683","type":"CDM"},{"code":"31526","type":"HCPCS"}],"standard_charges":[{"gross_charge":3996.0,"discounted_cash":2997.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED ESCHAROTOMY ADDL INCISION CDM","code_information":[{"code":"Px00045010684","type":"CDM"},{"code":"16036","type":"HCPCS"}],"standard_charges":[{"gross_charge":660.0,"discounted_cash":495.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED EXPLORE/REPAIR CHEST CDM","code_information":[{"code":"Px00045010685","type":"CDM"},{"code":"32110","type":"HCPCS"}],"standard_charges":[{"gross_charge":4914.0,"discounted_cash":3685.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INCISE/DRAIN TEAR GLAND CDM","code_information":[{"code":"Px00045010686","type":"CDM"},{"code":"68400","type":"HCPCS"}],"standard_charges":[{"gross_charge":2182.0,"discounted_cash":1636.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED LIGATION OF NECK ARTERY CDM","code_information":[{"code":"Px00045010687","type":"CDM"},{"code":"37615","type":"HCPCS"}],"standard_charges":[{"gross_charge":9020.0,"discounted_cash":6765.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED PARTIAL REMOVAL FINGER BONE CDM","code_information":[{"code":"Px00045010688","type":"CDM"},{"code":"26236","type":"HCPCS"}],"standard_charges":[{"gross_charge":5083.0,"discounted_cash":3812.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR FINGER/HAND TENDON NO MAN LND-PRIMARY CDM","code_information":[{"code":"Px00045010689","type":"CDM"},{"code":"26356","type":"HCPCS"}],"standard_charges":[{"gross_charge":9152.0,"discounted_cash":6864.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR PALATE CDM","code_information":[{"code":"Px00045010690","type":"CDM"},{"code":"42182","type":"HCPCS"}],"standard_charges":[{"gross_charge":18922.0,"discounted_cash":14191.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REVISE FINGER JOINT CDM","code_information":[{"code":"Px00045010691","type":"CDM"},{"code":"26535","type":"HCPCS"}],"standard_charges":[{"gross_charge":10548.0,"discounted_cash":7911.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT METACARPAL FRACTURE-PERC SK FIXATION CDM","code_information":[{"code":"Px00045010692","type":"CDM"},{"code":"26608","type":"HCPCS"}],"standard_charges":[{"gross_charge":9152.0,"discounted_cash":6864.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT THIGH FRACTURE-CLS FEM NCK W/MAN CDM","code_information":[{"code":"Px00045010693","type":"CDM"},{"code":"27232","type":"HCPCS"}],"standard_charges":[{"gross_charge":769.0,"discounted_cash":576.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREATMENT OF MISCARRIAGE-2ND TRIM CDM","code_information":[{"code":"Px00045010694","type":"CDM"},{"code":"59821","type":"HCPCS"}],"standard_charges":[{"gross_charge":10020.0,"discounted_cash":7515.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED SKIN TISSUE REARRANGEMENT 10.1 SQ CM TO 30.0 SQ CM FRHD CK CDM","code_information":[{"code":"Px00045010695","type":"CDM"},{"code":"14041","type":"HCPCS"}],"standard_charges":[{"gross_charge":5306.0,"discounted_cash":3979.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INCISIONAL BIOPSY SKIN SINGLE LESION CDM","code_information":[{"code":"Px00045010696","type":"CDM"},{"code":"11106","type":"HCPCS"}],"standard_charges":[{"gross_charge":2058.0,"discounted_cash":1543.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INCISIONAL BIOPSY SKIN EA SEP/ADDITIONAL LESION CDM","code_information":[{"code":"Px00045010697","type":"CDM"},{"code":"11107","type":"HCPCS"}],"standard_charges":[{"gross_charge":1029.0,"discounted_cash":771.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM OR LESS CDM","code_information":[{"code":"Px00045010698","type":"CDM"},{"code":"11440","type":"HCPCS"}],"standard_charges":[{"gross_charge":2298.0,"discounted_cash":1723.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM CDM","code_information":[{"code":"Px00045010699","type":"CDM"},{"code":"11441","type":"HCPCS"}],"standard_charges":[{"gross_charge":2298.0,"discounted_cash":1723.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED PUNCTURE ASPIRATION CYST BREAST CDM","code_information":[{"code":"Px00045010700","type":"CDM"},{"code":"19000","type":"HCPCS"}],"standard_charges":[{"gross_charge":2298.0,"discounted_cash":1723.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL OF ARM FOREIGN BODY ARM/ELBOW CDM","code_information":[{"code":"Px00045010701","type":"CDM"},{"code":"24201","type":"HCPCS"}],"standard_charges":[{"gross_charge":9154.0,"discounted_cash":6865.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED EXCISION/CURETTAGE BONE CYST/TUMOR TIBIA/FIBULA CDM","code_information":[{"code":"Px00045010702","type":"CDM"},{"code":"27635","type":"HCPCS"}],"standard_charges":[{"gross_charge":9152.0,"discounted_cash":6864.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR ARM TENDON/MUSCLE CDM","code_information":[{"code":"Px00045010704","type":"CDM"},{"code":"24341","type":"HCPCS"}],"standard_charges":[{"gross_charge":23440.0,"discounted_cash":17580.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT HUMERUS FX W/O MANIP CDM","code_information":[{"code":"Px00045010705","type":"CDM"},{"code":"24500","type":"HCPCS"}],"standard_charges":[{"gross_charge":734.0,"discounted_cash":550.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED STRAPPING UNNA BOOT CDM","code_information":[{"code":"Px00045010706","type":"CDM"},{"code":"29580","type":"HCPCS"}],"standard_charges":[{"gross_charge":973.0,"discounted_cash":729.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED WEDGING CAST EXCEPT CLUBFOOT CASTS CDM","code_information":[{"code":"Px00045010708","type":"CDM"},{"code":"29740","type":"HCPCS"}],"standard_charges":[{"gross_charge":850.0,"discounted_cash":637.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT HUMERUS FX W/MANIP CDM","code_information":[{"code":"Px00045010709","type":"CDM"},{"code":"24505","type":"HCPCS"}],"standard_charges":[{"gross_charge":7135.0,"discounted_cash":5351.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INSJ/RPLCMT TEMP TRANSVNS 2CHMBR PACG ELTRDS SPX CDM","code_information":[{"code":"Px00045010712","type":"CDM"},{"code":"33211","type":"HCPCS"}],"standard_charges":[{"gross_charge":24718.0,"discounted_cash":18538.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT HUMERUS FRACTURE CDM","code_information":[{"code":"Px00045010713","type":"CDM"},{"code":"24530","type":"HCPCS"}],"standard_charges":[{"gross_charge":734.0,"discounted_cash":550.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED NJX PX XTR VNGRPH W/INTRO NDL/INTRACATH CDM","code_information":[{"code":"Px00045010714","type":"CDM"},{"code":"36005","type":"HCPCS"}],"standard_charges":[{"gross_charge":1751.0,"discounted_cash":1313.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED COLLECTION CAPILLARY BLOOD SPECIMEN CDM","code_information":[{"code":"Px00045010716","type":"CDM"},{"code":"36416","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":20.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT HUMERUS FRACTURE W/MANIPULATION CDM","code_information":[{"code":"Px00045010717","type":"CDM"},{"code":"24535","type":"HCPCS"}],"standard_charges":[{"gross_charge":7135.0,"discounted_cash":5351.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CATHJ UMBILICAL VEIN DX/THER NB CDM","code_information":[{"code":"Px00045010718","type":"CDM"},{"code":"36510","type":"HCPCS"}],"standard_charges":[{"gross_charge":339.0,"discounted_cash":254.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED RPLCMT CATH CTR VAD SUBQ PORT/PMP CDM","code_information":[{"code":"Px00045010720","type":"CDM"},{"code":"36578","type":"HCPCS"}],"standard_charges":[{"gross_charge":10556.0,"discounted_cash":7917.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED PERCUTANEOUS FIXATION HUMERAL CDM","code_information":[{"code":"Px00045010721","type":"CDM"},{"code":"24538","type":"HCPCS"}],"standard_charges":[{"gross_charge":23440.0,"discounted_cash":17580.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT HUMERUS EPICOND FRACTURE CDM","code_information":[{"code":"Px00045010722","type":"CDM"},{"code":"24560","type":"HCPCS"}],"standard_charges":[{"gross_charge":734.0,"discounted_cash":550.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED RMVL TUN CVC W/O SUBQ PORT/PMP CDM","code_information":[{"code":"Px00045010723","type":"CDM"},{"code":"36589","type":"HCPCS"}],"standard_charges":[{"gross_charge":3465.0,"discounted_cash":2598.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED RMVL TUN CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ CDM","code_information":[{"code":"Px00045010725","type":"CDM"},{"code":"36590","type":"HCPCS"}],"standard_charges":[{"gross_charge":5273.0,"discounted_cash":3954.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT HUMERUS EPICOND FRACTURE W/MANIPULATION CDM","code_information":[{"code":"Px00045010726","type":"CDM"},{"code":"24565","type":"HCPCS"}],"standard_charges":[{"gross_charge":8287.0,"discounted_cash":6215.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DRG ABSC SUBMAXILLARY/SUBLINGUAL INTRAORAL CDM","code_information":[{"code":"Px00045010727","type":"CDM"},{"code":"42310","type":"HCPCS"}],"standard_charges":[{"gross_charge":1618.0,"discounted_cash":1213.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC CDM","code_information":[{"code":"Px00045010728","type":"CDM"},{"code":"43235","type":"HCPCS"}],"standard_charges":[{"gross_charge":2064.0,"discounted_cash":1548.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT HUMERUS CONDYLAR FRACTURE CDM","code_information":[{"code":"Px00045010730","type":"CDM"},{"code":"24576","type":"HCPCS"}],"standard_charges":[{"gross_charge":734.0,"discounted_cash":550.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INSERT GASTROSTOMY TUBE PERCUTANEOUS CDM","code_information":[{"code":"Px00045010732","type":"CDM"},{"code":"49440","type":"HCPCS"}],"standard_charges":[{"gross_charge":6171.0,"discounted_cash":4628.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REPLACE GASTROSTOMY/CECOSTOMY TUBE PERCUTANEOUS CDM","code_information":[{"code":"Px00045010733","type":"CDM"},{"code":"49450","type":"HCPCS"}],"standard_charges":[{"gross_charge":3723.0,"discounted_cash":2792.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT HUMERUS CONDYLAR FRACTURE W/MANIPULATION CDM","code_information":[{"code":"Px00045010734","type":"CDM"},{"code":"24577","type":"HCPCS"}],"standard_charges":[{"gross_charge":5083.0,"discounted_cash":3812.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED FIT&INSJ PESSARY/OTH INTRAVAGINAL SUPPORT DEVI CDM","code_information":[{"code":"Px00045010735","type":"CDM"},{"code":"57160","type":"HCPCS"}],"standard_charges":[{"gross_charge":630.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED EXCISION CHALAZION SINGLE CDM","code_information":[{"code":"Px00045010737","type":"CDM"},{"code":"67800","type":"HCPCS"}],"standard_charges":[{"gross_charge":662.0,"discounted_cash":496.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT ELBOW DISLOCATION W/O ANESTH CDM","code_information":[{"code":"Px00045010738","type":"CDM"},{"code":"24600","type":"HCPCS"}],"standard_charges":[{"gross_charge":1402.0,"discounted_cash":1051.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED SUBCUTANEOUS INFUSION INITIAL 1 HR W/PUMP SET-UP CDM","code_information":[{"code":"Px00045010739","type":"CDM"},{"code":"96369","type":"HCPCS"}],"standard_charges":[{"gross_charge":761.0,"discounted_cash":570.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT ELBOW DISLOCATION W/ANESTH CDM","code_information":[{"code":"Px00045010741","type":"CDM"},{"code":"24605","type":"HCPCS"}],"standard_charges":[{"gross_charge":3708.0,"discounted_cash":2781.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED SUBCUTANEOUS INFUSION EACH ADDITIONAL HOUR CDM","code_information":[{"code":"Px00045010742","type":"CDM"},{"code":"96370","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":93.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED OPEN TX CLAVICULAR FRACTURE INTERNAL FIXATION CDM","code_information":[{"code":"Px00045010744","type":"CDM"},{"code":"23515","type":"HCPCS"}],"standard_charges":[{"gross_charge":23440.0,"discounted_cash":17580.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TX MONTEGGIA FX DISLOCATION ELBOW W/MANI CDM","code_information":[{"code":"Px00045010745","type":"CDM"},{"code":"24620","type":"HCPCS"}],"standard_charges":[{"gross_charge":9708.0,"discounted_cash":7281.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TX HUMRAL SHAFT FX W/INSJ IMED IMPLT W/W CERCLGE CDM","code_information":[{"code":"Px00045010746","type":"CDM"},{"code":"24516","type":"HCPCS"}],"standard_charges":[{"gross_charge":40117.0,"discounted_cash":30087.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED EXCISION/CURETTAGE CYST/TUMOR METACARPAL CDM","code_information":[{"code":"Px00045010747","type":"CDM"},{"code":"26200","type":"HCPCS"}],"standard_charges":[{"gross_charge":5083.0,"discounted_cash":3812.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TREAT OF RADIAL HEAD SUBLUXATION W/MANIP CDM","code_information":[{"code":"Px00045010749","type":"CDM"},{"code":"24640","type":"HCPCS"}],"standard_charges":[{"gross_charge":1407.0,"discounted_cash":1055.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED PRQ SKEL FIXJ FEMORAL FX PROX END NECK CDM","code_information":[{"code":"Px00045010750","type":"CDM"},{"code":"27235","type":"HCPCS"}],"standard_charges":[{"gross_charge":20338.0,"discounted_cash":15253.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT RADIUS FRACTURE CDM","code_information":[{"code":"Px00045010752","type":"CDM"},{"code":"24650","type":"HCPCS"}],"standard_charges":[{"gross_charge":1350.0,"discounted_cash":1012.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED OPEN TREATMENT FRACTURE DISTAL TIBIA ONLY CDM","code_information":[{"code":"Px00045010753","type":"CDM"},{"code":"27827","type":"HCPCS"}],"standard_charges":[{"gross_charge":40117.0,"discounted_cash":30087.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED OPEN TREATMENT FRACTURE DISTAL TIBIA & FIBULA CDM","code_information":[{"code":"Px00045010755","type":"CDM"},{"code":"27828","type":"HCPCS"}],"standard_charges":[{"gross_charge":40117.0,"discounted_cash":30087.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TX RADIUS HD FRACTURE CDM","code_information":[{"code":"Px00045010756","type":"CDM"},{"code":"24655","type":"HCPCS"}],"standard_charges":[{"gross_charge":7135.0,"discounted_cash":5351.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED OPEN TX DISTAL TIBIOFIBULAR JOINT DISRUPTION CDM","code_information":[{"code":"Px00045010757","type":"CDM"},{"code":"27829","type":"HCPCS"}],"standard_charges":[{"gross_charge":20338.0,"discounted_cash":15253.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED EXCISION VAGINAL CYST/TUMOR CDM","code_information":[{"code":"Px00045010759","type":"CDM"},{"code":"57135","type":"HCPCS"}],"standard_charges":[{"gross_charge":8693.0,"discounted_cash":6519.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT ULNAR FRACTURE CDM","code_information":[{"code":"Px00045010760","type":"CDM"},{"code":"24670","type":"HCPCS"}],"standard_charges":[{"gross_charge":734.0,"discounted_cash":550.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REFILL&MAINTENANCE PUMP DRUG DLVR SYSTEMIC CDM","code_information":[{"code":"Px00045010761","type":"CDM"},{"code":"96522","type":"HCPCS"}],"standard_charges":[{"gross_charge":516.0,"discounted_cash":387.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED IRRIGAJ IMPLNTD VENOUS ACCESS DRUG DELIVERY SYST CDM","code_information":[{"code":"Px00045010763","type":"CDM"},{"code":"96523","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.0,"discounted_cash":173.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT ULNAR FRACTURE W/MANIPULATION CDM","code_information":[{"code":"Px00045010764","type":"CDM"},{"code":"24675","type":"HCPCS"}],"standard_charges":[{"gross_charge":7135.0,"discounted_cash":5351.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED FETAL NONSTRESS TEST CDM","code_information":[{"code":"Px00045010765","type":"CDM"},{"code":"59025","type":"HCPCS"}],"standard_charges":[{"gross_charge":1201.0,"discounted_cash":900.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED SLCTV CATH PLMT VEN SYS 1ST ORDER BRANCH CDM","code_information":[{"code":"Px00045010767","type":"CDM"},{"code":"36011","type":"HCPCS"}],"standard_charges":[{"gross_charge":1751.0,"discounted_cash":1313.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE FOREARM FOREIGN BODY - WRIST/FOREARM CDM","code_information":[{"code":"Px00045010769","type":"CDM"},{"code":"25248","type":"HCPCS"}],"standard_charges":[{"gross_charge":10077.0,"discounted_cash":7557.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED RPR TDN/MUSC FLXR F/ARM&/WRST PRIM 1 EA TDN/MU CDM","code_information":[{"code":"Px00045010770","type":"CDM"},{"code":"25260","type":"HCPCS"}],"standard_charges":[{"gross_charge":12128.0,"discounted_cash":9096.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TTRACH INTRO NDL WIRE DIL/STENT/TUBE O2 THER CDM","code_information":[{"code":"Px00045010771","type":"CDM"},{"code":"31730","type":"HCPCS"}],"standard_charges":[{"gross_charge":4914.0,"discounted_cash":3685.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED LARYNGOSCOPY W/WO TRACHEOSCOPY ASPIRATION CDM","code_information":[{"code":"Px00045010773","type":"CDM"},{"code":"31515","type":"HCPCS"}],"standard_charges":[{"gross_charge":943.0,"discounted_cash":707.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR FOREARM TENDON/MUSCLE SINGLE EA TENDON CDM","code_information":[{"code":"Px00045010774","type":"CDM"},{"code":"25270","type":"HCPCS"}],"standard_charges":[{"gross_charge":10548.0,"discounted_cash":7911.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED GASTRIC INTUBATJ & ASPIRAJ W/PHYS SKILL/LAVAGE CDM","code_information":[{"code":"Px00045010775","type":"CDM"},{"code":"43753","type":"HCPCS"}],"standard_charges":[{"gross_charge":1021.0,"discounted_cash":765.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INSERTION INTRAUTERINE DEVICE IUD CDM","code_information":[{"code":"Px00045010777","type":"CDM"},{"code":"58300","type":"HCPCS"}],"standard_charges":[{"gross_charge":630.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT FRACTURE OF RADIUS W/O MANIPULATION CDM","code_information":[{"code":"Px00045010778","type":"CDM"},{"code":"25500","type":"HCPCS"}],"standard_charges":[{"gross_charge":845.0,"discounted_cash":633.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED OBSTRUCTIVE MATERIAL REMOVAL FROM GI TUBE CDM","code_information":[{"code":"Px00045010779","type":"CDM"},{"code":"49460","type":"HCPCS"}],"standard_charges":[{"gross_charge":2538.0,"discounted_cash":1903.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REPLACEMENT G-J TUBE PERCUTANEOUS CDM","code_information":[{"code":"Px00045010781","type":"CDM"},{"code":"49452","type":"HCPCS"}],"standard_charges":[{"gross_charge":3177.0,"discounted_cash":2382.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT FRACTURE OF RADIUS W/MANIPULATION CDM","code_information":[{"code":"Px00045010782","type":"CDM"},{"code":"25505","type":"HCPCS"}],"standard_charges":[{"gross_charge":7135.0,"discounted_cash":5351.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US CDM","code_information":[{"code":"Px00045010783","type":"CDM"},{"code":"20605","type":"HCPCS"}],"standard_charges":[{"gross_charge":1298.0,"discounted_cash":973.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INSERTION OF CHEST TUBE CDM","code_information":[{"code":"Px00045010785","type":"CDM"},{"code":"32551","type":"HCPCS"}],"standard_charges":[{"gross_charge":2398.0,"discounted_cash":1798.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CLTX RDL SHFT FX&CLTX DISLC DSTL RAD/ULN JT CDM","code_information":[{"code":"Px00045010786","type":"CDM"},{"code":"25520","type":"HCPCS"}],"standard_charges":[{"gross_charge":4410.0,"discounted_cash":3307.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING CDM","code_information":[{"code":"Px00045010787","type":"CDM"},{"code":"32555","type":"HCPCS"}],"standard_charges":[{"gross_charge":2039.0,"discounted_cash":1529.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED PERQ DRAINAGE PLEURA INSERT CATH W/O IMAGING CDM","code_information":[{"code":"Px00045010789","type":"CDM"},{"code":"32556","type":"HCPCS"}],"standard_charges":[{"gross_charge":7862.0,"discounted_cash":5896.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT FRACTURE OF ULNA CDM","code_information":[{"code":"Px00045010790","type":"CDM"},{"code":"25530","type":"HCPCS"}],"standard_charges":[{"gross_charge":734.0,"discounted_cash":550.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED PERQ DRAINAGE PLEURA INSERT CATH W/IMAGING CDM","code_information":[{"code":"Px00045010791","type":"CDM"},{"code":"32557","type":"HCPCS"}],"standard_charges":[{"gross_charge":9054.0,"discounted_cash":6790.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INJECT SI JOINT ARTHRGRPHY&/ANES/STEROID W/IMA CDM","code_information":[{"code":"Px00045010793","type":"CDM"},{"code":"27096","type":"HCPCS"}],"standard_charges":[{"gross_charge":1159.0,"discounted_cash":869.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREATMENT OF FRACTURE OF ULNA W/MANIPULATION CDM","code_information":[{"code":"Px00045010794","type":"CDM"},{"code":"25535","type":"HCPCS"}],"standard_charges":[{"gross_charge":1005.0,"discounted_cash":753.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REP TNDN ACHILLES W GRFT CDM","code_information":[{"code":"Px00045010795","type":"CDM"},{"code":"27652","type":"HCPCS"}],"standard_charges":[{"gross_charge":20338.0,"discounted_cash":15253.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REP DISRUPT LIGAMENT ANKL SNGL CDM","code_information":[{"code":"Px00045010797","type":"CDM"},{"code":"27695","type":"HCPCS"}],"standard_charges":[{"gross_charge":23440.0,"discounted_cash":17580.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT FRACTURE OF RADIUS AND ULNA W/O MANIP CDM","code_information":[{"code":"Px00045010798","type":"CDM"},{"code":"25560","type":"HCPCS"}],"standard_charges":[{"gross_charge":1350.0,"discounted_cash":1012.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED AMPUT METATARSAL W TOE SINGLE CDM","code_information":[{"code":"Px00045010799","type":"CDM"},{"code":"28810","type":"HCPCS"}],"standard_charges":[{"gross_charge":9152.0,"discounted_cash":6864.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT FRACTURE RADIUS & ULNA W/MANIPULATION CDM","code_information":[{"code":"Px00045010801","type":"CDM"},{"code":"25565","type":"HCPCS"}],"standard_charges":[{"gross_charge":7135.0,"discounted_cash":5351.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM CDM","code_information":[{"code":"Px00045010802","type":"CDM"},{"code":"11444","type":"HCPCS"}],"standard_charges":[{"gross_charge":5314.0,"discounted_cash":3985.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT DISTAL RADIAL FRACTURE RADIUS/ULNA W/O MANIP CDM","code_information":[{"code":"Px00045010804","type":"CDM"},{"code":"25600","type":"HCPCS"}],"standard_charges":[{"gross_charge":1191.0,"discounted_cash":893.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M LT/4.0CM CDM","code_information":[{"code":"Px00045010805","type":"CDM"},{"code":"11446","type":"HCPCS"}],"standard_charges":[{"gross_charge":9154.0,"discounted_cash":6865.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/US CDM","code_information":[{"code":"Px00045010807","type":"CDM"},{"code":"20606","type":"HCPCS"}],"standard_charges":[{"gross_charge":2191.0,"discounted_cash":1643.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CLTX DSTL RDL FX/EPIPHYSL SEP W/MANJ WHEN PERF","code_information":[{"code":"Px00045010808","type":"CDM"},{"code":"25605","type":"HCPCS"}],"standard_charges":[{"gross_charge":7135.0,"discounted_cash":5351.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED PERQ CERVICOTHORACIC INJECT CDM","code_information":[{"code":"Px00045010809","type":"CDM"},{"code":"22510","type":"HCPCS"}],"standard_charges":[{"gross_charge":9152.0,"discounted_cash":6864.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED PERQ LUMBOSACRAL INJECTION CDM","code_information":[{"code":"Px00045010811","type":"CDM"},{"code":"22511","type":"HCPCS"}],"standard_charges":[{"gross_charge":9152.0,"discounted_cash":6864.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT WRIST BONE FRACTURE CDM","code_information":[{"code":"Px00045010812","type":"CDM"},{"code":"25622","type":"HCPCS"}],"standard_charges":[{"gross_charge":734.0,"discounted_cash":550.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED OPEN TX HUMERAL SUPRACONDYLAR FRACTURE W/O XTN CDM","code_information":[{"code":"Px00045010813","type":"CDM"},{"code":"24545","type":"HCPCS"}],"standard_charges":[{"gross_charge":40117.0,"discounted_cash":30087.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED EXC TUMOR SOFT TISSUE FOREARM &/WRIST SUBQ LT/3CM CDM","code_information":[{"code":"Px00045010815","type":"CDM"},{"code":"25075","type":"HCPCS"}],"standard_charges":[{"gross_charge":5314.0,"discounted_cash":3985.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT WRIST BONE FRACTURE W/MANIPULATION CDM","code_information":[{"code":"Px00045010816","type":"CDM"},{"code":"25624","type":"HCPCS"}],"standard_charges":[{"gross_charge":5083.0,"discounted_cash":3812.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED RPR & RCNSTJ FINGER VOLAR PLATE INTERPHALANGEAL CDM","code_information":[{"code":"Px00045010817","type":"CDM"},{"code":"26548","type":"HCPCS"}],"standard_charges":[{"gross_charge":9152.0,"discounted_cash":6864.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CLTX CARPO/MTCRPL DISLC THUMB MANJ EA JT W/ANES CDM","code_information":[{"code":"Px00045010819","type":"CDM"},{"code":"26675","type":"HCPCS"}],"standard_charges":[{"gross_charge":5083.0,"discounted_cash":3812.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT CARPAL BONE FRACTURE W/O MANIP EACH BONE CDM","code_information":[{"code":"Px00045010820","type":"CDM"},{"code":"25630","type":"HCPCS"}],"standard_charges":[{"gross_charge":845.0,"discounted_cash":633.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TX FEMORAL FRACTURE PROX HEAD W/MANJ CDM","code_information":[{"code":"Px00045010821","type":"CDM"},{"code":"27268","type":"HCPCS"}],"standard_charges":[{"gross_charge":9152.0,"discounted_cash":6864.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CLTX TARSAL DISLC OTH/THN TALOTARSAL W/ANES CDM","code_information":[{"code":"Px00045010823","type":"CDM"},{"code":"28545","type":"HCPCS"}],"standard_charges":[{"gross_charge":10548.0,"discounted_cash":7911.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT CARPAL BONE FRACTURE W/MANIP EACH BONE CDM","code_information":[{"code":"Px00045010824","type":"CDM"},{"code":"25635","type":"HCPCS"}],"standard_charges":[{"gross_charge":5083.0,"discounted_cash":3812.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED APPLICATION SHORT ARM SPLINT DYNAMIC CDM","code_information":[{"code":"Px00045010825","type":"CDM"},{"code":"29126","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":308.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED APPLICATION FINGER SPLINT DYNAMIC CDM","code_information":[{"code":"Px00045010827","type":"CDM"},{"code":"29131","type":"HCPCS"}],"standard_charges":[{"gross_charge":621.0,"discounted_cash":465.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT ULNAR STYLOID FRACTURE CDM","code_information":[{"code":"Px00045010828","type":"CDM"},{"code":"25650","type":"HCPCS"}],"standard_charges":[{"gross_charge":962.0,"discounted_cash":721.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED STRAPPING OF CHEST THORAX CDM","code_information":[{"code":"Px00045010829","type":"CDM"},{"code":"29200","type":"HCPCS"}],"standard_charges":[{"gross_charge":516.0,"discounted_cash":387.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED STRAPPING SHOULDER CDM","code_information":[{"code":"Px00045010831","type":"CDM"},{"code":"29240","type":"HCPCS"}],"standard_charges":[{"gross_charge":471.0,"discounted_cash":353.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT WRIST DISLOCATION W/MANIPULATION CDM","code_information":[{"code":"Px00045010832","type":"CDM"},{"code":"25660","type":"HCPCS"}],"standard_charges":[{"gross_charge":817.0,"discounted_cash":612.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED STRAPPING OF ELBOW OR WRIST CDM","code_information":[{"code":"Px00045010834","type":"CDM"},{"code":"29260","type":"HCPCS"}],"standard_charges":[{"gross_charge":505.0,"discounted_cash":378.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED STRAPPING OF HAND OR FINGER CDM","code_information":[{"code":"Px00045010835","type":"CDM"},{"code":"29280","type":"HCPCS"}],"standard_charges":[{"gross_charge":505.0,"discounted_cash":378.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT DISTAL RADIOULNAR DISLOCATION W/MANIP CDM","code_information":[{"code":"Px00045010836","type":"CDM"},{"code":"25675","type":"HCPCS"}],"standard_charges":[{"gross_charge":1448.0,"discounted_cash":1086.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED ADDITION OF WALKER TO CAST CDM","code_information":[{"code":"Px00045010837","type":"CDM"},{"code":"29440","type":"HCPCS"}],"standard_charges":[{"gross_charge":516.0,"discounted_cash":387.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED APPL CLUBFOOT CAST MOLDING/MANJ LONG/SHORT LEG CDM","code_information":[{"code":"Px00045010839","type":"CDM"},{"code":"29450","type":"HCPCS"}],"standard_charges":[{"gross_charge":516.0,"discounted_cash":387.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT TRANS-SCAPHOPERIULNAR FRACTURE W/MANIP CDM","code_information":[{"code":"Px00045010840","type":"CDM"},{"code":"25680","type":"HCPCS"}],"standard_charges":[{"gross_charge":734.0,"discounted_cash":550.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED RMVL NDWELLG TUNNELED PLEURAL CATHETER W/CUFF CDM","code_information":[{"code":"Px00045010841","type":"CDM"},{"code":"32552","type":"HCPCS"}],"standard_charges":[{"gross_charge":2747.0,"discounted_cash":2060.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT LUNATE DISLOCATION W/MANIPULATION CDM","code_information":[{"code":"Px00045010843","type":"CDM"},{"code":"25690","type":"HCPCS"}],"standard_charges":[{"gross_charge":5083.0,"discounted_cash":3812.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INTRO OF NEEDLE OR INTRACATHETER UPR/LXTR ARTERY CDM","code_information":[{"code":"Px00045010844","type":"CDM"},{"code":"36140","type":"HCPCS"}],"standard_charges":[{"gross_charge":2067.0,"discounted_cash":1550.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INSERTION PICC W/RS&I 5 YRS OR MORE CDM","code_information":[{"code":"Px00045010846","type":"CDM"},{"code":"36573","type":"HCPCS"}],"standard_charges":[{"gross_charge":6910.0,"discounted_cash":5182.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED PIN FINGER FRACTURE EACH CDM","code_information":[{"code":"Px00045010848","type":"CDM"},{"code":"26756","type":"HCPCS"}],"standard_charges":[{"gross_charge":10548.0,"discounted_cash":7911.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED OPEN TX DISTAL PHALANGEAL FRACTURE EACH CDM","code_information":[{"code":"Px00045010849","type":"CDM"},{"code":"26765","type":"HCPCS"}],"standard_charges":[{"gross_charge":10548.0,"discounted_cash":7911.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TX FINGER DISLOCATION W/O ANESTH CDM","code_information":[{"code":"Px00045010851","type":"CDM"},{"code":"26770","type":"HCPCS"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":840.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TX FINGER DISLOCATION W/ANESTH CDM","code_information":[{"code":"Px00045010852","type":"CDM"},{"code":"26775","type":"HCPCS"}],"standard_charges":[{"gross_charge":1173.0,"discounted_cash":879.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED COLLECT BLOOD FROM CATHETER VENOUS NOS CDM","code_information":[{"code":"Px00045010853","type":"CDM"},{"code":"36592","type":"HCPCS"}],"standard_charges":[{"gross_charge":674.0,"discounted_cash":505.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED XTRNL CANNULA DECLTNG SPX W/O BALO CATH CDM","code_information":[{"code":"Px00045010854","type":"CDM"},{"code":"36860","type":"HCPCS"}],"standard_charges":[{"gross_charge":4506.0,"discounted_cash":3379.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DRG LYMPH NODE ABSC/LYMPHADENITIS SMPL CDM","code_information":[{"code":"Px00045010855","type":"CDM"},{"code":"38300","type":"HCPCS"}],"standard_charges":[{"gross_charge":9154.0,"discounted_cash":6865.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE ABSCESS PAROTID SIMPLE CDM","code_information":[{"code":"Px00045010856","type":"CDM"},{"code":"42300","type":"HCPCS"}],"standard_charges":[{"gross_charge":4918.0,"discounted_cash":3688.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE ABSCESS PAROTID COMPLICATED CDM","code_information":[{"code":"Px00045010858","type":"CDM"},{"code":"42305","type":"HCPCS"}],"standard_charges":[{"gross_charge":10082.0,"discounted_cash":7561.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF FINGER ABCESS COMP CDM","code_information":[{"code":"Px00045010859","type":"CDM"},{"code":"26011","type":"HCPCS"}],"standard_charges":[{"gross_charge":8956.0,"discounted_cash":6717.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REPLACE DUODENOSTOMY/JEJUNOSTOMY TUBE PERQ CDM","code_information":[{"code":"Px00045010860","type":"CDM"},{"code":"49451","type":"HCPCS"}],"standard_charges":[{"gross_charge":3723.0,"discounted_cash":2792.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED ASPIRATION BLADDER INSERT SUPRAPUBIC CATHETER CDM","code_information":[{"code":"Px00045010861","type":"CDM"},{"code":"51102","type":"HCPCS"}],"standard_charges":[{"gross_charge":11382.0,"discounted_cash":8536.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED NJX DX/THER SBST INTRLMNR CRV/THRC W/O IMG GDN CDM","code_information":[{"code":"Px00045010862","type":"CDM"},{"code":"62320","type":"HCPCS"}],"standard_charges":[{"gross_charge":2283.0,"discounted_cash":1712.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR CARDIAC WOUND W/O BYPASS CDM","code_information":[{"code":"Px00045010863","type":"CDM"},{"code":"33300","type":"HCPCS"}],"standard_charges":[{"gross_charge":12358.0,"discounted_cash":9268.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED ROUTINE VENIPUNCTURE OR LEGAL DRAW CDM","code_information":[{"code":"Px00045010864","type":"CDM"},{"code":"36415","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":19.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED SUTR RPR AORTA/GRT VSL W/O SHUNT/CARD BYP CDM","code_information":[{"code":"Px00045010865","type":"CDM"},{"code":"33320","type":"HCPCS"}],"standard_charges":[{"gross_charge":2420.0,"discounted_cash":1815.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US CDM","code_information":[{"code":"Px00045010866","type":"CDM"},{"code":"20611","type":"HCPCS"}],"standard_charges":[{"gross_charge":2191.0,"discounted_cash":1643.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT CDM","code_information":[{"code":"Px00045010867","type":"CDM"},{"code":"20604","type":"HCPCS"}],"standard_charges":[{"gross_charge":1752.0,"discounted_cash":1314.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED APPLICATION LONG LEG CAST BRACE CDM","code_information":[{"code":"Px00045010869","type":"CDM"},{"code":"29358","type":"HCPCS"}],"standard_charges":[{"gross_charge":850.0,"discounted_cash":637.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE TENDON SHEATH LESION CDM","code_information":[{"code":"Px00045010870","type":"CDM"},{"code":"26160","type":"HCPCS"}],"standard_charges":[{"gross_charge":5083.0,"discounted_cash":3812.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR FINGER/HAND PROFUNDUS TENDON EA TENDON CDM","code_information":[{"code":"Px00045010871","type":"CDM"},{"code":"26370","type":"HCPCS"}],"standard_charges":[{"gross_charge":10548.0,"discounted_cash":7911.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR EXTENSOR TENDON HAND W/O GRAFT CDM","code_information":[{"code":"Px00045010872","type":"CDM"},{"code":"26410","type":"HCPCS"}],"standard_charges":[{"gross_charge":7794.0,"discounted_cash":5845.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REM SHOULDER HIP SPICA CDM","code_information":[{"code":"Px00045010875","type":"CDM"},{"code":"29710","type":"HCPCS"}],"standard_charges":[{"gross_charge":850.0,"discounted_cash":637.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR OF EXTENSOR TENDON FINGER W/O GRAFT CDM","code_information":[{"code":"Px00045010876","type":"CDM"},{"code":"26418","type":"HCPCS"}],"standard_charges":[{"gross_charge":7794.0,"discounted_cash":5845.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX CDM","code_information":[{"code":"Px00045010877","type":"CDM"},{"code":"58100","type":"HCPCS"}],"standard_charges":[{"gross_charge":630.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED BX INTRANASAL MUCOSA CDM","code_information":[{"code":"Px00045010878","type":"CDM"},{"code":"30100","type":"HCPCS"}],"standard_charges":[{"gross_charge":4918.0,"discounted_cash":3688.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REMV FB NOSE BY LAT RHINOTOMY CDM","code_information":[{"code":"Px00045010879","type":"CDM"},{"code":"30320","type":"HCPCS"}],"standard_charges":[{"gross_charge":4918.0,"discounted_cash":3688.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED BRONCH DX W WO CELL WASH CDM","code_information":[{"code":"Px00045010880","type":"CDM"},{"code":"31622","type":"HCPCS"}],"standard_charges":[{"gross_charge":3996.0,"discounted_cash":2997.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED BRONCH DX W ALVEOLAR LAV CDM","code_information":[{"code":"Px00045010881","type":"CDM"},{"code":"31624","type":"HCPCS"}],"standard_charges":[{"gross_charge":3996.0,"discounted_cash":2997.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED BRONCH W FB REM CDM","code_information":[{"code":"Px00045010882","type":"CDM"},{"code":"31635","type":"HCPCS"}],"standard_charges":[{"gross_charge":3996.0,"discounted_cash":2997.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INS TUN PLEURAL CATH CDM","code_information":[{"code":"Px00045010884","type":"CDM"},{"code":"32550","type":"HCPCS"}],"standard_charges":[{"gross_charge":12552.0,"discounted_cash":9414.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR BLD VESSEL DIRECT NECK CDM","code_information":[{"code":"Px00045010885","type":"CDM"},{"code":"35201","type":"HCPCS"}],"standard_charges":[{"gross_charge":15563.0,"discounted_cash":11672.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INS TUN CVC WO SQ PORT LT/5YRS CDM","code_information":[{"code":"Px00045010886","type":"CDM"},{"code":"36557","type":"HCPCS"}],"standard_charges":[{"gross_charge":20457.0,"discounted_cash":15342.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CLTX DSTL XTNSR TDN INSJ W/WO PERCUTAN PINNING CDM","code_information":[{"code":"Px00045010887","type":"CDM"},{"code":"26432","type":"HCPCS"}],"standard_charges":[{"gross_charge":5083.0,"discounted_cash":3812.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INSJ TUNNELED CTR VAD W/SUBQ PORT AGE 5 YR/GT CDM","code_information":[{"code":"Px00045010888","type":"CDM"},{"code":"36561","type":"HCPCS"}],"standard_charges":[{"gross_charge":16056.0,"discounted_cash":12042.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INS PICCCTH WO PRT/PMP LT/5 W US CDM","code_information":[{"code":"Px00045010889","type":"CDM"},{"code":"36572","type":"HCPCS"}],"standard_charges":[{"gross_charge":2050.0,"discounted_cash":1537.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REPLC NON TUN CVC WO PORT PUMP CDM","code_information":[{"code":"Px00045010890","type":"CDM"},{"code":"36580","type":"HCPCS"}],"standard_charges":[{"gross_charge":5273.0,"discounted_cash":3954.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REPLC TUN CV CATH WO PORT CDM","code_information":[{"code":"Px00045010891","type":"CDM"},{"code":"36581","type":"HCPCS"}],"standard_charges":[{"gross_charge":10556.0,"discounted_cash":7917.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REPLC PICC WO PORT PUMP CDM","code_information":[{"code":"Px00045010892","type":"CDM"},{"code":"36584","type":"HCPCS"}],"standard_charges":[{"gross_charge":5273.0,"discounted_cash":3954.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED LIGATION OR BX TEMPORAL ARTERY CDM","code_information":[{"code":"Px00045010893","type":"CDM"},{"code":"37609","type":"HCPCS"}],"standard_charges":[{"gross_charge":5314.0,"discounted_cash":3985.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED EXCSN MOUTH LSN W SMPL REP CDM","code_information":[{"code":"Px00045010894","type":"CDM"},{"code":"40812","type":"HCPCS"}],"standard_charges":[{"gross_charge":4918.0,"discounted_cash":3688.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED UGI W DILATION ESOPHAGUS BAL CDM","code_information":[{"code":"Px00045010895","type":"CDM"},{"code":"43249","type":"HCPCS"}],"standard_charges":[{"gross_charge":4354.0,"discounted_cash":3265.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED GASTRC INTUBN ASP DX SNGL SPEC CDM","code_information":[{"code":"Px00045010897","type":"CDM"},{"code":"43754","type":"HCPCS"}],"standard_charges":[{"gross_charge":992.0,"discounted_cash":744.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR EXTENSOR TENDON DISTAL INSERTION W/O GRAFT CDM","code_information":[{"code":"Px00045010898","type":"CDM"},{"code":"26433","type":"HCPCS"}],"standard_charges":[{"gross_charge":10548.0,"discounted_cash":7911.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR COLLATER LIGMNT METACAROPOPHALANGEAL OR INTERPHAL.JOINT CDM","code_information":[{"code":"Px00045010899","type":"CDM"},{"code":"26540","type":"HCPCS"}],"standard_charges":[{"gross_charge":10548.0,"discounted_cash":7911.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT METACARPAL FRACTURE SINGLE W/O MANIP CDM","code_information":[{"code":"Px00045010900","type":"CDM"},{"code":"26600","type":"HCPCS"}],"standard_charges":[{"gross_charge":677.0,"discounted_cash":507.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED PRESSURE TREATMENT ESOPHAGUS CDM","code_information":[{"code":"Px00045010902","type":"CDM"},{"code":"43460","type":"HCPCS"}],"standard_charges":[{"gross_charge":7774.0,"discounted_cash":5830.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT METACARPAL FRACTURE SINGLE W/MANIPULATION CDM","code_information":[{"code":"Px00045010904","type":"CDM"},{"code":"26605","type":"HCPCS"}],"standard_charges":[{"gross_charge":1448.0,"discounted_cash":1086.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DRN ABSC PELV TRNSREC CDM","code_information":[{"code":"Px00045010906","type":"CDM"},{"code":"45000","type":"HCPCS"}],"standard_charges":[{"gross_charge":3837.0,"discounted_cash":2877.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED SIGMOID DX FLX W WO SPEC COLL CDM","code_information":[{"code":"Px00045010907","type":"CDM"},{"code":"45330","type":"HCPCS"}],"standard_charges":[{"gross_charge":2078.0,"discounted_cash":1558.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT CARPOMETACARPAL DISLOCATION W/MANIP CDM","code_information":[{"code":"Px00045010909","type":"CDM"},{"code":"26641","type":"HCPCS"}],"standard_charges":[{"gross_charge":1144.0,"discounted_cash":858.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED PROCTOPLASTY PROLAPSE MUC MBRM CDM","code_information":[{"code":"Px00045010911","type":"CDM"},{"code":"45505","type":"HCPCS"}],"standard_charges":[{"gross_charge":9106.0,"discounted_cash":6829.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REP PERINEAL APRCH CDM","code_information":[{"code":"Px00045010912","type":"CDM"},{"code":"45541","type":"HCPCS"}],"standard_charges":[{"gross_charge":7900.0,"discounted_cash":5925.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED I&D SUPERF ABSC PERI/ISCHEAL CDM","code_information":[{"code":"Px00045010913","type":"CDM"},{"code":"46045","type":"HCPCS"}],"standard_charges":[{"gross_charge":9106.0,"discounted_cash":6829.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INJ SCLEROSING SOL HEMORROIDS CDM","code_information":[{"code":"Px00045010914","type":"CDM"},{"code":"46500","type":"HCPCS"}],"standard_charges":[{"gross_charge":2945.0,"discounted_cash":2208.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TX CARPOMETACARPAL FRACTURE/DISLOCATION W/MANIP CDM","code_information":[{"code":"Px00045010915","type":"CDM"},{"code":"26645","type":"HCPCS"}],"standard_charges":[{"gross_charge":7586.0,"discounted_cash":5689.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DESTRUC LSN ANUS SMPL CHEM CDM","code_information":[{"code":"Px00045010917","type":"CDM"},{"code":"46900","type":"HCPCS"}],"standard_charges":[{"gross_charge":1322.0,"discounted_cash":991.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REM FB FROM PERITNL CAV CDM","code_information":[{"code":"Px00045010918","type":"CDM"},{"code":"49402","type":"HCPCS"}],"standard_charges":[{"gross_charge":10890.0,"discounted_cash":8167.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED EXCHG ABSC CYST DRN CATH CDM","code_information":[{"code":"Px00045010919","type":"CDM"},{"code":"49423","type":"HCPCS"}],"standard_charges":[{"gross_charge":5354.0,"discounted_cash":4015.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CYSTO TX URETERAL STRICTURE CDM","code_information":[{"code":"Px00045010920","type":"CDM"},{"code":"52344","type":"HCPCS"}],"standard_charges":[{"gross_charge":8013.0,"discounted_cash":6009.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CLTX CARPO/METACARPL DISLO OTHER THAN THMB MANJ EA W/O ANES CDM","code_information":[{"code":"Px00045010921","type":"CDM"},{"code":"26670","type":"HCPCS"}],"standard_charges":[{"gross_charge":1633.0,"discounted_cash":1224.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CYSTO DX W URETSCP PYELSCP CDM","code_information":[{"code":"Px00045010923","type":"CDM"},{"code":"52351","type":"HCPCS"}],"standard_charges":[{"gross_charge":8013.0,"discounted_cash":6009.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED I&D PENIS LSN DEEP CDM","code_information":[{"code":"Px00045010924","type":"CDM"},{"code":"54015","type":"HCPCS"}],"standard_charges":[{"gross_charge":5314.0,"discounted_cash":3985.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT KNUCKLE DISLOCATION W/O ANESTH CDM","code_information":[{"code":"Px00045010926","type":"CDM"},{"code":"26700","type":"HCPCS"}],"standard_charges":[{"gross_charge":1546.0,"discounted_cash":1159.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED ORCHIOPEXY INGUINAL CDM","code_information":[{"code":"Px00045010927","type":"CDM"},{"code":"54640","type":"HCPCS"}],"standard_charges":[{"gross_charge":10890.0,"discounted_cash":8167.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED COLPOSCOPY VULVA CDM","code_information":[{"code":"Px00045010928","type":"CDM"},{"code":"56820","type":"HCPCS"}],"standard_charges":[{"gross_charge":630.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/O MANJ EA CDM","code_information":[{"code":"Px00045010929","type":"CDM"},{"code":"26720","type":"HCPCS"}],"standard_charges":[{"gross_charge":845.0,"discounted_cash":633.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED IV INFUSION HYDRATION EACH ADDITIONAL HOUR CDM","code_information":[{"code":"Px00045010930","type":"CDM"},{"code":"96361","type":"HCPCS"}],"standard_charges":[{"gross_charge":452.0,"discounted_cash":339.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DEBRIDEMENT OPEN WOUND 20 SQ CM OR LESS CDM","code_information":[{"code":"Px00045010931","type":"CDM"},{"code":"97597","type":"HCPCS"}],"standard_charges":[{"gross_charge":614.0,"discounted_cash":460.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DEBRIDEMENT OPEN WOUND EACH ADDITIONAL 20 SQ CM CDM","code_information":[{"code":"Px00045010932","type":"CDM"},{"code":"97598","type":"HCPCS"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":240.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED COLPOTOMY WITH EXPLORATION CDM","code_information":[{"code":"Px00045010933","type":"CDM"},{"code":"57000","type":"HCPCS"}],"standard_charges":[{"gross_charge":8693.0,"discounted_cash":6519.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED COLPOTOMY W DRN PELV ABSCS CDM","code_information":[{"code":"Px00045010934","type":"CDM"},{"code":"57010","type":"HCPCS"}],"standard_charges":[{"gross_charge":8693.0,"discounted_cash":6519.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED I&D HEMOTOMA VAG NON-OB CDM","code_information":[{"code":"Px00045010935","type":"CDM"},{"code":"57023","type":"HCPCS"}],"standard_charges":[{"gross_charge":9154.0,"discounted_cash":6865.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CAUTERIZATION CHEMICAL CERVIX CDM","code_information":[{"code":"Px00045010936","type":"CDM"},{"code":"58999","type":"HCPCS"}],"standard_charges":[{"gross_charge":547.0,"discounted_cash":410.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED OB ED-FETAL CONTRACT STRESS NS CDM","code_information":[{"code":"Px00045010938","type":"CDM"},{"code":"59020","type":"HCPCS"}],"standard_charges":[{"gross_charge":630.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED OB ED-EXT CEPHAL VERS BREECH N CDM","code_information":[{"code":"Px00045010939","type":"CDM"},{"code":"59412","type":"HCPCS"}],"standard_charges":[{"gross_charge":8693.0,"discounted_cash":6519.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INDUCED ABORT DILATION CURETGE CDM","code_information":[{"code":"Px00045010940","type":"CDM"},{"code":"59840","type":"HCPCS"}],"standard_charges":[{"gross_charge":10020.0,"discounted_cash":7515.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/O MANJ EA CDM","code_information":[{"code":"Px00045010942","type":"CDM"},{"code":"26720","type":"HCPCS"}],"standard_charges":[{"gross_charge":845.0,"discounted_cash":633.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TX PHALANGEAL SHAFT FRACTURE FINGER OR THUMB W/MANIP EA CDM","code_information":[{"code":"Px00045010943","type":"CDM"},{"code":"26725","type":"HCPCS"}],"standard_charges":[{"gross_charge":845.0,"discounted_cash":633.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED OB ED-REM CERCLAGE SUT ANES NS CDM","code_information":[{"code":"Px00045010944","type":"CDM"},{"code":"59871","type":"HCPCS"}],"standard_charges":[{"gross_charge":10020.0,"discounted_cash":7515.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INJ INTERLAMINR CRV-THOR W IMG CDM","code_information":[{"code":"Px00045010945","type":"CDM"},{"code":"62321","type":"HCPCS"}],"standard_charges":[{"gross_charge":7761.0,"discounted_cash":5820.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INJ EPI LUMB/SACRAL WO IMAGING CDM","code_information":[{"code":"Px00045010946","type":"CDM"},{"code":"62322","type":"HCPCS"}],"standard_charges":[{"gross_charge":3019.0,"discounted_cash":2264.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INJ EPI LUMB/SACRAL W IMAGING CDM","code_information":[{"code":"Px00045010947","type":"CDM"},{"code":"62323","type":"HCPCS"}],"standard_charges":[{"gross_charge":3208.0,"discounted_cash":2406.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INJ INF INTRLAM CRV THOR WO XR CDM","code_information":[{"code":"Px00045010948","type":"CDM"},{"code":"62324","type":"HCPCS"}],"standard_charges":[{"gross_charge":3019.0,"discounted_cash":2264.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE CDM","code_information":[{"code":"Px00045010949","type":"CDM"},{"code":"10021","type":"HCPCS"}],"standard_charges":[{"gross_charge":1529.0,"discounted_cash":1146.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED ARTL CATHJ/CANNULJ MNTR/TRANSFUSION SPX PRQ CDM","code_information":[{"code":"Px00045010950","type":"CDM"},{"code":"36620","type":"HCPCS"}],"standard_charges":[{"gross_charge":410.0,"discounted_cash":307.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED ANALYZE SP INFUS PMP W REPROG CDM","code_information":[{"code":"Px00045010951","type":"CDM"},{"code":"62368","type":"HCPCS"}],"standard_charges":[{"gross_charge":1509.0,"discounted_cash":1131.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INJ ANES NRV PUDENAL CDM","code_information":[{"code":"Px00045010952","type":"CDM"},{"code":"64430","type":"HCPCS"}],"standard_charges":[{"gross_charge":3019.0,"discounted_cash":2264.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INJECTION AA&/STRD SCIATIC NRV CONT NFS CATH IMG CDM","code_information":[{"code":"Px00045010953","type":"CDM"},{"code":"64446","type":"HCPCS"}],"standard_charges":[{"gross_charge":3019.0,"discounted_cash":2264.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED OPEN TX PHALANGEAL SHAFT FX FINGER/THUMB W/O MANIP CDM","code_information":[{"code":"Px00045010954","type":"CDM"},{"code":"26735","type":"HCPCS"}],"standard_charges":[{"gross_charge":10548.0,"discounted_cash":7911.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED NRV BLOCK INJ CELIAC PLEXUS CDM","code_information":[{"code":"Px00045010957","type":"CDM"},{"code":"64530","type":"HCPCS"}],"standard_charges":[{"gross_charge":3998.0,"discounted_cash":2998.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INJ EYE ANT CHAMBER W MEDS CDM","code_information":[{"code":"Px00045010958","type":"CDM"},{"code":"66030","type":"HCPCS"}],"standard_charges":[{"gross_charge":5399.0,"discounted_cash":4049.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED RECON EYELID CDM","code_information":[{"code":"Px00045010959","type":"CDM"},{"code":"67950","type":"HCPCS"}],"standard_charges":[{"gross_charge":5286.0,"discounted_cash":3964.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED EXPLR TEAR DUCTS W WO IRRIG CDM","code_information":[{"code":"Px00045010960","type":"CDM"},{"code":"68840","type":"HCPCS"}],"standard_charges":[{"gross_charge":662.0,"discounted_cash":496.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED US GUID VASC ACCESS CDM","code_information":[{"code":"Px00045010962","type":"CDM"},{"code":"76937","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":138.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TX ARTICULAR FRACTURE W/O MANIP CDM","code_information":[{"code":"Px00045010963","type":"CDM"},{"code":"26740","type":"HCPCS"}],"standard_charges":[{"gross_charge":734.0,"discounted_cash":550.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED VENOUS PRESSURE DETERMINATION CDM","code_information":[{"code":"Px00045010964","type":"CDM"},{"code":"93770","type":"HCPCS"}],"standard_charges":[{"gross_charge":600.0,"discounted_cash":450.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED SUBQ IV INFUSION ADDL SITE CDM","code_information":[{"code":"Px00045010965","type":"CDM"},{"code":"96371","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":150.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED ANOGENTL COLPO PED TRAUMA CDM","code_information":[{"code":"Px00045010966","type":"CDM"},{"code":"99170","type":"HCPCS"}],"standard_charges":[{"gross_charge":445.0,"discounted_cash":333.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TRAUMA ACT FULL WO PHOSP NOTIF CDM","code_information":[{"code":"Px00045010969","type":"CDM"},{"code":"TR450","type":"HCPCS"}],"standard_charges":[{"gross_charge":6984.0,"discounted_cash":5238.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TX ARTICULAR FRACTURE W/MANIP CDM","code_information":[{"code":"Px00045010974","type":"CDM"},{"code":"26742","type":"HCPCS"}],"standard_charges":[{"gross_charge":8819.0,"discounted_cash":6614.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED OPEN TX ARTICULARE FRACTURE CDM","code_information":[{"code":"Px00045010985","type":"CDM"},{"code":"26746","type":"HCPCS"}],"standard_charges":[{"gross_charge":10548.0,"discounted_cash":7911.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TX DISTAL PHALANGEAL FX FINGER/THUMB W/O MANIP EA -TUFT CDM","code_information":[{"code":"Px00045010986","type":"CDM"},{"code":"26750","type":"HCPCS"}],"standard_charges":[{"gross_charge":845.0,"discounted_cash":633.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TRAUMA ACT PART WO PHOSP NOTIF CDM","code_information":[{"code":"Px00045010989","type":"CDM"},{"code":"TR450","type":"HCPCS"}],"standard_charges":[{"gross_charge":6085.0,"discounted_cash":4563.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TRAUMA ACT MIN WO PHOSP NOTIF CDM","code_information":[{"code":"Px00045010990","type":"CDM"},{"code":"TR450","type":"HCPCS"}],"standard_charges":[{"gross_charge":4988.0,"discounted_cash":3741.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TX DISTAL PHALANG FX FINGER/THUMB W/MANIP TUFT FX CDM","code_information":[{"code":"Px00045010996","type":"CDM"},{"code":"26755","type":"HCPCS"}],"standard_charges":[{"gross_charge":930.0,"discounted_cash":697.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DEMO&/EVAL OF PT UTILIZ AERSL GEN/NEB/INHLR/IP CDM","code_information":[{"code":"Px00045011000","type":"CDM"},{"code":"94664","type":"HCPCS"}],"standard_charges":[{"gross_charge":678.0,"discounted_cash":508.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED IV HYDRATION INITIAL HR CDM","code_information":[{"code":"Px00045011001","type":"CDM"},{"code":"96360","type":"HCPCS"}],"standard_charges":[{"gross_charge":1381.0,"discounted_cash":1035.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED IV INFUSION THERAPY PROPHYLAXIS ADDL SEQUENTIAL TO 1 HR CDM","code_information":[{"code":"Px00045011002","type":"CDM"},{"code":"96367","type":"HCPCS"}],"standard_charges":[{"gross_charge":1306.0,"discounted_cash":979.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED IV INFUSION TX/PROPHYLAXIS/DX EA ADDNL HOUR CDM","code_information":[{"code":"Px00045011003","type":"CDM"},{"code":"96366","type":"HCPCS"}],"standard_charges":[{"gross_charge":585.0,"discounted_cash":438.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST TO 1 HR CDM","code_information":[{"code":"Px00045011004","type":"CDM"},{"code":"96365","type":"HCPCS"}],"standard_charges":[{"gross_charge":1626.0,"discounted_cash":1219.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED IV INFUSION TX/PROPHYLAXIS/DX CONCURRENT DRUG CDM","code_information":[{"code":"Px00045011005","type":"CDM"},{"code":"96368","type":"HCPCS"}],"standard_charges":[{"gross_charge":427.0,"discounted_cash":320.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED PULSE OXIMETRY MULT MEASUREMENTS ONCE/DAY CDM","code_information":[{"code":"Px00045011006","type":"CDM"},{"code":"94761","type":"HCPCS"}],"standard_charges":[{"gross_charge":656.0,"discounted_cash":492.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED PHLEBOTOMY THERAPEUTIC SEPARATE PROCEDURE CDM","code_information":[{"code":"Px00045011009","type":"CDM"},{"code":"99195","type":"HCPCS"}],"standard_charges":[{"gross_charge":944.0,"discounted_cash":708.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED IV INJECTION THERAPEUTIC PROPH/DX PUSH EA SEQL SBST/DRUG FAC CDM","code_information":[{"code":"Px00045011010","type":"CDM"},{"code":"96376","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":116.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED IV INJECTION THERAPEUTIC PROPH/DX PUSH SINGLE/1ST SBST/DRUG CDM","code_information":[{"code":"Px00045011011","type":"CDM"},{"code":"96374","type":"HCPCS"}],"standard_charges":[{"gross_charge":443.0,"discounted_cash":332.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED IV INJECTION THERAPEUTIC PROPH/DX PUSH EACH NEW DRUG CDM","code_information":[{"code":"Px00045011012","type":"CDM"},{"code":"96375","type":"HCPCS"}],"standard_charges":[{"gross_charge":312.0,"discounted_cash":234.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM CDM","code_information":[{"code":"Px00045011013","type":"CDM"},{"code":"96372","type":"HCPCS"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":151.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED THERAPEUTIC PROPHYLACTIC/DX NJX INTRA-ARTERIAL CDM","code_information":[{"code":"Px00045011014","type":"CDM"},{"code":"96373","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.0,"discounted_cash":183.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED UNLISTED THERAPEUTIC PROPH/DX IV/IA NJX/NFS CDM","code_information":[{"code":"Px00045011015","type":"CDM"},{"code":"96379","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":93.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED WOUND CLOSURE BY ADHESIVE CDM","code_information":[{"code":"Px00045011016","type":"CDM"},{"code":"G0168","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.0,"discounted_cash":132.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED APPL MLTLAYR COMPRES LEG BELOW KNEE W/ANKLE FOOT CDM","code_information":[{"code":"Px00045011088","type":"CDM"},{"code":"29581","type":"HCPCS"}],"standard_charges":[{"gross_charge":973.0,"discounted_cash":729.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CLTX PROX TIBFIB JT DISLC REQ ANES CDM","code_information":[{"code":"Px00045011089","type":"CDM"},{"code":"27831","type":"HCPCS"}],"standard_charges":[{"gross_charge":10548.0,"discounted_cash":7911.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CRITICAL CARE INTERFACILITY TRANSPORT 30-74 MIN CDM","code_information":[{"code":"Px00045011090","type":"CDM"},{"code":"99466","type":"HCPCS"}],"standard_charges":[{"gross_charge":719.0,"discounted_cash":539.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CRITICAL CARE INTERFACILITY TRANSPORT EA 30 MIN CDM","code_information":[{"code":"Px00045011091","type":"CDM"},{"code":"99467","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.0,"discounted_cash":108.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED EXCISION PILONIDAL CYST/SINUS SIMPLE CDM","code_information":[{"code":"Px00045011092","type":"CDM"},{"code":"11770","type":"HCPCS"}],"standard_charges":[{"gross_charge":9154.0,"discounted_cash":6865.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED EXCISION MALIGNANT LESION S/N/H/F/G 0.6-1.0 CM CDM","code_information":[{"code":"Px00045011093","type":"CDM"},{"code":"11621","type":"HCPCS"}],"standard_charges":[{"gross_charge":2298.0,"discounted_cash":1723.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED GASTRIC INTUBATION DX & ASPIRATJ MULTIPLE SPEC CDM","code_information":[{"code":"Px00045011094","type":"CDM"},{"code":"43755","type":"HCPCS"}],"standard_charges":[{"gross_charge":516.0,"discounted_cash":387.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE CDM","code_information":[{"code":"Px00045011095","type":"CDM"},{"code":"10030","type":"HCPCS"}],"standard_charges":[{"gross_charge":9054.0,"discounted_cash":6790.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED RPR TUN/NON-TUN CTR VAD CATH W/O SUBQ PORT/PMP CDM","code_information":[{"code":"Px00045011096","type":"CDM"},{"code":"36575","type":"HCPCS"}],"standard_charges":[{"gross_charge":2050.0,"discounted_cash":1537.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TEMPORARY CLOSURE EYELID BY SUTURE CDM","code_information":[{"code":"Px00045011111","type":"CDM"},{"code":"67875","type":"HCPCS"}],"standard_charges":[{"gross_charge":3092.0,"discounted_cash":2319.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TREATMENT OF ANKLE FX DIS FIBULA W/MANIP CDM","code_information":[{"code":"Px00045013002","type":"CDM"},{"code":"27788","type":"HCPCS"}],"standard_charges":[{"gross_charge":1448.0,"discounted_cash":1086.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREATMENT OF ANKLE FRACTURE W/O MANIP CDM","code_information":[{"code":"Px00045013005","type":"CDM"},{"code":"27808","type":"HCPCS"}],"standard_charges":[{"gross_charge":1414.0,"discounted_cash":1060.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREATMENT OF ANKLE FRACTURE BIMALL W/MANIP CDM","code_information":[{"code":"Px00045013009","type":"CDM"},{"code":"27810","type":"HCPCS"}],"standard_charges":[{"gross_charge":7135.0,"discounted_cash":5351.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREATMENT OF ANKLE FRACTURE TRIMAL W/O MANIP CDM","code_information":[{"code":"Px00045013011","type":"CDM"},{"code":"27816","type":"HCPCS"}],"standard_charges":[{"gross_charge":1350.0,"discounted_cash":1012.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TX OF ANKLE FRACTURE TRIMALL W/MANIP CDM","code_information":[{"code":"Px00045013015","type":"CDM"},{"code":"27818","type":"HCPCS"}],"standard_charges":[{"gross_charge":7135.0,"discounted_cash":5351.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TREAT LOWER LEG FRACTURE W/O MANIP CDM","code_information":[{"code":"Px00045013018","type":"CDM"},{"code":"27824","type":"HCPCS"}],"standard_charges":[{"gross_charge":1350.0,"discounted_cash":1012.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TREAT LOWER LEG FRACTURE W/MANIPULATION CDM","code_information":[{"code":"Px00045013020","type":"CDM"},{"code":"27825","type":"HCPCS"}],"standard_charges":[{"gross_charge":7924.0,"discounted_cash":5943.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TREATMENT OF ANKLE DISLOCATION W/O ANESTH CDM","code_information":[{"code":"Px00045013021","type":"CDM"},{"code":"27840","type":"HCPCS"}],"standard_charges":[{"gross_charge":1414.0,"discounted_cash":1060.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TREAT ANKLE DISLOCATION W/ANESTH CDM","code_information":[{"code":"Px00045013025","type":"CDM"},{"code":"27842","type":"HCPCS"}],"standard_charges":[{"gross_charge":12159.0,"discounted_cash":9119.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED OPEN TREAT ANKLE DISLOCATION CDM","code_information":[{"code":"Px00045013027","type":"CDM"},{"code":"27846","type":"HCPCS"}],"standard_charges":[{"gross_charge":20338.0,"discounted_cash":15253.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL OF FOOT FOREIGN BODY CDM","code_information":[{"code":"Px00045013029","type":"CDM"},{"code":"28190","type":"HCPCS"}],"standard_charges":[{"gross_charge":2582.0,"discounted_cash":1936.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL OF FOOT FOREIGN BODY DEEP CDM","code_information":[{"code":"Px00045013032","type":"CDM"},{"code":"28192","type":"HCPCS"}],"standard_charges":[{"gross_charge":5314.0,"discounted_cash":3985.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL OF FOOT FOREIGN BODY COMPLEX CDM","code_information":[{"code":"Px00045013036","type":"CDM"},{"code":"28193","type":"HCPCS"}],"standard_charges":[{"gross_charge":5314.0,"discounted_cash":3985.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR OF FOOT TENDON CDM","code_information":[{"code":"Px00045013039","type":"CDM"},{"code":"28200","type":"HCPCS"}],"standard_charges":[{"gross_charge":10548.0,"discounted_cash":7911.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR OF FOOT TENDON EXTENSOR TENDON CDM","code_information":[{"code":"Px00045013040","type":"CDM"},{"code":"28208","type":"HCPCS"}],"standard_charges":[{"gross_charge":10548.0,"discounted_cash":7911.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED RELEASE OF BIG TOE CDM","code_information":[{"code":"Px00045013043","type":"CDM"},{"code":"28240","type":"HCPCS"}],"standard_charges":[{"gross_charge":10548.0,"discounted_cash":7911.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREATMENT OF HEEL FRACTURE W/O MANIPULATION CDM","code_information":[{"code":"Px00045013045","type":"CDM"},{"code":"28400","type":"HCPCS"}],"standard_charges":[{"gross_charge":734.0,"discounted_cash":550.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREATMENT OF HEEL FRACTURE W/MANIPULATION CDM","code_information":[{"code":"Px00045013048","type":"CDM"},{"code":"28405","type":"HCPCS"}],"standard_charges":[{"gross_charge":734.0,"discounted_cash":550.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREATMENT OF TALUS FRACTURE W/O MANIP CDM","code_information":[{"code":"Px00045013051","type":"CDM"},{"code":"28430","type":"HCPCS"}],"standard_charges":[{"gross_charge":734.0,"discounted_cash":550.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREATMENT OF ANKLE FRACTURE W/MANIPULATION CDM","code_information":[{"code":"Px00045013054","type":"CDM"},{"code":"28435","type":"HCPCS"}],"standard_charges":[{"gross_charge":9708.0,"discounted_cash":7281.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT MIDFOOT FRACTURE EACH W/O MANIPULATION CDM","code_information":[{"code":"Px00045013056","type":"CDM"},{"code":"28450","type":"HCPCS"}],"standard_charges":[{"gross_charge":1407.0,"discounted_cash":1055.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT MIDFOOT FRACTURE EACH W/MANIPULATION CDM","code_information":[{"code":"Px00045013059","type":"CDM"},{"code":"28455","type":"HCPCS"}],"standard_charges":[{"gross_charge":17659.0,"discounted_cash":13244.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT METATARSAL FRACTURE W/O MANIPULATION CDM","code_information":[{"code":"Px00045013063","type":"CDM"},{"code":"28470","type":"HCPCS"}],"standard_charges":[{"gross_charge":845.0,"discounted_cash":633.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TREAT METATARSAL FRACTURE W/MANIPULATION CDM","code_information":[{"code":"Px00045013065","type":"CDM"},{"code":"28475","type":"HCPCS"}],"standard_charges":[{"gross_charge":845.0,"discounted_cash":633.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT BIG TOE FRACTURE W/MANIPULATION CDM","code_information":[{"code":"Px00045013069","type":"CDM"},{"code":"28495","type":"HCPCS"}],"standard_charges":[{"gross_charge":1350.0,"discounted_cash":1012.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED OPEN TREAT BIG TOE FRACTURE CDM","code_information":[{"code":"Px00045013074","type":"CDM"},{"code":"28505","type":"HCPCS"}],"standard_charges":[{"gross_charge":10548.0,"discounted_cash":7911.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CLTX FX PHLX/PHLG OTH/THN GRT TOE W/O MANJ CDM","code_information":[{"code":"Px00045013075","type":"CDM"},{"code":"28510","type":"HCPCS"}],"standard_charges":[{"gross_charge":845.0,"discounted_cash":633.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CLTX FX PHLX/PHLG OTH/THN GRT TOE W/MANJ CDM","code_information":[{"code":"Px00045013076","type":"CDM"},{"code":"28515","type":"HCPCS"}],"standard_charges":[{"gross_charge":1273.0,"discounted_cash":954.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT SESAMOID BONE FRACTURE CDM","code_information":[{"code":"Px00045013077","type":"CDM"},{"code":"28530","type":"HCPCS"}],"standard_charges":[{"gross_charge":734.0,"discounted_cash":550.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TREAT TARSAL DISLOCATION CDM","code_information":[{"code":"Px00045013078","type":"CDM"},{"code":"28540","type":"HCPCS"}],"standard_charges":[{"gross_charge":734.0,"discounted_cash":550.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT FOOT DISLOCATION CDM","code_information":[{"code":"Px00045013082","type":"CDM"},{"code":"28570","type":"HCPCS"}],"standard_charges":[{"gross_charge":1414.0,"discounted_cash":1060.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT FOOT DISLOCATION W/ANESTH CDM","code_information":[{"code":"Px00045013083","type":"CDM"},{"code":"28575","type":"HCPCS"}],"standard_charges":[{"gross_charge":2905.0,"discounted_cash":2178.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT FOOT DISLOCATION W/O ANESTH CDM","code_information":[{"code":"Px00045013084","type":"CDM"},{"code":"28600","type":"HCPCS"}],"standard_charges":[{"gross_charge":734.0,"discounted_cash":550.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CLTX METATARSOPHLNGL JT DISLC W/O ANES CDM","code_information":[{"code":"Px00045013087","type":"CDM"},{"code":"28630","type":"HCPCS"}],"standard_charges":[{"gross_charge":1448.0,"discounted_cash":1086.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CLTX METATARSOPHLNGL JT DISLC REQ ANES CDM","code_information":[{"code":"Px00045013090","type":"CDM"},{"code":"28635","type":"HCPCS"}],"standard_charges":[{"gross_charge":6629.0,"discounted_cash":4971.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TREAT TOE DISLOCATION CDM","code_information":[{"code":"Px00045013091","type":"CDM"},{"code":"28660","type":"HCPCS"}],"standard_charges":[{"gross_charge":1144.0,"discounted_cash":858.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT TOE DISLOCATION W/ANETH CDM","code_information":[{"code":"Px00045013092","type":"CDM"},{"code":"28665","type":"HCPCS"}],"standard_charges":[{"gross_charge":1175.0,"discounted_cash":881.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED APPLICATION OF BODY CAST CDM","code_information":[{"code":"Px00045013094","type":"CDM"},{"code":"29035","type":"HCPCS"}],"standard_charges":[{"gross_charge":850.0,"discounted_cash":637.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED APPLICATION OF SHOULDER CAST CDM","code_information":[{"code":"Px00045013095","type":"CDM"},{"code":"29055","type":"HCPCS"}],"standard_charges":[{"gross_charge":850.0,"discounted_cash":637.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED LONG ARM CAST APPLICATION CDM","code_information":[{"code":"Px00045013096","type":"CDM"},{"code":"29065","type":"HCPCS"}],"standard_charges":[{"gross_charge":850.0,"discounted_cash":637.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED SHORT ARM CAST APPLICATION CDM","code_information":[{"code":"Px00045013099","type":"CDM"},{"code":"29075","type":"HCPCS"}],"standard_charges":[{"gross_charge":850.0,"discounted_cash":637.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED APPLY HAND/WRIST CAST CDM","code_information":[{"code":"Px00045013103","type":"CDM"},{"code":"29085","type":"HCPCS"}],"standard_charges":[{"gross_charge":516.0,"discounted_cash":387.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED APPLY FINGER CAST CDM","code_information":[{"code":"Px00045013105","type":"CDM"},{"code":"29086","type":"HCPCS"}],"standard_charges":[{"gross_charge":516.0,"discounted_cash":387.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED LONG ARM SPLINT APPLICATION CDM","code_information":[{"code":"Px00045013106","type":"CDM"},{"code":"29105","type":"HCPCS"}],"standard_charges":[{"gross_charge":525.0,"discounted_cash":393.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED SHORT ARM SPLINT APPLICATION CDM","code_information":[{"code":"Px00045013110","type":"CDM"},{"code":"29125","type":"HCPCS"}],"standard_charges":[{"gross_charge":774.0,"discounted_cash":580.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED APPLICATION OF FINGER SPLINT STATIC CDM","code_information":[{"code":"Px00045013112","type":"CDM"},{"code":"29130","type":"HCPCS"}],"standard_charges":[{"gross_charge":410.0,"discounted_cash":307.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED APPLICATION OF HIP CAST CDM","code_information":[{"code":"Px00045013119","type":"CDM"},{"code":"29305","type":"HCPCS"}],"standard_charges":[{"gross_charge":850.0,"discounted_cash":637.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED APPLICATION OF HIP CASTS CDM","code_information":[{"code":"Px00045013120","type":"CDM"},{"code":"29325","type":"HCPCS"}],"standard_charges":[{"gross_charge":850.0,"discounted_cash":637.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED APPLICATION OF LONG LEG CAST CDM","code_information":[{"code":"Px00045013121","type":"CDM"},{"code":"29345","type":"HCPCS"}],"standard_charges":[{"gross_charge":850.0,"discounted_cash":637.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CYLINDER CAST APPLICATION CDM","code_information":[{"code":"Px00045013122","type":"CDM"},{"code":"29365","type":"HCPCS"}],"standard_charges":[{"gross_charge":850.0,"discounted_cash":637.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED SHORT LEG CAST APPLICATION CDM","code_information":[{"code":"Px00045013123","type":"CDM"},{"code":"29405","type":"HCPCS"}],"standard_charges":[{"gross_charge":850.0,"discounted_cash":637.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED APPLY SHORT WALKING LEG CAST CDM","code_information":[{"code":"Px00045013124","type":"CDM"},{"code":"29425","type":"HCPCS"}],"standard_charges":[{"gross_charge":850.0,"discounted_cash":637.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED APPLICATION LONG LEG SPLINT CDM","code_information":[{"code":"Px00045013127","type":"CDM"},{"code":"29505","type":"HCPCS"}],"standard_charges":[{"gross_charge":580.0,"discounted_cash":435.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED SHORT LEG SPLINT APPLICATION CDM","code_information":[{"code":"Px00045013130","type":"CDM"},{"code":"29515","type":"HCPCS"}],"standard_charges":[{"gross_charge":525.0,"discounted_cash":393.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED STRAPPING OF KNEE CDM","code_information":[{"code":"Px00045013135","type":"CDM"},{"code":"29530","type":"HCPCS"}],"standard_charges":[{"gross_charge":537.0,"discounted_cash":402.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED STRAPPING OF ANKLE AND/OR FT CDM","code_information":[{"code":"Px00045013137","type":"CDM"},{"code":"29540","type":"HCPCS"}],"standard_charges":[{"gross_charge":537.0,"discounted_cash":402.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED STRAPPING OF TOES CDM","code_information":[{"code":"Px00045013139","type":"CDM"},{"code":"29550","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.0,"discounted_cash":153.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REMOV BIVAL GAUN BOOT/BODY CAST CDM","code_information":[{"code":"Px00045013145","type":"CDM"},{"code":"29700","type":"HCPCS"}],"standard_charges":[{"gross_charge":1356.0,"discounted_cash":1017.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE OR BIVALVE CAST-FULL ARM OR LEG CDM","code_information":[{"code":"Px00045013147","type":"CDM"},{"code":"29705","type":"HCPCS"}],"standard_charges":[{"gross_charge":1356.0,"discounted_cash":1017.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR OF BODY CAST CDM","code_information":[{"code":"Px00045013150","type":"CDM"},{"code":"29720","type":"HCPCS"}],"standard_charges":[{"gross_charge":516.0,"discounted_cash":387.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED WINDOWING OF CAST CDM","code_information":[{"code":"Px00045013151","type":"CDM"},{"code":"29730","type":"HCPCS"}],"standard_charges":[{"gross_charge":516.0,"discounted_cash":387.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TX OF PORC TIBIOFIBULAR JOINT DISLOCATION W/O ANESTH CDM","code_information":[{"code":"Px00045013166","type":"CDM"},{"code":"27830","type":"HCPCS"}],"standard_charges":[{"gross_charge":1366.0,"discounted_cash":1024.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE FOREIGN BODY FROM EYE CORNEAL W/ SLIT LAMP CDM","code_information":[{"code":"Px00045013170","type":"CDM"},{"code":"65222","type":"HCPCS"}],"standard_charges":[{"gross_charge":720.0,"discounted_cash":540.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF MOUTH LESION COMPL CDM","code_information":[{"code":"Px00045013172","type":"CDM"},{"code":"40801","type":"HCPCS"}],"standard_charges":[{"gross_charge":1618.0,"discounted_cash":1213.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DRAIN OUTER EAR CANAL LESION CDM","code_information":[{"code":"Px00045013173","type":"CDM"},{"code":"69020","type":"HCPCS"}],"standard_charges":[{"gross_charge":2298.0,"discounted_cash":1723.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CONTROL OF NOSEBLEED POSTERIOR CDM","code_information":[{"code":"Px00045013183","type":"CDM"},{"code":"30905","type":"HCPCS"}],"standard_charges":[{"gross_charge":1884.0,"discounted_cash":1413.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY SUBSQ CDM","code_information":[{"code":"Px00045013185","type":"CDM"},{"code":"30906","type":"HCPCS"}],"standard_charges":[{"gross_charge":737.0,"discounted_cash":552.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED NASAL ENDOSCOPY DX CDM","code_information":[{"code":"Px00045013187","type":"CDM"},{"code":"31231","type":"HCPCS"}],"standard_charges":[{"gross_charge":253.0,"discounted_cash":189.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED NASAL/SINUS ENDOSCOPY SURG W/ HEMORRHAGE CONTROL CDM","code_information":[{"code":"Px00045013188","type":"CDM"},{"code":"31238","type":"HCPCS"}],"standard_charges":[{"gross_charge":3996.0,"discounted_cash":2997.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED SINUS ENDO W/BALLOON DILATION CDM","code_information":[{"code":"Px00045013189","type":"CDM"},{"code":"31295","type":"HCPCS"}],"standard_charges":[{"gross_charge":15468.0,"discounted_cash":11601.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DIAGNOSTIC LARYNGOSCOPY INDIRECT CDM","code_information":[{"code":"Px00045013192","type":"CDM"},{"code":"31505","type":"HCPCS"}],"standard_charges":[{"gross_charge":353.0,"discounted_cash":264.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE FOREIGN BODY LARYNX INDIRECT CDM","code_information":[{"code":"Px00045013193","type":"CDM"},{"code":"31511","type":"HCPCS"}],"standard_charges":[{"gross_charge":353.0,"discounted_cash":264.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DX LARYNGOSCOPY NEWBORN CDM","code_information":[{"code":"Px00045013194","type":"CDM"},{"code":"31520","type":"HCPCS"}],"standard_charges":[{"gross_charge":943.0,"discounted_cash":707.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DX LARYNGOSCOPY EXCL NEWBORN CDM","code_information":[{"code":"Px00045013195","type":"CDM"},{"code":"31525","type":"HCPCS"}],"standard_charges":[{"gross_charge":2701.0,"discounted_cash":2025.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED LARYNGOSCOPY W/FB REMOVAL CDM","code_information":[{"code":"Px00045013196","type":"CDM"},{"code":"31530","type":"HCPCS"}],"standard_charges":[{"gross_charge":3996.0,"discounted_cash":2997.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DIAGNOSTIC LARYNGOSCOPY CDM","code_information":[{"code":"Px00045013197","type":"CDM"},{"code":"31575","type":"HCPCS"}],"standard_charges":[{"gross_charge":613.0,"discounted_cash":459.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"},{"gross_charge":592.0,"discounted_cash":444.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD RADIATION ONCOLOGY"}]},{"description":"HC ED LARYNGOSCOPY WITH BIOPSY CDM","code_information":[{"code":"Px00045013198","type":"CDM"},{"code":"31576","type":"HCPCS"}],"standard_charges":[{"gross_charge":3996.0,"discounted_cash":2997.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE FOREIGN BODY LARYNX FLEXIBLE FIBEROPTIC CDM","code_information":[{"code":"Px00045013199","type":"CDM"},{"code":"31577","type":"HCPCS"}],"standard_charges":[{"gross_charge":1225.0,"discounted_cash":918.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL OF LARYNX LESION CDM","code_information":[{"code":"Px00045013200","type":"CDM"},{"code":"31578","type":"HCPCS"}],"standard_charges":[{"gross_charge":3996.0,"discounted_cash":2997.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TRACHEOSTOMY CDM","code_information":[{"code":"Px00045013201","type":"CDM"},{"code":"31603","type":"HCPCS"}],"standard_charges":[{"gross_charge":4267.0,"discounted_cash":3200.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CRICOTHYROIDOTOMY CDM","code_information":[{"code":"Px00045013202","type":"CDM"},{"code":"31605","type":"HCPCS"}],"standard_charges":[{"gross_charge":2577.0,"discounted_cash":1932.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED VISUALIZATION OF WINDPIPE CDM","code_information":[{"code":"Px00045013203","type":"CDM"},{"code":"31615","type":"HCPCS"}],"standard_charges":[{"gross_charge":3996.0,"discounted_cash":2997.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED EXPLORATION/BIOPSY OF CHEST CDM","code_information":[{"code":"Px00045013206","type":"CDM"},{"code":"32100","type":"HCPCS"}],"standard_charges":[{"gross_charge":4914.0,"discounted_cash":3685.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED OPEN CHEST HEART MASSAGE CDM","code_information":[{"code":"Px00045013207","type":"CDM"},{"code":"32160","type":"HCPCS"}],"standard_charges":[{"gross_charge":4914.0,"discounted_cash":3685.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR AV FISTULA EXTREMITIES CDM","code_information":[{"code":"Px00045013209","type":"CDM"},{"code":"35190","type":"HCPCS"}],"standard_charges":[{"gross_charge":15563.0,"discounted_cash":11672.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR BLOOD VESSEL LESION UPPER EXTREMITY CDM","code_information":[{"code":"Px00045013210","type":"CDM"},{"code":"35206","type":"HCPCS"}],"standard_charges":[{"gross_charge":10309.0,"discounted_cash":7731.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR BLOOD VESSEL LESION HAND/FINGER CDM","code_information":[{"code":"Px00045013211","type":"CDM"},{"code":"35207","type":"HCPCS"}],"standard_charges":[{"gross_charge":10309.0,"discounted_cash":7731.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR LIP FULL THICKNESS VERMILION ONLY CDM","code_information":[{"code":"Px00045013214","type":"CDM"},{"code":"40650","type":"HCPCS"}],"standard_charges":[{"gross_charge":1819.0,"discounted_cash":1364.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR LIP FULL THICKNESS UP TO HALF VERTICAL HEIGHT CDM","code_information":[{"code":"Px00045013215","type":"CDM"},{"code":"40652","type":"HCPCS"}],"standard_charges":[{"gross_charge":4670.0,"discounted_cash":3502.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED RPR LIP FULL THKNS GT/ONE-HALF VERT HEIGHT/COMPLE CDM","code_information":[{"code":"Px00045013216","type":"CDM"},{"code":"40654","type":"HCPCS"}],"standard_charges":[{"gross_charge":8186.0,"discounted_cash":6139.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF MOUTH LESION SIMPLE CDM","code_information":[{"code":"Px00045013217","type":"CDM"},{"code":"40800","type":"HCPCS"}],"standard_charges":[{"gross_charge":677.0,"discounted_cash":507.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL FOREIGN BODY MOUTH SIMPLE CDM","code_information":[{"code":"Px00045013218","type":"CDM"},{"code":"40804","type":"HCPCS"}],"standard_charges":[{"gross_charge":2925.0,"discounted_cash":2193.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL FOREIGN BODY MOUTH COMPLEX CDM","code_information":[{"code":"Px00045013219","type":"CDM"},{"code":"40805","type":"HCPCS"}],"standard_charges":[{"gross_charge":2925.0,"discounted_cash":2193.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR MOUTH LACERATION LT/2.5CM CDM","code_information":[{"code":"Px00045013220","type":"CDM"},{"code":"40830","type":"HCPCS"}],"standard_charges":[{"gross_charge":737.0,"discounted_cash":552.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR MOUTH LACERATION GT/2.5CM CDM","code_information":[{"code":"Px00045013221","type":"CDM"},{"code":"40831","type":"HCPCS"}],"standard_charges":[{"gross_charge":5342.0,"discounted_cash":4006.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF MOUTH LESION LINGUAL CDM","code_information":[{"code":"Px00045013222","type":"CDM"},{"code":"41000","type":"HCPCS"}],"standard_charges":[{"gross_charge":1618.0,"discounted_cash":1213.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INCISION & DRAINAGE OF MOUTH LESION SUBLINGUAL SUPERFICIAL CDM","code_information":[{"code":"Px00045013223","type":"CDM"},{"code":"41005","type":"HCPCS"}],"standard_charges":[{"gross_charge":737.0,"discounted_cash":552.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR TONGUE LAC LT/2.6CM FLOOR OF MOUTH AND/OR ANTERIOR TWO-T CDM","code_information":[{"code":"Px00045013224","type":"CDM"},{"code":"41250","type":"HCPCS"}],"standard_charges":[{"gross_charge":1910.0,"discounted_cash":1432.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR TONGUE LACERATION LT/2.6CM POSTERIOR ONE-THIRD OF TONGUE CDM","code_information":[{"code":"Px00045013225","type":"CDM"},{"code":"41251","type":"HCPCS"}],"standard_charges":[{"gross_charge":737.0,"discounted_cash":552.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED RPR LAC TONGUE FLOOR MOUTH GT/2.6 CM/CPLX CDM","code_information":[{"code":"Px00045013226","type":"CDM"},{"code":"41252","type":"HCPCS"}],"standard_charges":[{"gross_charge":2197.0,"discounted_cash":1647.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL FOREIGN BODY GUM CDM","code_information":[{"code":"Px00045013227","type":"CDM"},{"code":"41805","type":"HCPCS"}],"standard_charges":[{"gross_charge":4918.0,"discounted_cash":3688.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE MOUTH ROOF LESION CDM","code_information":[{"code":"Px00045013229","type":"CDM"},{"code":"42000","type":"HCPCS"}],"standard_charges":[{"gross_charge":1284.0,"discounted_cash":963.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREATMENT MOUTH ROOF LESION CDM","code_information":[{"code":"Px00045013230","type":"CDM"},{"code":"42160","type":"HCPCS"}],"standard_charges":[{"gross_charge":10082.0,"discounted_cash":7561.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR LACERATION OF PALATE UP TO 2 CM CDM","code_information":[{"code":"Px00045013231","type":"CDM"},{"code":"42180","type":"HCPCS"}],"standard_charges":[{"gross_charge":1618.0,"discounted_cash":1213.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF TONSIL ABSCESS CDM","code_information":[{"code":"Px00045013232","type":"CDM"},{"code":"42700","type":"HCPCS"}],"standard_charges":[{"gross_charge":1125.0,"discounted_cash":843.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF THROAT ABSCESS CDM","code_information":[{"code":"Px00045013233","type":"CDM"},{"code":"42720","type":"HCPCS"}],"standard_charges":[{"gross_charge":10082.0,"discounted_cash":7561.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE PHARYNX FOREIGN BODY CDM","code_information":[{"code":"Px00045013234","type":"CDM"},{"code":"42809","type":"HCPCS"}],"standard_charges":[{"gross_charge":292.0,"discounted_cash":219.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CONTROL THROAT BLEEDING SIMPLE CDM","code_information":[{"code":"Px00045013235","type":"CDM"},{"code":"42960","type":"HCPCS"}],"standard_charges":[{"gross_charge":1618.0,"discounted_cash":1213.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED ESOPHAGOSCOPY FLEXIBLE BRUSH CDM","code_information":[{"code":"Px00045013237","type":"CDM"},{"code":"43200","type":"HCPCS"}],"standard_charges":[{"gross_charge":1586.0,"discounted_cash":1189.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED ESOPHAGOSCOPY FLEX REMOVE FB CDM","code_information":[{"code":"Px00045013238","type":"CDM"},{"code":"43215","type":"HCPCS"}],"standard_charges":[{"gross_charge":2201.0,"discounted_cash":1650.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED EGD US FINE NEEDLE BX/ASPIR CDM","code_information":[{"code":"Px00045013240","type":"CDM"},{"code":"43242","type":"HCPCS"}],"standard_charges":[{"gross_charge":4354.0,"discounted_cash":3265.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED GASTRIC INTUBATJ & ASPIRAJ W/PHYS SKILL/LAVAGE CDM","code_information":[{"code":"Px00045013243","type":"CDM"},{"code":"43753","type":"HCPCS"}],"standard_charges":[{"gross_charge":1021.0,"discounted_cash":765.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED I/D FINGER ABSC-SIM-FA CDM","code_information":[{"code":"Px00045014005","type":"CDM"},{"code":"26010","type":"HCPCS"}],"standard_charges":[{"gross_charge":827.0,"discounted_cash":620.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CLSD TX TOE FX W/O MANIP CDM","code_information":[{"code":"Px00045014022","type":"CDM"},{"code":"28510","type":"HCPCS"}],"standard_charges":[{"gross_charge":845.0,"discounted_cash":633.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED COLPOSCOPY CERVIX UPPER/ADJACENT VAGINA CDM","code_information":[{"code":"Px00045014033","type":"CDM"},{"code":"57452","type":"HCPCS"}],"standard_charges":[{"gross_charge":3996.0,"discounted_cash":2997.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED INJECTION ANES OTHER PERIPHERAL NERVE/BRANCH CDM","code_information":[{"code":"Px00045014035","type":"CDM"},{"code":"64450","type":"HCPCS"}],"standard_charges":[{"gross_charge":1844.0,"discounted_cash":1383.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CARDIOPULMONARY RESUSCITATION CDM","code_information":[{"code":"Px00045014038","type":"CDM"},{"code":"92950","type":"HCPCS"}],"standard_charges":[{"gross_charge":946.0,"discounted_cash":709.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED THROMBOLYSIS INTRACORONARY NFS SLCTV ANGRPH CDM","code_information":[{"code":"Px00045014040","type":"CDM"},{"code":"92975","type":"HCPCS"}],"standard_charges":[{"gross_charge":580.0,"discounted_cash":435.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED ABD PARACENTESIS W/O IMAG GUID CDM","code_information":[{"code":"Px00045014046","type":"CDM"},{"code":"49082","type":"HCPCS"}],"standard_charges":[{"gross_charge":2526.0,"discounted_cash":1894.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED ABD PARACENTESIS W/IMAG GUIDANCE CDM","code_information":[{"code":"Px00045014047","type":"CDM"},{"code":"49083","type":"HCPCS"}],"standard_charges":[{"gross_charge":2758.0,"discounted_cash":2068.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED FAC PERITONEAL LAVAGE CDM","code_information":[{"code":"Px00045014048","type":"CDM"},{"code":"49084","type":"HCPCS"}],"standard_charges":[{"gross_charge":2538.0,"discounted_cash":1903.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED DIAGNOSTIC ANOSCOPY CDM","code_information":[{"code":"Px00045014050","type":"CDM"},{"code":"46601","type":"HCPCS"}],"standard_charges":[{"gross_charge":3996.0,"discounted_cash":2997.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TREAT FOOT DISLOCATION W/ ANESTHESIA CDM","code_information":[{"code":"Px00045014051","type":"CDM"},{"code":"28605","type":"HCPCS"}],"standard_charges":[{"gross_charge":734.0,"discounted_cash":550.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED FUSION OF HAND BONES CDM","code_information":[{"code":"Px00045014052","type":"CDM"},{"code":"25820","type":"HCPCS"}],"standard_charges":[{"gross_charge":23440.0,"discounted_cash":17580.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED CLEAR OUTER EAR CANAL CDM","code_information":[{"code":"Px00045014053","type":"CDM"},{"code":"69205","type":"HCPCS"}],"standard_charges":[{"gross_charge":5314.0,"discounted_cash":3985.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED MANIPULATE WRIST W/ANESTHES CDM","code_information":[{"code":"Px00045014054","type":"CDM"},{"code":"25259","type":"HCPCS"}],"standard_charges":[{"gross_charge":5083.0,"discounted_cash":3812.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED OPN TX ORBIT FX W/O IMPLANT CDM","code_information":[{"code":"Px00045014055","type":"CDM"},{"code":"21406","type":"HCPCS"}],"standard_charges":[{"gross_charge":16416.0,"discounted_cash":12312.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE EAR CANAL LESION(S) CDM","code_information":[{"code":"Px00045014056","type":"CDM"},{"code":"69145","type":"HCPCS"}],"standard_charges":[{"gross_charge":9154.0,"discounted_cash":6865.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED BRONCHOSCOPY W/THER ASPIR TRACHBRNCL TREE 1ST CDM","code_information":[{"code":"Px00045044404","type":"CDM"},{"code":"31645","type":"HCPCS"}],"standard_charges":[{"gross_charge":3996.0,"discounted_cash":2997.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION CDM","code_information":[{"code":"Px00045050511","type":"CDM"},{"code":"10005","type":"HCPCS"}],"standard_charges":[{"gross_charge":3661.0,"discounted_cash":2745.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC INHLJ BRNCL CHALLENGE TSTG W/HISTAM/METHACHOL CDM","code_information":[{"code":"Px00046000003","type":"CDM"},{"code":"95070","type":"HCPCS"}],"standard_charges":[{"gross_charge":352.0,"discounted_cash":264.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BRNCSPSM PROVOCATION EVAL MLT SPMTRY W/ADMN AGT CDM","code_information":[{"code":"Px00046010002","type":"CDM"},{"code":"94070","type":"HCPCS"}],"standard_charges":[{"gross_charge":1798.0,"discounted_cash":1348.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CO/MEMBANE DIFFUSE CAPACITY","code_information":[{"code":"Px00046010012","type":"CDM"},{"code":"94729","type":"HCPCS"}],"standard_charges":[{"gross_charge":716.0,"discounted_cash":537.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HIGH ALTITUDE SIMULATJ TEST W/PHYS INTERP&REPORT","code_information":[{"code":"Px00046010019","type":"CDM"},{"code":"94452","type":"HCPCS"}],"standard_charges":[{"gross_charge":419.0,"discounted_cash":314.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HIGH ALTITUDE SIMULATJ W/PHYS I&R W/O2 TITRATION","code_information":[{"code":"Px00046010020","type":"CDM"},{"code":"94453","type":"HCPCS"}],"standard_charges":[{"gross_charge":506.0,"discounted_cash":379.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC GAS DILUT/WASHOUT LUNG VOL W/WO DISTRIB VENT&VOR OTH","code_information":[{"code":"Px00046010024","type":"CDM"},{"code":"94727","type":"HCPCS"}],"standard_charges":[{"gross_charge":609.0,"discounted_cash":456.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MAX BREATHING CAPACITY MAXIMAL VOLUNTARY VENTJ","code_information":[{"code":"Px00046010026","type":"CDM"},{"code":"94200","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":140.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CARDIOPULMONARY EXERCISE TESTING","code_information":[{"code":"Px00046010040","type":"CDM"},{"code":"94621","type":"HCPCS"}],"standard_charges":[{"gross_charge":1253.0,"discounted_cash":939.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PULMONARY STRESS TESTING - SIX MINUTE WALK CDM","code_information":[{"code":"Px00046010048","type":"CDM"},{"code":"94618","type":"HCPCS"}],"standard_charges":[{"gross_charge":742.0,"discounted_cash":556.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ","code_information":[{"code":"Px00046010055","type":"CDM"},{"code":"94010","type":"HCPCS"}],"standard_charges":[{"gross_charge":1468.0,"discounted_cash":1101.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC SPIROMETRY PRE POST BRONCHODILATOR CDM","code_information":[{"code":"Px00046010063","type":"CDM"},{"code":"94060","type":"HCPCS"}],"standard_charges":[{"gross_charge":1583.0,"discounted_cash":1187.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PLETHYSMOGRAPHY LUNG VOLUMES W/WO AIRWAY RESIST CDM","code_information":[{"code":"Px00046010089","type":"CDM"},{"code":"94726","type":"HCPCS"}],"standard_charges":[{"gross_charge":497.0,"discounted_cash":372.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC BEDSIDE SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ CDM","code_information":[{"code":"Px00046010092","type":"CDM"},{"code":"94010","type":"HCPCS"}],"standard_charges":[{"gross_charge":1468.0,"discounted_cash":1101.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC TINNITUS ASSESSMENT","code_information":[{"code":"Px00047010015","type":"CDM"},{"code":"92625","type":"HCPCS"}],"standard_charges":[{"gross_charge":390.0,"discounted_cash":292.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC POSITIONAL NYSTAGMUS TEST","code_information":[{"code":"Px00047010025","type":"CDM"},{"code":"92532","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":281.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R CDM","code_information":[{"code":"Px00047100005","type":"CDM"},{"code":"92652","type":"HCPCS"}],"standard_charges":[{"gross_charge":886.0,"discounted_cash":664.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC AEP SCR AUDITORY POTENTIAL W/STIMULI AUTO ALYS CDM","code_information":[{"code":"Px00047100007","type":"CDM"},{"code":"92650","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.0,"discounted_cash":120.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC EVOKED OTOACOUSTIC EMISSIONS SCREEN AUTO ANALYS CDM","code_information":[{"code":"Px00047110105","type":"CDM"},{"code":"92558","type":"HCPCS"}],"standard_charges":[{"gross_charge":284.0,"discounted_cash":213.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PERQ TRLUML CORONRY LITHOTRP ADD-ON CDM","code_information":[{"code":"Px00048000007","type":"CDM"},{"code":"92972","type":"HCPCS"}],"standard_charges":[{"gross_charge":16352.0,"discounted_cash":12264.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL","code_information":[{"code":"Px00048010001","type":"CDM"},{"code":"92960","type":"HCPCS"}],"standard_charges":[{"gross_charge":3022.0,"discounted_cash":2266.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":2317.0,"discounted_cash":1737.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ECHO TRANSTHORC R-T 2D W/WO M-MODE REC F-UP/LMTD","code_information":[{"code":"Px00048010059","type":"CDM"},{"code":"93308","type":"HCPCS"}],"standard_charges":[{"gross_charge":682.0,"discounted_cash":511.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ECHO TRANSESOPHAG R-T 2D W/PRB IMG ACQUISJ I&R","code_information":[{"code":"Px00048010063","type":"CDM"},{"code":"93312","type":"HCPCS"}],"standard_charges":[{"gross_charge":1779.0,"discounted_cash":1334.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ECHO DOPPLER PULSE CONTIN LTD PW & CW","code_information":[{"code":"Px00048010066","type":"CDM"},{"code":"93321","type":"HCPCS"}],"standard_charges":[{"gross_charge":399.0,"discounted_cash":299.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DOP ECHOCARD COLOR FLOW VELOCITY MAPPING CDM","code_information":[{"code":"Px00048010067","type":"CDM"},{"code":"93325","type":"HCPCS"}],"standard_charges":[{"gross_charge":680.0,"discounted_cash":510.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DOPPLER ECHOCARD PULSE WAVE W/SPECTRAL DISPLAY","code_information":[{"code":"Px00048010074","type":"CDM"},{"code":"93320","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":225.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ECHO TTHRC R-T 2D W/WO M-MODE COMPLETE REST&ST","code_information":[{"code":"Px00048010075","type":"CDM"},{"code":"93350","type":"HCPCS"}],"standard_charges":[{"gross_charge":2438.0,"discounted_cash":1828.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ECHO TTE 2D W/WO CONTRAST DOP COLOR","code_information":[{"code":"Px00048010077","type":"CDM"},{"code":"C8929","type":"HCPCS"}],"standard_charges":[{"gross_charge":3592.0,"discounted_cash":2694.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC REVASC LITHOTRIP TIBI/PERONE CDM","code_information":[{"code":"Px00048100011","type":"CDM"},{"code":"C9772","type":"HCPCS"}],"standard_charges":[{"gross_charge":43702.0,"discounted_cash":32776.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC R HRT CATH CHD W/IMG CATH TRGT ZONE NML NT CONNJ CDM","code_information":[{"code":"Px00048100028","type":"CDM"},{"code":"93593","type":"HCPCS"}],"standard_charges":[{"gross_charge":12614.0,"discounted_cash":9460.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC R HRT CATH CHD W/IMG CATH TRGT ZON ABNL NT CONNJ CDM","code_information":[{"code":"Px00048100029","type":"CDM"},{"code":"93594","type":"HCPCS"}],"standard_charges":[{"gross_charge":12614.0,"discounted_cash":9460.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC R&L HRT CATH CHD IMG CATH TRGT ZONE NML NT CONNJ CDM","code_information":[{"code":"Px00048100031","type":"CDM"},{"code":"93596","type":"HCPCS"}],"standard_charges":[{"gross_charge":12614.0,"discounted_cash":9460.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC R&L HRT CATH CHD IMG CATH TRGT ZON ABNL NT CONNJ CDM","code_information":[{"code":"Px00048100032","type":"CDM"},{"code":"93597","type":"HCPCS"}],"standard_charges":[{"gross_charge":12614.0,"discounted_cash":9460.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CAR OUTP MEAS DRG CAR CATH EVAL CGEN HRT DEFECT CDM","code_information":[{"code":"Px00048100033","type":"CDM"},{"code":"93598","type":"HCPCS"}],"standard_charges":[{"gross_charge":12614.0,"discounted_cash":9460.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC REVJ OPN ARVEN FSTL W/O THRMBC DIAL GRF","code_information":[{"code":"Px00048100034","type":"CDM"},{"code":"36832","type":"HCPCS"}],"standard_charges":[{"gross_charge":17481.0,"discounted_cash":13110.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC TCAT RMVL/DEBULK ICAR MASS SUCTION DEVICE PERQ","code_information":[{"code":"Px00048100039","type":"CDM"},{"code":"0644T","type":"HCPCS"}],"standard_charges":[{"gross_charge":17981.0,"discounted_cash":13485.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":17981.0,"discounted_cash":13485.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PERQ P-ART REVSC ST 1ST NML NATIVE CONNJ UNI CDM","code_information":[{"code":"Px00048100042","type":"CDM"},{"code":"33900","type":"HCPCS"}],"standard_charges":[{"gross_charge":38669.0,"discounted_cash":29001.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC PERQ P-ART REVSC ST 1ST NML NATIVE CONNJ BI CDM","code_information":[{"code":"Px00048100043","type":"CDM"},{"code":"33901","type":"HCPCS"}],"standard_charges":[{"gross_charge":38669.0,"discounted_cash":29001.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC PERQ P-ART REVSC ST 1ST ABNOR CONNJ UNILATERAL CDM","code_information":[{"code":"Px00048100044","type":"CDM"},{"code":"33902","type":"HCPCS"}],"standard_charges":[{"gross_charge":62572.0,"discounted_cash":46929.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC PERQ P-ART REVSC ST 1ST ABNORMAL CONNJ BILATERAL CDM","code_information":[{"code":"Px00048100045","type":"CDM"},{"code":"33903","type":"HCPCS"}],"standard_charges":[{"gross_charge":93858.0,"discounted_cash":70393.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC HEART INSTANT FLOW RESERVE MEASURE CDM","code_information":[{"code":"Px00048100062","type":"CDM"},{"code":"93799","type":"HCPCS"}],"standard_charges":[{"gross_charge":2632.0,"discounted_cash":1974.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC REVJ FEM ANAST BPG GRN OPN W/NONAUTOG PATCH GRF CDM","code_information":[{"code":"Px00048100065","type":"CDM"},{"code":"35883","type":"HCPCS"}],"standard_charges":[{"gross_charge":17481.0,"discounted_cash":13110.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IV DOP VEL&/OR PRESS C/FLO RSRV MEAS ADDL VSL","code_information":[{"code":"Px00048100069","type":"CDM"},{"code":"93799","type":"HCPCS"}],"standard_charges":[{"gross_charge":2632.0,"discounted_cash":1974.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC EVASC RPR A-AO NDGFT","code_information":[{"code":"Px00048110004","type":"CDM"},{"code":"34701","type":"HCPCS"}],"standard_charges":[{"gross_charge":60607.0,"discounted_cash":45455.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC EVASC RPR A-UNILAC NDGFT","code_information":[{"code":"Px00048110006","type":"CDM"},{"code":"34703","type":"HCPCS"}],"standard_charges":[{"gross_charge":63522.0,"discounted_cash":47641.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC EVAC RPR A-BIILIAC NDGFT","code_information":[{"code":"Px00048110008","type":"CDM"},{"code":"34705","type":"HCPCS"}],"standard_charges":[{"gross_charge":63846.0,"discounted_cash":47884.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC INSERT COR DRUG ELUTING STENT PERC SINGLE","code_information":[{"code":"Px00048110011","type":"CDM"},{"code":"C9600","type":"HCPCS"}],"standard_charges":[{"gross_charge":35580.0,"discounted_cash":26685.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC INSERT COR DRUG ELUTING STENT PERC EA ADDL BRANCH","code_information":[{"code":"Px00048110012","type":"CDM"},{"code":"C9601","type":"HCPCS"}],"standard_charges":[{"gross_charge":15718.0,"discounted_cash":11788.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC INSERT COR DRUG ELUTING STENT PERC ATHER SINGLE","code_information":[{"code":"Px00048110013","type":"CDM"},{"code":"C9602","type":"HCPCS"}],"standard_charges":[{"gross_charge":34211.0,"discounted_cash":25658.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC INSERT COR DRUG ELUTING STENT PERC ATHER ADDL BRANCH","code_information":[{"code":"Px00048110014","type":"CDM"},{"code":"C9603","type":"HCPCS"}],"standard_charges":[{"gross_charge":35061.0,"discounted_cash":26295.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC INSERT COR DRUG ELUTING STENT PERC REVASC CABG SINGLE","code_information":[{"code":"Px00048110015","type":"CDM"},{"code":"C9604","type":"HCPCS"}],"standard_charges":[{"gross_charge":34211.0,"discounted_cash":25658.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC INSERT COR DRUG ELUTING STENT PERC REVASC W AMI SINGLE","code_information":[{"code":"Px00048110017","type":"CDM"},{"code":"C9606","type":"HCPCS"}],"standard_charges":[{"gross_charge":35580.0,"discounted_cash":26685.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC INSERT COR DRUG ELUTING STENT PERC REVASC CHRONIC SINGLE","code_information":[{"code":"Px00048110018","type":"CDM"},{"code":"C9607","type":"HCPCS"}],"standard_charges":[{"gross_charge":34211.0,"discounted_cash":25658.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC PRQ TRLUML CORONARY ANGIOPLASTY ONE ART/BRANCH","code_information":[{"code":"Px00048110025","type":"CDM"},{"code":"92920","type":"HCPCS"}],"standard_charges":[{"gross_charge":19559.0,"discounted_cash":14669.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PRQ TRLUML CORONARY ANGIOPLASTY ADDL BRANCH","code_information":[{"code":"Px00048110026","type":"CDM"},{"code":"92921","type":"HCPCS"}],"standard_charges":[{"gross_charge":19559.0,"discounted_cash":14669.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC INSERT COR STENT TRLUML TOT OCCLUS REVASC MI ONE VSL","code_information":[{"code":"Px00048110035","type":"CDM"},{"code":"92941","type":"HCPCS"}],"standard_charges":[{"gross_charge":40601.0,"discounted_cash":30450.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC INSERT COR STENT TRLUML CHRONIC OCCLUS REVASC ONE VSL","code_information":[{"code":"Px00048110036","type":"CDM"},{"code":"92943","type":"HCPCS"}],"standard_charges":[{"gross_charge":29352.0,"discounted_cash":22014.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC EVASC RPR ILIO-ILIAC NDGFT","code_information":[{"code":"Px00048110042","type":"CDM"},{"code":"34707","type":"HCPCS"}],"standard_charges":[{"gross_charge":8765.0,"discounted_cash":6573.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC PLMT XTN PROSTH EVASC RPR","code_information":[{"code":"Px00048110044","type":"CDM"},{"code":"34709","type":"HCPCS"}],"standard_charges":[{"gross_charge":29142.0,"discounted_cash":21856.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC DLYD PLMT XTN PROSTH 1ST VSL","code_information":[{"code":"Px00048110045","type":"CDM"},{"code":"34710","type":"HCPCS"}],"standard_charges":[{"gross_charge":43747.0,"discounted_cash":32810.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC DLYD PLMT XTN PROSTH EA ADDL","code_information":[{"code":"Px00048110046","type":"CDM"},{"code":"34711","type":"HCPCS"}],"standard_charges":[{"gross_charge":29142.0,"discounted_cash":21856.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC PERQ ACCESS & CLSR FEM ART","code_information":[{"code":"Px00048110048","type":"CDM"},{"code":"34713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6843.0,"discounted_cash":5132.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC REVASC INTRAVASC LITHOTRIPSY","code_information":[{"code":"Px00048110073","type":"CDM"},{"code":"C9764","type":"HCPCS"}],"standard_charges":[{"gross_charge":26161.0,"discounted_cash":19620.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC REVASC INTRA LITHOTRIP-STENT","code_information":[{"code":"Px00048110074","type":"CDM"},{"code":"C9765","type":"HCPCS"}],"standard_charges":[{"gross_charge":26161.0,"discounted_cash":19620.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC ENDOLUMINAL CORONARY IVUS OCT I&R INITIAL VESSEL","code_information":[{"code":"Px00048110106","type":"CDM"},{"code":"92978","type":"HCPCS"}],"standard_charges":[{"gross_charge":6207.0,"discounted_cash":4655.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC ENDOLUMINAL CORONARY IVUS OCT I&R ADDL VESSEL","code_information":[{"code":"Px00048110107","type":"CDM"},{"code":"92979","type":"HCPCS"}],"standard_charges":[{"gross_charge":6207.0,"discounted_cash":4655.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC RIGHT HEART CATH O2 SATURATION & CARDIAC OUTPUT","code_information":[{"code":"Px00048110141","type":"CDM"},{"code":"93451","type":"HCPCS"}],"standard_charges":[{"gross_charge":11933.0,"discounted_cash":8949.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC R & L HRT CATH W/NJX L VENTRICULOG IMG S&I","code_information":[{"code":"Px00048110143","type":"CDM"},{"code":"93453","type":"HCPCS"}],"standard_charges":[{"gross_charge":11933.0,"discounted_cash":8949.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC CATH PLACEMENT & NJX CORONARY ART ANGIO IMG S&I","code_information":[{"code":"Px00048110144","type":"CDM"},{"code":"93454","type":"HCPCS"}],"standard_charges":[{"gross_charge":11933.0,"discounted_cash":8949.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC CATH PLMT & NJX CORONARY ART/GRFT ANGIO IMG S&I","code_information":[{"code":"Px00048110145","type":"CDM"},{"code":"93455","type":"HCPCS"}],"standard_charges":[{"gross_charge":11933.0,"discounted_cash":8949.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC CATH PLMT R HRT & ARTS W/NJX & ANGIO IMG S&I","code_information":[{"code":"Px00048110146","type":"CDM"},{"code":"93456","type":"HCPCS"}],"standard_charges":[{"gross_charge":11933.0,"discounted_cash":8949.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC CATH PLMT L HRT & ARTS W/NJX & ANGIO IMG S&I","code_information":[{"code":"Px00048110148","type":"CDM"},{"code":"93458","type":"HCPCS"}],"standard_charges":[{"gross_charge":11933.0,"discounted_cash":8949.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC CATH PLMT L HRT/ARTS/GRFTS WNJX & ANGIO IMG S&I","code_information":[{"code":"Px00048110149","type":"CDM"},{"code":"93459","type":"HCPCS"}],"standard_charges":[{"gross_charge":11933.0,"discounted_cash":8949.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC R & L HRT CATH WINJX HRT ART& L VENTR IMG","code_information":[{"code":"Px00048110150","type":"CDM"},{"code":"93460","type":"HCPCS"}],"standard_charges":[{"gross_charge":11933.0,"discounted_cash":8949.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC R& L HRT CATH W/INJEC HRT ART/GRFT& L VENT I","code_information":[{"code":"Px00048110151","type":"CDM"},{"code":"93461","type":"HCPCS"}],"standard_charges":[{"gross_charge":11933.0,"discounted_cash":8949.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC LEFT HEART CATH BY TRANSEPTAL PUNCTURE CDM","code_information":[{"code":"Px00048110152","type":"CDM"},{"code":"93462","type":"HCPCS"}],"standard_charges":[{"gross_charge":2563.0,"discounted_cash":1922.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":21123.0,"discounted_cash":15842.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC NJX DRG C-CATHJ SUPRAVALVULAR AORTOGRAPHY S&I","code_information":[{"code":"Px00048110187","type":"CDM"},{"code":"93567","type":"HCPCS"}],"standard_charges":[{"gross_charge":3914.0,"discounted_cash":2935.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC IV DOP VEL&/OR PRESS C/FLO RSRV MEAS 1ST VSL","code_information":[{"code":"Px00048110189","type":"CDM"},{"code":"93571","type":"HCPCS"}],"standard_charges":[{"gross_charge":2792.0,"discounted_cash":2094.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC IV DOP VEL&/OR PRESS C/FLO RSRV MEAS ADDL VSL","code_information":[{"code":"Px00048110190","type":"CDM"},{"code":"93572","type":"HCPCS"}],"standard_charges":[{"gross_charge":2792.0,"discounted_cash":2094.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC TRANSCATH CLOSURE OF ASD","code_information":[{"code":"Px00048110191","type":"CDM"},{"code":"93580","type":"HCPCS"}],"standard_charges":[{"gross_charge":59057.0,"discounted_cash":44292.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC ILIAC ART ANGIO,CARDIAC CATH","code_information":[{"code":"Px00048110224","type":"CDM"},{"code":"G0278","type":"HCPCS"}],"standard_charges":[{"gross_charge":6596.0,"discounted_cash":4947.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC OCCLUSIVE DEVICE IN VEIN ART","code_information":[{"code":"Px00048110275","type":"CDM"},{"code":"G0269","type":"HCPCS"}],"standard_charges":[{"gross_charge":3735.0,"discounted_cash":2801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC TEAEC W/WO PATCH GRAFT DEEP PROFUNDA FEMORAL","code_information":[{"code":"Px00048110343","type":"CDM"},{"code":"35372","type":"HCPCS"}],"standard_charges":[{"gross_charge":25595.0,"discounted_cash":19196.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CV STRS TST XERS&/OR RX CONT ECG TRCG ONLY","code_information":[{"code":"Px00048210003","type":"CDM"},{"code":"93017","type":"HCPCS"}],"standard_charges":[{"gross_charge":1832.0,"discounted_cash":1374.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 93228 REMOTE 30 DAY ECG REV/REPORT","code_information":[{"code":"Px00048210015","type":"CDM"},{"code":"93228","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.0,"discounted_cash":104.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC REMOTE 30 DAY ECG TECH SUPP","code_information":[{"code":"Px00048210016","type":"CDM"},{"code":"93229","type":"HCPCS"}],"standard_charges":[{"gross_charge":663.0,"discounted_cash":497.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC AMBULATORY BP RECORDING","code_information":[{"code":"Px00048210023","type":"CDM"},{"code":"93786","type":"HCPCS"}],"standard_charges":[{"gross_charge":551.0,"discounted_cash":413.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC AMBULATORY BP ANALYSIS","code_information":[{"code":"Px00048210024","type":"CDM"},{"code":"93788","type":"HCPCS"}],"standard_charges":[{"gross_charge":2147.0,"discounted_cash":1610.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC COMPLETE TTHRC ECHO CONGENITAL CARDIAC ANOMALY","code_information":[{"code":"Px00048310001","type":"CDM"},{"code":"93303","type":"HCPCS"}],"standard_charges":[{"gross_charge":2105.0,"discounted_cash":1578.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC F-UP/LIMITED TTHRC ECHO CONGENITAL CAR ANOMALY","code_information":[{"code":"Px00048310002","type":"CDM"},{"code":"93304","type":"HCPCS"}],"standard_charges":[{"gross_charge":2100.0,"discounted_cash":1575.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ECHO TTE 2D W DOPPLER COMPLETE","code_information":[{"code":"Px00048310003","type":"CDM"},{"code":"93306","type":"HCPCS"}],"standard_charges":[{"gross_charge":2721.0,"discounted_cash":2040.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ECHO MYOCRD STRAIN IMG SPECKLE TRCK ASSMT MYOCRD MECH CDM","code_information":[{"code":"Px00048310004","type":"CDM"},{"code":"93356","type":"HCPCS"}],"standard_charges":[{"gross_charge":940.0,"discounted_cash":705.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ECHO DOPPLER PULSE CONTIN LTD","code_information":[{"code":"Px00048310013","type":"CDM"},{"code":"93321","type":"HCPCS"}],"standard_charges":[{"gross_charge":399.0,"discounted_cash":299.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ECHO W/WO CONTRAST F/U LIMITED","code_information":[{"code":"Px00048310020","type":"CDM"},{"code":"C8924","type":"HCPCS"}],"standard_charges":[{"gross_charge":1310.0,"discounted_cash":982.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ECHO TEE W/WO CONTRAST COMPLETE","code_information":[{"code":"Px00048310021","type":"CDM"},{"code":"C8925","type":"HCPCS"}],"standard_charges":[{"gross_charge":1310.0,"discounted_cash":982.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ECHO W/WO CONTRAST STRESS TEST","code_information":[{"code":"Px00048310024","type":"CDM"},{"code":"C8928","type":"HCPCS"}],"standard_charges":[{"gross_charge":3385.0,"discounted_cash":2538.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ET ESTAB PT VISIT - LEVEL 1","code_information":[{"code":"Px00051010022","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":192.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC REPORT BRIEF NARRATIVE","code_information":[{"code":"Px00051010089","type":"CDM"},{"code":"N0001","type":"HCPCS"}],"standard_charges":[{"gross_charge":169.0,"discounted_cash":126.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC INJECTION TREATMENT OF OTHER PERIPHERAL NERVE OR BRANCH","code_information":[{"code":"Px00051010136","type":"CDM"},{"code":"64640","type":"HCPCS"}],"standard_charges":[{"gross_charge":4948.0,"discounted_cash":3711.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE  CDM","code_information":[{"code":"Px00051010498","type":"CDM"},{"code":"10060","type":"HCPCS"}],"standard_charges":[{"gross_charge":1143.0,"discounted_cash":857.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CATH HEMO 13FR 15CM CRV DUAL","code_information":[{"code":"Px0005626150L","type":"CDM"},{"code":"C1752","type":"HCPCS"}],"standard_charges":[{"gross_charge":266.0,"discounted_cash":199.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MRI WHOLE BODY SCREENING W/WO CONTRAST","code_information":[{"code":"Px00061000008","type":"CDM"},{"code":"76498","type":"HCPCS"}],"standard_charges":[{"gross_charge":1517.0,"discounted_cash":1137.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"}]},{"description":"HC MRI ORBIT/FACE/NECK WO & W CONTRAST","code_information":[{"code":"Px00061010007","type":"CDM"},{"code":"70543","type":"HCPCS"}],"standard_charges":[{"gross_charge":6182.0,"discounted_cash":4636.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MRA HEAD WO CONTRAST","code_information":[{"code":"Px00061010009","type":"CDM"},{"code":"70544","type":"HCPCS"}],"standard_charges":[{"gross_charge":2940.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MRA HEAD W CONTRAST","code_information":[{"code":"Px00061010010","type":"CDM"},{"code":"70545","type":"HCPCS"}],"standard_charges":[{"gross_charge":3026.0,"discounted_cash":2269.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MRA HEAD WO & W CONTRAST","code_information":[{"code":"Px00061010012","type":"CDM"},{"code":"70546","type":"HCPCS"}],"standard_charges":[{"gross_charge":4601.0,"discounted_cash":3450.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MRA NECK WO CONTRAST","code_information":[{"code":"Px00061010013","type":"CDM"},{"code":"70547","type":"HCPCS"}],"standard_charges":[{"gross_charge":2933.0,"discounted_cash":2199.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MRA NECK WO & W CONTRAST","code_information":[{"code":"Px00061010015","type":"CDM"},{"code":"70549","type":"HCPCS"}],"standard_charges":[{"gross_charge":4671.0,"discounted_cash":3503.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MRI CHEST WO & W CONTRAST","code_information":[{"code":"Px00061010025","type":"CDM"},{"code":"71552","type":"HCPCS"}],"standard_charges":[{"gross_charge":1590.0,"discounted_cash":1192.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MRI PELVIS WO CONTRAST","code_information":[{"code":"Px00061010029","type":"CDM"},{"code":"72195","type":"HCPCS"}],"standard_charges":[{"gross_charge":2741.0,"discounted_cash":2055.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MRI PELVIS WO & W CONTRAST","code_information":[{"code":"Px00061010044","type":"CDM"},{"code":"72197","type":"HCPCS"}],"standard_charges":[{"gross_charge":5552.0,"discounted_cash":4164.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MRI LOWER EXTREMITY NO JOINT WO & W CONTRAST","code_information":[{"code":"Px00061010053","type":"CDM"},{"code":"73720","type":"HCPCS"}],"standard_charges":[{"gross_charge":6292.0,"discounted_cash":4719.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MRI UPPER EXTREMITY NO JOINT WO CONTRAST","code_information":[{"code":"Px00061010054","type":"CDM"},{"code":"73218","type":"HCPCS"}],"standard_charges":[{"gross_charge":2771.0,"discounted_cash":2078.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MRI UPPER EXTREMITY NO JOINT WO & W CONTRAST","code_information":[{"code":"Px00061010059","type":"CDM"},{"code":"73220","type":"HCPCS"}],"standard_charges":[{"gross_charge":4162.0,"discounted_cash":3121.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MRI UPPER EXTREMITY JOINT WO CONTRAST","code_information":[{"code":"Px00061010063","type":"CDM"},{"code":"73221","type":"HCPCS"}],"standard_charges":[{"gross_charge":2602.0,"discounted_cash":1951.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MRI LOWER EXTREMITY NO JOINT WO CONTRAST","code_information":[{"code":"Px00061010065","type":"CDM"},{"code":"73718","type":"HCPCS"}],"standard_charges":[{"gross_charge":2715.0,"discounted_cash":2036.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MRI UPPER EXTREMITY JOINT W CONTRAST","code_information":[{"code":"Px00061010066","type":"CDM"},{"code":"73222","type":"HCPCS"}],"standard_charges":[{"gross_charge":3959.0,"discounted_cash":2969.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MRI UPPER EXTREMITY JOINT WO & W CONTRAST","code_information":[{"code":"Px00061010068","type":"CDM"},{"code":"73223","type":"HCPCS"}],"standard_charges":[{"gross_charge":3959.0,"discounted_cash":2969.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MRI LOWER EXTREMITY JOINT WO CONTRAST","code_information":[{"code":"Px00061010075","type":"CDM"},{"code":"73721","type":"HCPCS"}],"standard_charges":[{"gross_charge":2651.0,"discounted_cash":1988.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MRI LOWER EXTREMITY JOINT WO & W CONTRAST","code_information":[{"code":"Px00061010079","type":"CDM"},{"code":"73723","type":"HCPCS"}],"standard_charges":[{"gross_charge":6295.0,"discounted_cash":4721.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MRI ABDOMEN WO CONTRAST","code_information":[{"code":"Px00061010083","type":"CDM"},{"code":"74181","type":"HCPCS"}],"standard_charges":[{"gross_charge":2449.0,"discounted_cash":1836.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MRI ABDOMEN WO & W CONTRAST","code_information":[{"code":"Px00061010087","type":"CDM"},{"code":"74183","type":"HCPCS"}],"standard_charges":[{"gross_charge":4165.0,"discounted_cash":3123.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MRI SPECTROSCOPY","code_information":[{"code":"Px00061010095","type":"CDM"},{"code":"76390","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1428.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MRI ORBIT/FACE/NECK W/O DYE","code_information":[{"code":"Px00061010142","type":"CDM"},{"code":"70540","type":"HCPCS"}],"standard_charges":[{"gross_charge":762.0,"discounted_cash":571.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MRA CHEST W/O & W/CONTRAST MATERIAL","code_information":[{"code":"Px00061010143","type":"CDM"},{"code":"71555","type":"HCPCS"}],"standard_charges":[{"gross_charge":2307.0,"discounted_cash":1730.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MRI ANGIO ABDOM W/O DYE","code_information":[{"code":"Px00061010239","type":"CDM"},{"code":"74185","type":"HCPCS"}],"standard_charges":[{"gross_charge":2357.0,"discounted_cash":1767.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MRI BRAIN STEM W/O DYE","code_information":[{"code":"Px00061110001","type":"CDM"},{"code":"70551","type":"HCPCS"}],"standard_charges":[{"gross_charge":2723.0,"discounted_cash":2042.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MRI BRAIN W/DYE","code_information":[{"code":"Px00061110007","type":"CDM"},{"code":"70552","type":"HCPCS"}],"standard_charges":[{"gross_charge":3009.0,"discounted_cash":2256.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MRI BRAIN W/O & W/DYE","code_information":[{"code":"Px00061110015","type":"CDM"},{"code":"70553","type":"HCPCS"}],"standard_charges":[{"gross_charge":6089.0,"discounted_cash":4566.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MRI CERVICAL SPINE W/O DYE","code_information":[{"code":"Px00061210001","type":"CDM"},{"code":"72141","type":"HCPCS"}],"standard_charges":[{"gross_charge":2782.0,"discounted_cash":2086.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MRI CERVICAL SPINE W/DYE","code_information":[{"code":"Px00061210003","type":"CDM"},{"code":"72142","type":"HCPCS"}],"standard_charges":[{"gross_charge":3006.0,"discounted_cash":2254.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MRI THORACIC SPINE W/O DYE","code_information":[{"code":"Px00061210005","type":"CDM"},{"code":"72146","type":"HCPCS"}],"standard_charges":[{"gross_charge":3003.0,"discounted_cash":2252.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MRI THORACIC SPINE W/O DYE LIMITED","code_information":[{"code":"Px00061210006","type":"CDM"},{"code":"72146","type":"HCPCS"}],"standard_charges":[{"gross_charge":3003.0,"discounted_cash":2252.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MRI THORACIC SPINE W/DYE","code_information":[{"code":"Px00061210007","type":"CDM"},{"code":"72147","type":"HCPCS"}],"standard_charges":[{"gross_charge":3814.0,"discounted_cash":2860.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MRI LUMBAR SPINE W/O DYE","code_information":[{"code":"Px00061210009","type":"CDM"},{"code":"72148","type":"HCPCS"}],"standard_charges":[{"gross_charge":3034.0,"discounted_cash":2275.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MRI LUMBAR SPINE W/DYE","code_information":[{"code":"Px00061210011","type":"CDM"},{"code":"72149","type":"HCPCS"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MRI CERVICAL SPINE W/O & W/DYE","code_information":[{"code":"Px00061210013","type":"CDM"},{"code":"72156","type":"HCPCS"}],"standard_charges":[{"gross_charge":3978.0,"discounted_cash":2983.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MRI THORACIC SPINE W/O & W/DYE","code_information":[{"code":"Px00061210015","type":"CDM"},{"code":"72157","type":"HCPCS"}],"standard_charges":[{"gross_charge":3814.0,"discounted_cash":2860.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MRI LUMBAR SPINE W/O & W/DYE","code_information":[{"code":"Px00061210017","type":"CDM"},{"code":"72158","type":"HCPCS"}],"standard_charges":[{"gross_charge":4049.0,"discounted_cash":3036.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR RX COVID-19 VACCINE SINGLE DOSE (NOVAVAX) PF ADJ IM 5 MCG/0.5 ML","code_information":[{"code":"Px00063600166","type":"CDM"},{"code":"91304","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.4,"discounted_cash":222.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":296.4,"discounted_cash":222.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Base Price)"}]},{"description":"HC PR RX COV19 VAC SINGLE DOS (PFIZER) PF 6M TO 4Y TRIS-SUC IM 3 MCG/0.3 ML","code_information":[{"code":"Px00063600167","type":"CDM"},{"code":"91318","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.72,"discounted_cash":98.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":130.72,"discounted_cash":98.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Base Price)"}]},{"description":"HC PR RX COV19 VAC SGL DOSE (PFIZER) PF 5Y TO 11Y TRIS-SUC IM 10 MCG/0.3 ML","code_information":[{"code":"Px00063600168","type":"CDM"},{"code":"91319","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.56,"discounted_cash":131.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":175.56,"discounted_cash":131.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Base Price)"}]},{"description":"HC PR RX COVID-19 VACCINE SINGLE DOSE (PFIZER) PF TRIS-SUC IM 30 MCG/0.3 ML","code_information":[{"code":"Px00063600169","type":"CDM"},{"code":"91320","type":"HCPCS"}],"standard_charges":[{"gross_charge":262.2,"discounted_cash":196.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":262.2,"discounted_cash":196.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Base Price)"}]},{"description":"HC PR RX COVID-19 VAC SINGLE DOSE (MODERNA) PF 6M TO 11Y IM 25 M","code_information":[{"code":"Px00063600170","type":"CDM"},{"code":"91321","type":"HCPCS"}],"standard_charges":[{"gross_charge":291.84,"discounted_cash":218.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":291.84,"discounted_cash":218.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Base Price)"}]},{"description":"HC PR RX COVID-19 VACCINE SINGLE DOSE (MODERNA) PF IM 50 MCG/0.5 ML","code_information":[{"code":"Px00063600171","type":"CDM"},{"code":"91322","type":"HCPCS"}],"standard_charges":[{"gross_charge":291.84,"discounted_cash":218.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":291.84,"discounted_cash":218.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Base Price)"}]},{"description":"HC PR RX TDAP VACCINE 7 YRS OR OLDER IM 0.5 ML","code_information":[{"code":"Px00063610056","type":"CDM"},{"code":"90715","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":78.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR RX TRIAMCINOLONE ACETATE INJ 10 MG","code_information":[{"code":"Px00063610250","type":"CDM"},{"code":"J3301","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.96,"discounted_cash":16.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR RX CEFTRIAXONE SODIUM INJ 250 MG","code_information":[{"code":"Px00063610278","type":"CDM"},{"code":"J0696","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":12.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR RX KETOROLAC TROMETHAMINE INJ 15 MG","code_information":[{"code":"Px00063610289","type":"CDM"},{"code":"J1885","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":24.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR RX HEPB VACCINE ADULT 3 DOSE IM 1 ML","code_information":[{"code":"Px00063610299","type":"CDM"},{"code":"90746","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":55.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TRAUMA ACTIVATION PARTIAL WITH CRITICAL CARE G0390 CDM","code_information":[{"code":"Px00068210001","type":"CDM"},{"code":"G0390","type":"HCPCS"}],"standard_charges":[{"gross_charge":7196.0,"discounted_cash":5397.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TRAUMA ACTIVATION PARTIAL WO CRITICAL CARE CDM","code_information":[{"code":"Px00068210002","type":"CDM"}],"standard_charges":[{"gross_charge":3025.0,"discounted_cash":2268.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TRAUMA ACTIVATION FULL WO CRITICAL CARE CDM","code_information":[{"code":"Px00068210104","type":"CDM"}],"standard_charges":[{"gross_charge":5844.0,"discounted_cash":4383.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ED TRAUMA ACTIVATION FULL WITH CRITICAL CARE G0390 CDM","code_information":[{"code":"Px00068310001","type":"CDM"},{"code":"G0390","type":"HCPCS"}],"standard_charges":[{"gross_charge":10649.0,"discounted_cash":7986.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC RECOVERY CLASS I - 1ST HOUR","code_information":[{"code":"Px00071010109","type":"CDM"}],"standard_charges":[{"gross_charge":1043.0,"discounted_cash":782.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC RECOVERY CLASS I - ADDL 15 MIN","code_information":[{"code":"Px00071010110","type":"CDM"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":135.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC RECOVERY CLASS II - 1ST HOUR","code_information":[{"code":"Px00071010113","type":"CDM"}],"standard_charges":[{"gross_charge":1043.0,"discounted_cash":782.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC RECOVERY CLASS II - ADDL 15 MIN","code_information":[{"code":"Px00071010114","type":"CDM"}],"standard_charges":[{"gross_charge":191.0,"discounted_cash":143.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC RECOVERY CLASS III - 1ST HOUR","code_information":[{"code":"Px00071010117","type":"CDM"}],"standard_charges":[{"gross_charge":1317.0,"discounted_cash":987.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC RECOVERY CLASS III - ADDL 15 MIN","code_information":[{"code":"Px00071010118","type":"CDM"}],"standard_charges":[{"gross_charge":225.0,"discounted_cash":168.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC RECOVERY CLASS IV - 1ST HOUR","code_information":[{"code":"Px00071010120","type":"CDM"}],"standard_charges":[{"gross_charge":1317.0,"discounted_cash":987.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC RECOVERY CLASS IV - ADDL 15 MIN","code_information":[{"code":"Px00071010121","type":"CDM"}],"standard_charges":[{"gross_charge":225.0,"discounted_cash":168.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC RECOVERY CLASS V - 1ST HOUR","code_information":[{"code":"Px00071010124","type":"CDM"}],"standard_charges":[{"gross_charge":1586.0,"discounted_cash":1189.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC RECOVERY CLASS V - ADDL 15 MIN","code_information":[{"code":"Px00071010125","type":"CDM"}],"standard_charges":[{"gross_charge":295.0,"discounted_cash":221.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PACU ACUITY LVL 1 INITIAL 15","code_information":[{"code":"Px00071010131","type":"CDM"}],"standard_charges":[{"gross_charge":299.0,"discounted_cash":224.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PACU ACUITY LVL 2 INITIAL 15","code_information":[{"code":"Px00071010132","type":"CDM"}],"standard_charges":[{"gross_charge":330.0,"discounted_cash":247.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PACU ACUITY LVL 3 INITIAL 15","code_information":[{"code":"Px00071010133","type":"CDM"}],"standard_charges":[{"gross_charge":362.0,"discounted_cash":271.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PACU ACUITY LVL 4 INITIAL 15","code_information":[{"code":"Px00071010134","type":"CDM"}],"standard_charges":[{"gross_charge":390.0,"discounted_cash":292.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PACU ACUITY LVL 5 INITIAL 15","code_information":[{"code":"Px00071010135","type":"CDM"}],"standard_charges":[{"gross_charge":417.0,"discounted_cash":312.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PACU ACUITY LVL 1 PER MIN","code_information":[{"code":"Px00071010231","type":"CDM"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":15.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PACU ACUITY LVL 2 PER MIN","code_information":[{"code":"Px00071010232","type":"CDM"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":15.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PACU ACUITY LVL 3 PER MIN","code_information":[{"code":"Px00071010233","type":"CDM"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":15.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PACU ACUITY LVL 4 PER MIN","code_information":[{"code":"Px00071010234","type":"CDM"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":16.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PACU ACUITY LVL 5 PER MIN","code_information":[{"code":"Px00071010358","type":"CDM"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":16.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC VAGINAL DELIVERY LEVEL 1 CDM","code_information":[{"code":"Px00072210001","type":"CDM"}],"standard_charges":[{"gross_charge":7116.0,"discounted_cash":5337.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC VAGINAL DELIVERY LEVEL 2 CDM","code_information":[{"code":"Px00072210002","type":"CDM"}],"standard_charges":[{"gross_charge":8823.0,"discounted_cash":6617.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC VAGINAL DELIVERY LEVEL 3 CDM","code_information":[{"code":"Px00072210003","type":"CDM"}],"standard_charges":[{"gross_charge":11100.0,"discounted_cash":8325.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC VAGINAL DELIVERY LEVEL 4 CDM","code_information":[{"code":"Px00072210004","type":"CDM"}],"standard_charges":[{"gross_charge":13519.0,"discounted_cash":10139.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ECG 12 LEAD TRACING ONLY","code_information":[{"code":"Px00073010002","type":"CDM"},{"code":"93005","type":"HCPCS"}],"standard_charges":[{"gross_charge":485.0,"discounted_cash":363.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC EXTERNAL ECG REC/ GT 7 DAYS/ UP TO 15 DAYS RECORDING CDM","code_information":[{"code":"Px00073100001","type":"CDM"},{"code":"93246","type":"HCPCS"}],"standard_charges":[{"gross_charge":500.0,"discounted_cash":375.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC EXTERNAL ECG REC/ GT 7 DAYS/ UP TO 15 DAYS SCAN ANLYS W/REPORT CDM","code_information":[{"code":"Px00073100002","type":"CDM"},{"code":"93247","type":"HCPCS"}],"standard_charges":[{"gross_charge":645.0,"discounted_cash":483.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC EXTERNAL ECG REC/ GT 48 HRS/ UP TO 7DAYS RECORDING CDM","code_information":[{"code":"Px00073100003","type":"CDM"},{"code":"93242","type":"HCPCS"}],"standard_charges":[{"gross_charge":400.0,"discounted_cash":300.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC EXTERNAL ECG REC/ GT 48 HRS/ UP TO 7 DAYS ANALYSIS W/REPORT CDM","code_information":[{"code":"Px00073100004","type":"CDM"},{"code":"93243","type":"HCPCS"}],"standard_charges":[{"gross_charge":406.0,"discounted_cash":304.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HOLTER MONITOR UP TO 48 HRS","code_information":[{"code":"Px00073110001","type":"CDM"},{"code":"93225","type":"HCPCS"}],"standard_charges":[{"gross_charge":2890.0,"discounted_cash":2167.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HOLTER MONITOR ANALYSIS & REPT","code_information":[{"code":"Px00073110002","type":"CDM"},{"code":"93226","type":"HCPCS"}],"standard_charges":[{"gross_charge":1357.0,"discounted_cash":1017.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CARDIAC EVENT MONITOR SET UP","code_information":[{"code":"Px00073210001","type":"CDM"},{"code":"93270","type":"HCPCS"}],"standard_charges":[{"gross_charge":1175.0,"discounted_cash":881.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ECG/MONITORING AND ANALYSIS PT HOME ACTIVATED UP TO 30DAYS","code_information":[{"code":"Px00073210002","type":"CDM"},{"code":"93271","type":"HCPCS"}],"standard_charges":[{"gross_charge":1464.0,"discounted_cash":1098.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MULTIPLE SLEEP LATENCY TEST","code_information":[{"code":"Px00074010002","type":"CDM"},{"code":"95805","type":"HCPCS"}],"standard_charges":[{"gross_charge":3643.0,"discounted_cash":2732.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC SLEEP STUDY UNATT&RESP EFFT","code_information":[{"code":"Px00074010004","type":"CDM"},{"code":"95806","type":"HCPCS"}],"standard_charges":[{"gross_charge":810.0,"discounted_cash":607.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC POLYSOMNOGRAPHY 4 OR MORE","code_information":[{"code":"Px00074010009","type":"CDM"},{"code":"95810","type":"HCPCS"}],"standard_charges":[{"gross_charge":5734.0,"discounted_cash":4300.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC POLYSOMNOGRAM REDUCED SERVICE","code_information":[{"code":"Px00074010010","type":"CDM"},{"code":"95810","type":"HCPCS"}],"standard_charges":[{"gross_charge":4134.0,"discounted_cash":3100.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC POLYSOMNOGRAPHY W/CPAP","code_information":[{"code":"Px00074010011","type":"CDM"},{"code":"95811","type":"HCPCS"}],"standard_charges":[{"gross_charge":6670.0,"discounted_cash":5002.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC POLYSOMNOGRAPHY W/CPAP REDUCED","code_information":[{"code":"Px00074010012","type":"CDM"},{"code":"95811","type":"HCPCS"}],"standard_charges":[{"gross_charge":4806.0,"discounted_cash":3604.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC EEG EXTENDED MONITORING 61-119 MINUTES","code_information":[{"code":"Px00074010014","type":"CDM"},{"code":"95813","type":"HCPCS"}],"standard_charges":[{"gross_charge":1995.0,"discounted_cash":1496.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ELECTROENCEPHALOGRAM W/REC AWAKE&DROWSY","code_information":[{"code":"Px00074010015","type":"CDM"},{"code":"95816","type":"HCPCS"}],"standard_charges":[{"gross_charge":983.0,"discounted_cash":737.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC EEG AWAKE AND ASLEEP","code_information":[{"code":"Px00074010018","type":"CDM"},{"code":"95819","type":"HCPCS"}],"standard_charges":[{"gross_charge":2240.0,"discounted_cash":1680.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC EEG CEREBRAL DEATH ONLY","code_information":[{"code":"Px00074010022","type":"CDM"},{"code":"95824","type":"HCPCS"}],"standard_charges":[{"gross_charge":2924.0,"discounted_cash":2193.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC EEG CONT REC W/VIDEO BY TECH MIN 8 CHANNELS CDM","code_information":[{"code":"Px00074010057","type":"CDM"},{"code":"95700","type":"HCPCS"}],"standard_charges":[{"gross_charge":1328.0,"discounted_cash":996.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC EEG W/O VIDEO BY TECH 2-12 HR UNMONITORED CDM","code_information":[{"code":"Px00074010058","type":"CDM"},{"code":"95705","type":"HCPCS"}],"standard_charges":[{"gross_charge":1328.0,"discounted_cash":996.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC EEG W/O VIDEO BY TECH 2-12 HR INTERMITTENT MNTR CDM","code_information":[{"code":"Px00074010059","type":"CDM"},{"code":"95706","type":"HCPCS"}],"standard_charges":[{"gross_charge":1328.0,"discounted_cash":996.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC EEG W/O VIDEO BY TECH 2-12HR CONTINUOUS R-T MNTR CDM","code_information":[{"code":"Px00074010060","type":"CDM"},{"code":"95707","type":"HCPCS"}],"standard_charges":[{"gross_charge":1328.0,"discounted_cash":996.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC EEG W/O VID BY TECH EA INCR 12-26HR UNMONITORED CDM","code_information":[{"code":"Px00074010061","type":"CDM"},{"code":"95708","type":"HCPCS"}],"standard_charges":[{"gross_charge":2547.0,"discounted_cash":1910.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC EEG W/O VID BY TECH EA INCR 12-26 HR INTMT MNTR CDM","code_information":[{"code":"Px00074010062","type":"CDM"},{"code":"95709","type":"HCPCS"}],"standard_charges":[{"gross_charge":2547.0,"discounted_cash":1910.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC EEG W/O VID TECH EA INCR 12-26 HR CONT R-T MNTR CDM","code_information":[{"code":"Px00074010063","type":"CDM"},{"code":"95710","type":"HCPCS"}],"standard_charges":[{"gross_charge":2547.0,"discounted_cash":1910.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC VEEG BY TECH 2-12 HOURS UNMONITORED CDM","code_information":[{"code":"Px00074010064","type":"CDM"},{"code":"95711","type":"HCPCS"}],"standard_charges":[{"gross_charge":1328.0,"discounted_cash":996.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC VEEG BY TECH 2-12 HR INTERMITTENT MONITORING CDM","code_information":[{"code":"Px00074010065","type":"CDM"},{"code":"95712","type":"HCPCS"}],"standard_charges":[{"gross_charge":1328.0,"discounted_cash":996.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC VEEG BY TECH 2-12 HR CONTINUOUS R-T MONITORING CDM","code_information":[{"code":"Px00074010066","type":"CDM"},{"code":"95713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2547.0,"discounted_cash":1910.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC VEEG BY TECH EA INCR 12-26 HR UNMONITORED CDM","code_information":[{"code":"Px00074010067","type":"CDM"},{"code":"95714","type":"HCPCS"}],"standard_charges":[{"gross_charge":2547.0,"discounted_cash":1910.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC VEEG BY TECH EA INCR 12-26 HR INTERMITTENT MNTR CDM","code_information":[{"code":"Px00074010068","type":"CDM"},{"code":"95715","type":"HCPCS"}],"standard_charges":[{"gross_charge":2547.0,"discounted_cash":1910.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC VEEG BY TECH EA INCR 12-26 HR CONT R-T MNTR CDM","code_information":[{"code":"Px00074010069","type":"CDM"},{"code":"95716","type":"HCPCS"}],"standard_charges":[{"gross_charge":4767.0,"discounted_cash":3575.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HOME SLEEP TEST/TYPE 3 PORTABLE","code_information":[{"code":"Px00074010123","type":"CDM"},{"code":"G0399","type":"HCPCS"}],"standard_charges":[{"gross_charge":962.0,"discounted_cash":721.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC POLYSOMNO-CPAP/BIPAP-1 ON 1 PT","code_information":[{"code":"Px00074010126","type":"CDM"},{"code":"95811","type":"HCPCS"}],"standard_charges":[{"gross_charge":6670.0,"discounted_cash":5002.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC POLYSOMNOGRAM 1 ON 1 PT","code_information":[{"code":"Px00074010127","type":"CDM"},{"code":"95810","type":"HCPCS"}],"standard_charges":[{"gross_charge":5734.0,"discounted_cash":4300.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ENDOSCOPY/GASTROINTESTINAL PROCEDURE LEVEL 6","code_information":[{"code":"Px00075010272","type":"CDM"}],"standard_charges":[{"gross_charge":13043.0,"discounted_cash":9782.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Base Price)"}]},{"description":"HC ENDOSCOPY/GASTROINTESTINAL PROCEDURE LEVEL 1","code_information":[{"code":"Px00075010315","type":"CDM"}],"standard_charges":[{"gross_charge":4878.0,"discounted_cash":3658.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Base Price)"}]},{"description":"HC ENDOSCOPY/GASTROINTESTINAL PROCEDURE LEVEL 2","code_information":[{"code":"Px00075010316","type":"CDM"}],"standard_charges":[{"gross_charge":6405.0,"discounted_cash":4803.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Base Price)"}]},{"description":"HC ENDOSCOPY/GASTROINTESTINAL PROCEDURE LEVEL 3","code_information":[{"code":"Px00075010317","type":"CDM"}],"standard_charges":[{"gross_charge":7480.0,"discounted_cash":5610.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Base Price)"}]},{"description":"HC ENDOSCOPY/GASTROINTESTINAL PROCEDURE LEVEL 4","code_information":[{"code":"Px00075010318","type":"CDM"}],"standard_charges":[{"gross_charge":8333.0,"discounted_cash":6249.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Base Price)"}]},{"description":"HC ENDOSCOPY/GASTROINTESTINAL PROCEDURE LEVEL 5","code_information":[{"code":"Px00075010319","type":"CDM"}],"standard_charges":[{"gross_charge":11382.0,"discounted_cash":8536.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Base Price)"}]},{"description":"HC L&D TRIAGE NEW PATIENT LVL 1 CDM","code_information":[{"code":"Px00076100001","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":192.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC L&D TRIAGE NEW PATIENT LVL 2 CDM","code_information":[{"code":"Px00076100002","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":444.0,"discounted_cash":333.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC L&D TRIAGE NEW PATIENT LVL 3 CDM","code_information":[{"code":"Px00076100003","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":557.0,"discounted_cash":417.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC L&D TRIAGE NEW PATIENT LVL 4 CDM","code_information":[{"code":"Px00076100004","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":656.0,"discounted_cash":492.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC L&D TRIAGE NEW PATIENT LVL 5 CDM","code_information":[{"code":"Px00076100005","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":1053.0,"discounted_cash":789.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC NEW PT VISIT - LEVEL 3","code_information":[{"code":"Px00076110003","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":557.0,"discounted_cash":417.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC NEW PT VISIT - LEVEL 4","code_information":[{"code":"Px00076110004","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":656.0,"discounted_cash":492.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC NEW PT VISIT - LEVEL 5","code_information":[{"code":"Px00076110005","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":767.0,"discounted_cash":575.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ESTAB PT VISIT - LEVEL 1","code_information":[{"code":"Px00076110006","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":192.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"},{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD RADIATION ONCOLOGY"}]},{"description":"HC ESTAB PT VISIT - LEVEL 5","code_information":[{"code":"Px00076110021","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":996.0,"discounted_cash":747.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"},{"gross_charge":996.0,"discounted_cash":747.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD RADIATION ONCOLOGY"}]},{"description":"HC ESTAB PT VISIT - LEVEL 2","code_information":[{"code":"Px00076110039","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.0,"discounted_cash":311.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"},{"gross_charge":261.0,"discounted_cash":195.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD RADIATION ONCOLOGY"}]},{"description":"HC ESTAB PT VISIT - LEVEL 3","code_information":[{"code":"Px00076110040","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":536.0,"discounted_cash":402.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"},{"gross_charge":431.0,"discounted_cash":323.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD RADIATION ONCOLOGY"}]},{"description":"HC ESTAB PT VISIT - LEVEL 4","code_information":[{"code":"Px00076110041","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":622.0,"discounted_cash":466.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"},{"gross_charge":550.0,"discounted_cash":412.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD RADIATION ONCOLOGY"}]},{"description":"HC CAR SEAT/BED TEST INFT THRU 12 MO 60 MIN CDM","code_information":[{"code":"Px00076110233","type":"CDM"},{"code":"94780","type":"HCPCS"}],"standard_charges":[{"gross_charge":3996.0,"discounted_cash":2997.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CAR SEAT/BED TEST INFT THRU 12 MO EA ADDL 30 MIN CDM","code_information":[{"code":"Px00076110234","type":"CDM"},{"code":"94781","type":"HCPCS"}],"standard_charges":[{"gross_charge":3996.0,"discounted_cash":2997.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC REFIL/MAINT IMP PUM OR RES SPINAL/BRAIN BY RN CDM","code_information":[{"code":"Px00076110301","type":"CDM"},{"code":"95990","type":"HCPCS"}],"standard_charges":[{"gross_charge":3996.0,"discounted_cash":2997.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC SUBQ INFUSION INITIAL HR W/PUMP SET-UP CDM","code_information":[{"code":"Px00076110303","type":"CDM"},{"code":"96369","type":"HCPCS"}],"standard_charges":[{"gross_charge":761.0,"discounted_cash":570.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC REFILL MAINT PORTABLE PUMP CDM","code_information":[{"code":"Px00076110305","type":"CDM"},{"code":"96521","type":"HCPCS"}],"standard_charges":[{"gross_charge":695.0,"discounted_cash":521.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IRRIGATION IMPLANTED VAD","code_information":[{"code":"Px00076110307","type":"CDM"},{"code":"96523","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.0,"discounted_cash":173.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DEBRIDEMENT NAIL ANY METHOD 1-5 CDM","code_information":[{"code":"Px00076110453","type":"CDM"},{"code":"11720","type":"HCPCS"}],"standard_charges":[{"gross_charge":324.0,"discounted_cash":243.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DEBRIDEMENT NAIL ANY METHOD 6/GT CDM","code_information":[{"code":"Px00076110454","type":"CDM"},{"code":"11721","type":"HCPCS"}],"standard_charges":[{"gross_charge":324.0,"discounted_cash":243.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC L&D TRIAGE ESTAB PATIENT LVL 1 CDM","code_information":[{"code":"Px00076110507","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":837.0,"discounted_cash":627.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC L&D TRIAGE ESTAB PATIENT LVL 2 CDM","code_information":[{"code":"Px00076110526","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":874.0,"discounted_cash":655.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC L&D TRIAGE ESTAB PATIENT LVL 3 CDM","code_information":[{"code":"Px00076110533","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":908.0,"discounted_cash":681.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC L&D TRIAGE ESTAB PATIENT LVL 4 CDM","code_information":[{"code":"Px00076110534","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":943.0,"discounted_cash":707.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC L&D TRIAGE ESTAB PATIENT LVL 5 CDM","code_information":[{"code":"Px00076110551","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":982.0,"discounted_cash":736.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HOSPITAL OBSERVATION PER HR CDM","code_information":[{"code":"Px00076210001","type":"CDM"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":160.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DIRECT REFERRAL TO OBSERVATION CARE CDM","code_information":[{"code":"Px00076210010","type":"CDM"},{"code":"G0379","type":"HCPCS"}],"standard_charges":[{"gross_charge":2295.0,"discounted_cash":1721.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC COVID 19 IMMUNIZATION SINGLE DOSE ADMIN CDM","code_information":[{"code":"Px00077100046","type":"CDM"},{"code":"90480","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":55.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD CARDIOVASCULAR LAB (59075700)"},{"gross_charge":74.0,"discounted_cash":55.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Base Price)"}]},{"description":"HC IMMUNIZATION ADMIN CDM","code_information":[{"code":"Px00077110001","type":"CDM"},{"code":"90471","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":23.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC IMMUNIZATION ADMIN EACH ADD CDM","code_information":[{"code":"Px00077110002","type":"CDM"},{"code":"90472","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":23.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ADMIN INFLUENZA VIRUS VAC CDM","code_information":[{"code":"Px00077110003","type":"CDM"},{"code":"90471","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":23.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ADMIN PNEUMOCOCCAL VACCINE CDM","code_information":[{"code":"Px00077110004","type":"CDM"},{"code":"90471","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":23.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ADMIN HEPATITIS B VACCINE CDM","code_information":[{"code":"Px00077110005","type":"CDM"},{"code":"90471","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":23.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC THERAPEUTIC ULTRAFILTRATION CDM","code_information":[{"code":"Px00080000001","type":"CDM"},{"code":"0692T","type":"HCPCS"}],"standard_charges":[{"gross_charge":1526.0,"discounted_cash":1144.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HEMODIALYSIS IP","code_information":[{"code":"Px00080110006","type":"CDM"},{"code":"90935","type":"HCPCS"}],"standard_charges":[{"gross_charge":4150.0,"discounted_cash":3112.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DIALYSIS CRRT","code_information":[{"code":"Px00080110022","type":"CDM"},{"code":"90999","type":"HCPCS"}],"standard_charges":[{"gross_charge":3831.0,"discounted_cash":2873.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DIALYSIS CAPD IP","code_information":[{"code":"Px00080310002","type":"CDM"},{"code":"90945","type":"HCPCS"}],"standard_charges":[{"gross_charge":1668.0,"discounted_cash":1251.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DIALYSIS CCPD IP","code_information":[{"code":"Px00080410001","type":"CDM"},{"code":"90945","type":"HCPCS"}],"standard_charges":[{"gross_charge":1668.0,"discounted_cash":1251.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DIALYSIS CRRT IP","code_information":[{"code":"Px00080900001","type":"CDM"},{"code":"90945","type":"HCPCS"}],"standard_charges":[{"gross_charge":1668.0,"discounted_cash":1251.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HEMODIAL OP ER/POSTOP NON ESRD","code_information":[{"code":"Px00082900001","type":"CDM"},{"code":"90935","type":"HCPCS"}],"standard_charges":[{"gross_charge":4150.0,"discounted_cash":3112.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DIALYSIS PD OP ER/POSTOP ESRD PT","code_information":[{"code":"Px00082900002","type":"CDM"},{"code":"90945","type":"HCPCS"}],"standard_charges":[{"gross_charge":1668.0,"discounted_cash":1251.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC HEMODIAL OP ER/POSTOP ESRD","code_information":[{"code":"Px00082910001","type":"CDM"},{"code":"G0257","type":"HCPCS"}],"standard_charges":[{"gross_charge":4424.0,"discounted_cash":3318.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DIALYSIS CAPD OP","code_information":[{"code":"Px00084110001","type":"CDM"},{"code":"90945","type":"HCPCS"}],"standard_charges":[{"gross_charge":1668.0,"discounted_cash":1251.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DIALYSIS CCPD OP","code_information":[{"code":"Px00085100001","type":"CDM"},{"code":"90945","type":"HCPCS"}],"standard_charges":[{"gross_charge":1668.0,"discounted_cash":1251.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DIALYSIS CRRT OP","code_information":[{"code":"Px00088110001","type":"CDM"},{"code":"90945","type":"HCPCS"}],"standard_charges":[{"gross_charge":1668.0,"discounted_cash":1251.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC TELEH MENTAL HLTH BY HOSP EMPLYED QMP 15-29 MIN C7900 CDM","code_information":[{"code":"Px00090000064","type":"CDM"},{"code":"C7900","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":64.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC TELEH MENTAL HLTH BY HOSP EMPLYED QMP INITIAL 30-60 MIN C7901 CDM","code_information":[{"code":"Px00090000065","type":"CDM"},{"code":"C7901","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.0,"discounted_cash":163.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC TELEH MENTAL HLTH BY HOSP EMPLYED QMP EA ADDL 15 MIN C7902 CDM","code_information":[{"code":"Px00090000066","type":"CDM"},{"code":"C7902","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":64.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DEMONSTRATE USE HOME INR MON","code_information":[{"code":"Px00092010009","type":"CDM"},{"code":"G0248","type":"HCPCS"}],"standard_charges":[{"gross_charge":572.0,"discounted_cash":429.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PROVIDE INR TEST MATER/EQUIP","code_information":[{"code":"Px00092010010","type":"CDM"},{"code":"G0249","type":"HCPCS"}],"standard_charges":[{"gross_charge":3996.0,"discounted_cash":2997.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC FETAL NON-STRESS TEST CDM","code_information":[{"code":"Px00092010032","type":"CDM"},{"code":"59025","type":"HCPCS"}],"standard_charges":[{"gross_charge":1201.0,"discounted_cash":900.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC SLP STDY UNATTENDED","code_information":[{"code":"Px00092010106","type":"CDM"},{"code":"95800","type":"HCPCS"}],"standard_charges":[{"gross_charge":611.0,"discounted_cash":458.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY","code_information":[{"code":"Px00092110002","type":"CDM"},{"code":"93880","type":"HCPCS"}],"standard_charges":[{"gross_charge":1662.0,"discounted_cash":1246.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DUPLEX SCAN EXTRACRANIAL ART UNI/LMTD STUDY","code_information":[{"code":"Px00092110003","type":"CDM"},{"code":"93882","type":"HCPCS"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":903.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART LMTD","code_information":[{"code":"Px00092110005","type":"CDM"},{"code":"93888","type":"HCPCS"}],"standard_charges":[{"gross_charge":1235.0,"discounted_cash":926.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVLS","code_information":[{"code":"Px00092110008","type":"CDM"},{"code":"93923","type":"HCPCS"}],"standard_charges":[{"gross_charge":2210.0,"discounted_cash":1657.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC N-INVAS PHYSIOLOGIC STD LXTR ART COMPL BI","code_information":[{"code":"Px00092110009","type":"CDM"},{"code":"93924","type":"HCPCS"}],"standard_charges":[{"gross_charge":1252.0,"discounted_cash":939.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY","code_information":[{"code":"Px00092110010","type":"CDM"},{"code":"93925","type":"HCPCS"}],"standard_charges":[{"gross_charge":1265.0,"discounted_cash":948.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DUP-SCAN LXTR ART/ARTL BPGS UNI/LMTD STUDY","code_information":[{"code":"Px00092110011","type":"CDM"},{"code":"93926","type":"HCPCS"}],"standard_charges":[{"gross_charge":1225.0,"discounted_cash":918.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DUP-SCAN UXTR ART/ARTL BPGS COMPL BI STUDY","code_information":[{"code":"Px00092110012","type":"CDM"},{"code":"93930","type":"HCPCS"}],"standard_charges":[{"gross_charge":2306.0,"discounted_cash":1729.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STUDY","code_information":[{"code":"Px00092110013","type":"CDM"},{"code":"93931","type":"HCPCS"}],"standard_charges":[{"gross_charge":1856.0,"discounted_cash":1392.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY","code_information":[{"code":"Px00092110015","type":"CDM"},{"code":"93970","type":"HCPCS"}],"standard_charges":[{"gross_charge":1838.0,"discounted_cash":1378.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY","code_information":[{"code":"Px00092110016","type":"CDM"},{"code":"93971","type":"HCPCS"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":742.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN COM","code_information":[{"code":"Px00092110017","type":"CDM"},{"code":"93975","type":"HCPCS"}],"standard_charges":[{"gross_charge":2259.0,"discounted_cash":1694.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN LMT","code_information":[{"code":"Px00092110018","type":"CDM"},{"code":"93976","type":"HCPCS"}],"standard_charges":[{"gross_charge":1484.0,"discounted_cash":1113.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DUP-SCAN AORTA IVC ILIAC VASCL/BPGS COMPLETE","code_information":[{"code":"Px00092110019","type":"CDM"},{"code":"93978","type":"HCPCS"}],"standard_charges":[{"gross_charge":2048.0,"discounted_cash":1536.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DUP-SCAN AORTA IVC ILIAC VASCL/BPGS UNI/LMTD","code_information":[{"code":"Px00092110020","type":"CDM"},{"code":"93979","type":"HCPCS"}],"standard_charges":[{"gross_charge":1534.0,"discounted_cash":1150.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DUPLEX SCAN HEMODIALYSIS ACCESS","code_information":[{"code":"Px00092110024","type":"CDM"},{"code":"93990","type":"HCPCS"}],"standard_charges":[{"gross_charge":1229.0,"discounted_cash":921.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DUPLEX SCAN ARTL INFL&VEN O/F HEMO COMPL BI STD CDM","code_information":[{"code":"Px00092110025","type":"CDM"},{"code":"93985","type":"HCPCS"}],"standard_charges":[{"gross_charge":1036.0,"discounted_cash":777.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DUPLEX SCAN ARTL INFL&VEN O/F HEMO COMPL UNI STD CDM","code_information":[{"code":"Px00092110026","type":"CDM"},{"code":"93986","type":"HCPCS"}],"standard_charges":[{"gross_charge":499.0,"discounted_cash":374.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL","code_information":[{"code":"Px00092110028","type":"CDM"},{"code":"93922","type":"HCPCS"}],"standard_charges":[{"gross_charge":898.0,"discounted_cash":673.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PHYSICAL CAPACITY EVAL - LVL 2 (OR L&I CODE)","code_information":[{"code":"Px00094010034","type":"CDM"},{"code":"99197","type":"HCPCS"}],"standard_charges":[{"gross_charge":830.0,"discounted_cash":622.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC ACTINOTHERAPY ULTRAVIOLET LIGHT","code_information":[{"code":"Px00094010052","type":"CDM"},{"code":"96900","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.0,"discounted_cash":173.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC THER/PROPH/DIAG INJ INTRA-ARTERIAL CDM","code_information":[{"code":"Px00094010061","type":"CDM"},{"code":"96373","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.0,"discounted_cash":183.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC THERAPUTIC PHLEBOTOMY","code_information":[{"code":"Px00094010204","type":"CDM"},{"code":"99195","type":"HCPCS"}],"standard_charges":[{"gross_charge":944.0,"discounted_cash":708.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC INJ SQ OR IM CDM","code_information":[{"code":"Px00094010205","type":"CDM"},{"code":"96372","type":"HCPCS"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":151.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC INJ IV PUSH INITIAL DRUG CDM","code_information":[{"code":"Px00094010207","type":"CDM"},{"code":"96374","type":"HCPCS"}],"standard_charges":[{"gross_charge":443.0,"discounted_cash":332.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC INJ IV PUSH SEQUENTIAL NEW DRUG CDM","code_information":[{"code":"Px00094010208","type":"CDM"},{"code":"96375","type":"HCPCS"}],"standard_charges":[{"gross_charge":312.0,"discounted_cash":234.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC THER PROPH/DX NJX EA SEQL IV PUSH SBST/DRUG FAC CDM","code_information":[{"code":"Px00094010209","type":"CDM"},{"code":"96376","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":116.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MEDICAL NUTRITION INDIV INITIAL THERAPY EA 15 MIN CDM","code_information":[{"code":"Px00094210001","type":"CDM"},{"code":"97802","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":107.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MED NUTRITION INDIV SUBSEQ EA 15 MIN CDM","code_information":[{"code":"Px00094210013","type":"CDM"},{"code":"97803","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":93.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CRISIS PHONE 97802 MED NUTRITION INDIV INIT EA 15 MIN CDM","code_information":[{"code":"Px00094210014","type":"CDM"},{"code":"97802","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":107.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CRISIS PHONE 97803 MED NUTRITION INDIV SUBSEQ EA 15 MIN CDM","code_information":[{"code":"Px00094210015","type":"CDM"},{"code":"97803","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":93.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CRISIS PHONE 99211 LACTATION EDUCATION ESTAB PT VISIT  CDM","code_information":[{"code":"Px00094210017","type":"CDM"},{"code":"99211","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":87.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CRISIS PHONE 99212 LACTATION EDUCATION ESTAB PT VISIT  CDM","code_information":[{"code":"Px00094210018","type":"CDM"},{"code":"99212","type":"HCPCS"}],"standard_charges":[{"gross_charge":232.0,"discounted_cash":174.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CRISIS PHONE 99213 LACTATION EDUCATION ESTAB PT VISIT  CDM","code_information":[{"code":"Px00094210019","type":"CDM"},{"code":"99213","type":"HCPCS"}],"standard_charges":[{"gross_charge":274.0,"discounted_cash":205.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CRISIS PHONE 99214 LACTATION EDUCATION ESTAB PT VISIT  CDM","code_information":[{"code":"Px00094210020","type":"CDM"},{"code":"99214","type":"HCPCS"}],"standard_charges":[{"gross_charge":371.0,"discounted_cash":278.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CRISIS TELEH 97802 MEDICAL NUTRITION INDIV INIT THERAPY EA 15 MIN CDM","code_information":[{"code":"Px00094210044","type":"CDM"},{"code":"97802","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":107.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CRISIS TELEH 97803 MED NUTRITION INDIV SUBSEQ EA 15 MIN CDM","code_information":[{"code":"Px00094210045","type":"CDM"},{"code":"97803","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":93.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MEDICAL NUTRITION GROUP EA 30 MIN CDM","code_information":[{"code":"Px00094210049","type":"CDM"},{"code":"97804","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":45.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DIAB MANAGE TRN PER INDIV 30 MIN CDM","code_information":[{"code":"Px00094210071","type":"CDM"},{"code":"G0108","type":"HCPCS"}],"standard_charges":[{"gross_charge":196.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC DIAB MANAGE TRN GROUP 30 MIN CDM","code_information":[{"code":"Px00094210088","type":"CDM"},{"code":"G0109","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":48.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC MNT SUBS TX FOR CHANGE DX (G0270)","code_information":[{"code":"Px00094210089","type":"CDM"},{"code":"G0270","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":93.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC GROUP MNT 2 OR MORE 30 MINS","code_information":[{"code":"Px00094210090","type":"CDM"},{"code":"G0271","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":45.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC LACTATION CONSULT/LESS THAN 30 MINS","code_information":[{"code":"Px00094210100","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.0,"discounted_cash":104.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC LACTATION CONSULT 30 MIN","code_information":[{"code":"Px00094210105","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":244.0,"discounted_cash":183.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC LACTATION CONSULT 60 MIN","code_information":[{"code":"Px00094210106","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":446.0,"discounted_cash":334.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC LACTATION CONSULT 90 MIN","code_information":[{"code":"Px00094210303","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":568.0,"discounted_cash":426.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CARDIAC REHAB NON MONITOR PHASE 2","code_information":[{"code":"Px00094310001","type":"CDM"},{"code":"93797","type":"HCPCS"}],"standard_charges":[{"gross_charge":499.0,"discounted_cash":374.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC CARDIAC REHAB/MONITOR PHASE 2","code_information":[{"code":"Px00094310023","type":"CDM"},{"code":"93798","type":"HCPCS"}],"standard_charges":[{"gross_charge":499.0,"discounted_cash":374.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 11900 INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS CDM","code_information":[{"code":"Px00096300032","type":"CDM"},{"code":"11900","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.0,"discounted_cash":159.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR 51705 CHANGE CYSTOSTOMY TUBE SIMPLE","code_information":[{"code":"Px00096910238","type":"CDM"},{"code":"51705","type":"HCPCS"}],"standard_charges":[{"gross_charge":362.0,"discounted_cash":271.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR 76815 US OB LIMITED FETUS(S)","code_information":[{"code":"Px00096910319","type":"CDM"},{"code":"76815","type":"HCPCS"}],"standard_charges":[{"gross_charge":583.0,"discounted_cash":437.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR 11404 EXC TR-EXT B9+MARG 3.1-4 CM","code_information":[{"code":"Px00096910485","type":"CDM"},{"code":"11404","type":"HCPCS"}],"standard_charges":[{"gross_charge":1169.0,"discounted_cash":876.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR 11719 TRIMMING NONDYSTROPHIC NAILS ANY NUMBER","code_information":[{"code":"Px00096910497","type":"CDM"},{"code":"11719","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":39.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR 27130 TOTAL HIP ARTHROPLASTY","code_information":[{"code":"Px00096910747","type":"CDM"},{"code":"27130","type":"HCPCS"}],"standard_charges":[{"gross_charge":9137.0,"discounted_cash":6852.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR 27825 CLOSED TREAT LOWER LEG FRACTURE W/MANIP","code_information":[{"code":"Px00096910781","type":"CDM"},{"code":"27825","type":"HCPCS"}],"standard_charges":[{"gross_charge":3563.0,"discounted_cash":2672.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR 54450 PREPUTIAL STRETCHING","code_information":[{"code":"Px00096910817","type":"CDM"},{"code":"54450","type":"HCPCS"}],"standard_charges":[{"gross_charge":400.0,"discounted_cash":300.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR 55000 DRAINAGE OF HYDROCELE","code_information":[{"code":"Px00096910829","type":"CDM"},{"code":"55000","type":"HCPCS"}],"standard_charges":[{"gross_charge":593.0,"discounted_cash":444.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR 57200 REPAIR OF VAGINA, SUTURE","code_information":[{"code":"Px00096910841","type":"CDM"},{"code":"57200","type":"HCPCS"}],"standard_charges":[{"gross_charge":2375.0,"discounted_cash":1781.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR 64405 NERVE BLOCK INJ OCCIPITAL","code_information":[{"code":"Px00096910857","type":"CDM"},{"code":"64405","type":"HCPCS"}],"standard_charges":[{"gross_charge":374.0,"discounted_cash":280.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR 23040 EXPLORATORY SHOULDER SURGERY","code_information":[{"code":"Px00096911025","type":"CDM"},{"code":"23040","type":"HCPCS"}],"standard_charges":[{"gross_charge":5153.0,"discounted_cash":3864.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR 87207 SMR PRIM SRC SPEC STAIN BODIES/PARASITS CDM","code_information":[{"code":"Px00097100013","type":"CDM"},{"code":"87207","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":19.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR G0452 MOLECULAR PATHOLOGY INTERPR CDM","code_information":[{"code":"Px00097100015","type":"CDM"},{"code":"G0452","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":127.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR G0452 MOLECULAR PATHOLOGY INTERPR CDM","code_information":[{"code":"Px00097100016","type":"CDM"},{"code":"G0452","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":127.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR G0452 MOLECULAR PATHOLOGY INTERPR #","code_information":[{"code":"Px00097100017","type":"CDM"},{"code":"G0452","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":127.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR G0452 MOLECULAR PATHOLOGY INTERPR CDM","code_information":[{"code":"Px00097100018","type":"CDM"},{"code":"G0452","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":127.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR G0452 MOLECULAR PATHOLOGY INTERPR CDM","code_information":[{"code":"Px00097100019","type":"CDM"},{"code":"G0452","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":127.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR G0452 MOLECULAR PATHOLOGY INTERPR LAB","code_information":[{"code":"Px00097100020","type":"CDM"},{"code":"G0452","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":127.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR G0452 MOLECULAR PATHOLOGY INTERPR LAB","code_information":[{"code":"Px00097100021","type":"CDM"},{"code":"G0452","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":127.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR G0452 MOLECULAR PATHOLOGY INTERPR CDM","code_information":[{"code":"Px00097100022","type":"CDM"},{"code":"G0452","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":127.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR G0452 MOLECULAR PATHOLOGY INTERPR CDM","code_information":[{"code":"Px00097100023","type":"CDM"},{"code":"G0452","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":127.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR G0452 MOLECULAR PATHOLOGY INTERPR CDM","code_information":[{"code":"Px00097100024","type":"CDM"},{"code":"G0452","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":127.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR G0452 MOLECULAR PATHOLOGY INTERPR LAB","code_information":[{"code":"Px00097100025","type":"CDM"},{"code":"G0452","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":127.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR G0452 MOLECULAR PATHOLOGY INTERPR CDM","code_information":[{"code":"Px00097100026","type":"CDM"},{"code":"G0452","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":127.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR G0452 MOLECULAR PATHOLOGY INTERPR LAB","code_information":[{"code":"Px00097100027","type":"CDM"},{"code":"G0452","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":127.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR G0452 MOLECULAR PATHOLOGY INTERPR CDM","code_information":[{"code":"Px00097100028","type":"CDM"},{"code":"G0452","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":127.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR G0452 MOLECULAR PATHOLOGY INTERPR CDM","code_information":[{"code":"Px00097100029","type":"CDM"},{"code":"G0452","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":127.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR G0452 MOLECULAR PATHOLOGY INTERPR CDM","code_information":[{"code":"Px00097100030","type":"CDM"},{"code":"G0452","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":127.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR G0452 MOLECULAR PATHOLOGY INTERPR CDM","code_information":[{"code":"Px00097100031","type":"CDM"},{"code":"G0452","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":127.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR G0452 MOLECULAR PATHOLOGY INTERPR CDM","code_information":[{"code":"Px00097100032","type":"CDM"},{"code":"G0452","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":127.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR G0452 MOLECULAR PATHOLOGY INTERPR CDM","code_information":[{"code":"Px00097100033","type":"CDM"},{"code":"G0452","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":127.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR G0452 MOLECULAR PATHOLOGY INTERPR CDM","code_information":[{"code":"Px00097100034","type":"CDM"},{"code":"G0452","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":127.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR G0452 MOLECULAR PATHOLOGY INTERPR CDM","code_information":[{"code":"Px00097100035","type":"CDM"},{"code":"G0452","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":127.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR G0452 MOLECULAR PATHOLOGY INTERPR LAB","code_information":[{"code":"Px00097100036","type":"CDM"},{"code":"G0452","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":127.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR G0452 MOLECULAR PATHOLOGY INTERPR LAB","code_information":[{"code":"Px00097100037","type":"CDM"},{"code":"G0452","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":127.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR G0452 MOLECULAR PATHOLOGY INTERPR CDM","code_information":[{"code":"Px00097100038","type":"CDM"},{"code":"G0452","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":127.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR G0452 MOLECULAR PATHOLOGY INTERPR CDM","code_information":[{"code":"Px00097100039","type":"CDM"},{"code":"G0452","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":127.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR G0452 MOLECULAR PATHOLOGY INTERPR CDM","code_information":[{"code":"Px00097100040","type":"CDM"},{"code":"G0452","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":127.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 88108 CYTP CONCENTRATION SMEARS & INTERPRETATION","code_information":[{"code":"Px00097100041","type":"CDM"},{"code":"88108","type":"HCPCS"}],"standard_charges":[{"gross_charge":247.0,"discounted_cash":185.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 85060 BLOOD SMEAR INTERPRETATION #","code_information":[{"code":"Px00097100042","type":"CDM"},{"code":"85060","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 88360 M/PHMTRC ALYS TUMOR IMHCHEM EA ANTIBODY MANUAL","code_information":[{"code":"Px00097110005","type":"CDM"},{"code":"88360","type":"HCPCS"}],"standard_charges":[{"gross_charge":433.0,"discounted_cash":324.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 88141 BILL CYTO GYN W-PATH INTERP","code_information":[{"code":"Px00097110007","type":"CDM"},{"code":"88141","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":64.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 88108 BILL CYTO NON GYN CONC SMR-INT","code_information":[{"code":"Px00097110009","type":"CDM"},{"code":"88108","type":"HCPCS"}],"standard_charges":[{"gross_charge":247.0,"discounted_cash":185.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 88112 BILL CYTO NON GYN LBC-INT","code_information":[{"code":"Px00097110012","type":"CDM"},{"code":"88112","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.0,"discounted_cash":183.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 88323 BILL SURG CONSULT BLOCKS","code_information":[{"code":"Px00097110016","type":"CDM"},{"code":"88323","type":"HCPCS"}],"standard_charges":[{"gross_charge":414.0,"discounted_cash":310.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 88325 BILL SURG CONSULT REFER COMP","code_information":[{"code":"Px00097110017","type":"CDM"},{"code":"88325","type":"HCPCS"}],"standard_charges":[{"gross_charge":470.0,"discounted_cash":352.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 88321 BILL SURG CONSULT SLIDES","code_information":[{"code":"Px00097110018","type":"CDM"},{"code":"88321","type":"HCPCS"}],"standard_charges":[{"gross_charge":293.0,"discounted_cash":219.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 88311 BILL SURG DECAL","code_information":[{"code":"Px00097110019","type":"CDM"},{"code":"88311","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":54.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 88329 BILL SURG GRSS INTRAOP CONSLT","code_information":[{"code":"Px00097110025","type":"CDM"},{"code":"88329","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":93.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 88368 BILL SURG HER2NEU BY FISH","code_information":[{"code":"Px00097110026","type":"CDM"},{"code":"88368","type":"HCPCS"}],"standard_charges":[{"gross_charge":533.0,"discounted_cash":399.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 88346 BILL SURG IF","code_information":[{"code":"Px00097110027","type":"CDM"},{"code":"88346","type":"HCPCS"}],"standard_charges":[{"gross_charge":540.0,"discounted_cash":405.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR IMHISTOCHEM/CYTCHM 1ST ANTIBODY STAIN PROCEDURE #","code_information":[{"code":"Px00097110028","type":"CDM"},{"code":"88342","type":"HCPCS"}],"standard_charges":[{"gross_charge":382.0,"discounted_cash":286.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 88304 BILL SURG LEVEL 3","code_information":[{"code":"Px00097110043","type":"CDM"},{"code":"88304","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":116.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 88305 BILL SURG LEVEL 4","code_information":[{"code":"Px00097110044","type":"CDM"},{"code":"88305","type":"HCPCS"}],"standard_charges":[{"gross_charge":258.0,"discounted_cash":193.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 88312 BILL SURG STAINS GROUP 1","code_information":[{"code":"Px00097110047","type":"CDM"},{"code":"88312","type":"HCPCS"}],"standard_charges":[{"gross_charge":406.0,"discounted_cash":304.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 88313 BILL SURG STAINS GROUP 2","code_information":[{"code":"Px00097110048","type":"CDM"},{"code":"88313","type":"HCPCS"}],"standard_charges":[{"gross_charge":299.0,"discounted_cash":224.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 88187 FLOW CYTO 2-8 MARKERS","code_information":[{"code":"Px00097110053","type":"CDM"},{"code":"88187","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 88188 FLOW CYTO 9-15 MARKERS","code_information":[{"code":"Px00097110054","type":"CDM"},{"code":"88188","type":"HCPCS"}],"standard_charges":[{"gross_charge":217.0,"discounted_cash":162.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 88189 FLOW CYTO GT 16 MARKERS","code_information":[{"code":"Px00097110055","type":"CDM"},{"code":"88189","type":"HCPCS"}],"standard_charges":[{"gross_charge":294.0,"discounted_cash":220.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 88365 IN SITU HYBRIDIZATION","code_information":[{"code":"Px00097110060","type":"CDM"},{"code":"88365","type":"HCPCS"}],"standard_charges":[{"gross_charge":638.0,"discounted_cash":478.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 88291 INTERP AND REPORT (PCPNL)","code_information":[{"code":"Px00097110068","type":"CDM"},{"code":"88291","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":90.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 86077 BB ANTIBODY EVALUATION","code_information":[{"code":"Px00097110093","type":"CDM"},{"code":"86077","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":129.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 86078 TRANSFUSION REACT PATH REVIEW","code_information":[{"code":"Px00097110095","type":"CDM"},{"code":"86078","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":129.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 88173 BILL CYTO FNA INTERP","code_information":[{"code":"Px00097110098","type":"CDM"},{"code":"88173","type":"HCPCS"}],"standard_charges":[{"gross_charge":602.0,"discounted_cash":451.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 85097 BONE MARROW INTERPRETATION","code_information":[{"code":"Px00097110117","type":"CDM"},{"code":"85097","type":"HCPCS"}],"standard_charges":[{"gross_charge":169.0,"discounted_cash":126.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 85060 BLOOD SMEAR INTERPRETATION","code_information":[{"code":"Px00097110120","type":"CDM"},{"code":"85060","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 85060 BLOOD SMEAR INTERPRETATION - REVIEW","code_information":[{"code":"Px00097110121","type":"CDM"},{"code":"85060","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 88361 TUMOR IHC COMPUTER","code_information":[{"code":"Px00097110127","type":"CDM"},{"code":"88361","type":"HCPCS"}],"standard_charges":[{"gross_charge":430.0,"discounted_cash":322.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 88368 M/PHMTRC ALYS IN SITU HYBRIDIZATION EA PROBE MNL","code_information":[{"code":"Px00097110136","type":"CDM"},{"code":"88368","type":"HCPCS"}],"standard_charges":[{"gross_charge":533.0,"discounted_cash":399.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 88341 IMMUNOHISTO ANTIBODY SLIDE EA ADDL","code_information":[{"code":"Px00097110163","type":"CDM"},{"code":"88341","type":"HCPCS"}],"standard_charges":[{"gross_charge":326.0,"discounted_cash":244.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 88344 IMMUNOHISTO ANTIBODY SLIDE EA MULTIPLEX","code_information":[{"code":"Px00097110164","type":"CDM"},{"code":"88344","type":"HCPCS"}],"standard_charges":[{"gross_charge":623.0,"discounted_cash":467.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 88364 INSITU HYBRIDIZATION (FISH) EACH ADDL","code_information":[{"code":"Px00097110165","type":"CDM"},{"code":"88364","type":"HCPCS"}],"standard_charges":[{"gross_charge":480.0,"discounted_cash":360.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 88366 INSITU HYBRIDIZATION (FISH) EA MULTIPLEX","code_information":[{"code":"Px00097110166","type":"CDM"},{"code":"88366","type":"HCPCS"}],"standard_charges":[{"gross_charge":978.0,"discounted_cash":733.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 88369 M/PHMTRC ALYSISHQUANT/SEMIQ MANUAL","code_information":[{"code":"Px00097110167","type":"CDM"},{"code":"88369","type":"HCPCS"}],"standard_charges":[{"gross_charge":462.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 88374 M/PHMTRC ALYS ISHQUANT/SEMIQ COMPUTER EA MULTIPLEX","code_information":[{"code":"Px00097110169","type":"CDM"},{"code":"88374","type":"HCPCS"}],"standard_charges":[{"gross_charge":1036.0,"discounted_cash":777.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 88377 M/PHMTRC ALYS ISHQUANT/SEMIQ MANUAL EA MULTIPLEX","code_information":[{"code":"Px00097110170","type":"CDM"},{"code":"88377","type":"HCPCS"}],"standard_charges":[{"gross_charge":1423.0,"discounted_cash":1067.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 84165 PROTEIN E-PHORESIS SERUM","code_information":[{"code":"Px00097110173","type":"CDM"},{"code":"84165","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":40.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 84166 PROTEIN E-PHORESIS/URINE/CSF","code_information":[{"code":"Px00097110174","type":"CDM"},{"code":"84166","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":40.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 86334 IMMUNOFIX E-PHORESIS SERUM","code_information":[{"code":"Px00097110175","type":"CDM"},{"code":"86334","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":40.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 86335 IMMUNFIX E-PHORSIS/URINE/CSF","code_information":[{"code":"Px00097110176","type":"CDM"},{"code":"86335","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":40.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR G0452 MOLECULAR PATHOLOGY INTERP","code_information":[{"code":"Px00097110198","type":"CDM"},{"code":"G0452","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.0,"discounted_cash":132.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 88350 IMMUNOFLUORESCENCE PER SPEC ADD SINGL ANTB STAIN","code_information":[{"code":"Px00097110210","type":"CDM"},{"code":"88350","type":"HCPCS"}],"standard_charges":[{"gross_charge":410.0,"discounted_cash":307.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 88305 TISSUE EXAM BY PATHOLOGIST","code_information":[{"code":"Px00097110230","type":"CDM"},{"code":"88305","type":"HCPCS"}],"standard_charges":[{"gross_charge":258.0,"discounted_cash":193.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 76857 US EXAM PELVIC LIMITED","code_information":[{"code":"Px00097210012","type":"CDM"},{"code":"76857","type":"HCPCS"}],"standard_charges":[{"gross_charge":347.0,"discounted_cash":260.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR 49525 RPR INGUN HERNIA SLIDING ANY AGE CDM","code_information":[{"code":"Px00097500404","type":"CDM"},{"code":"49525","type":"HCPCS"}],"standard_charges":[{"gross_charge":2169.0,"discounted_cash":1626.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 97597 DEBRIDEMENT OPEN WOUND FIRST 20 SQ CM/OR LESS","code_information":[{"code":"Px00097510016","type":"CDM"},{"code":"97597","type":"HCPCS"}],"standard_charges":[{"gross_charge":250.0,"discounted_cash":187.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR11400 EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM/OR LESS","code_information":[{"code":"Px00097510066","type":"CDM"},{"code":"11400","type":"HCPCS"}],"standard_charges":[{"gross_charge":597.0,"discounted_cash":447.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR 11982 REMOVE DRUG IMPLANT DEVICE","code_information":[{"code":"Px00097510098","type":"CDM"},{"code":"11982","type":"HCPCS"}],"standard_charges":[{"gross_charge":524.0,"discounted_cash":393.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR 54235 NJX C/P/A CAVERNOSA W/PHARMACOLOGIC AGT","code_information":[{"code":"Px00097510108","type":"CDM"},{"code":"54235","type":"HCPCS"}],"standard_charges":[{"gross_charge":521.0,"discounted_cash":390.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR 35207 REPAIR BLOOD VESSEL LESION, HAND/FINGER","code_information":[{"code":"Px00097510199","type":"CDM"},{"code":"35207","type":"HCPCS"}],"standard_charges":[{"gross_charge":5405.0,"discounted_cash":4053.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR 42815 EXCISION OF NECK CYST FISTULA","code_information":[{"code":"Px00097511163","type":"CDM"},{"code":"42815","type":"HCPCS"}],"standard_charges":[{"gross_charge":2020.0,"discounted_cash":1515.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 43762 PERQ REPLACEMENT GTUBE NOT REQ REVJ GSTRST TRC","code_information":[{"code":"Px00097511246","type":"CDM"},{"code":"43762","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":194.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR 43763 PERQ REPLACEMENT GTUBE REQ REVJ GSTRST TRC","code_information":[{"code":"Px00097511247","type":"CDM"},{"code":"43763","type":"HCPCS"}],"standard_charges":[{"gross_charge":616.0,"discounted_cash":462.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR 11102 TANGENTIAL BIOPSY SKIN SINGLE LESION","code_information":[{"code":"Px00097511282","type":"CDM"},{"code":"11102","type":"HCPCS"}],"standard_charges":[{"gross_charge":267.0,"discounted_cash":200.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR 11103 TANGENTIAL BIOPSY SKIN EA SEP/ADDITIONAL LESION","code_information":[{"code":"Px00097511283","type":"CDM"},{"code":"11103","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":114.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR 54235 NJX C/P/A CAVERNOSA W/PHARMACOLOGIC AGT CDM","code_information":[{"code":"Px00097513907","type":"CDM"},{"code":"54235","type":"HCPCS"}],"standard_charges":[{"gross_charge":521.0,"discounted_cash":390.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR 94010 SPIROMETRY","code_information":[{"code":"Px00097610016","type":"CDM"},{"code":"94010","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":97.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR ED 54235 NJX C/P/A CAVERNOSA W/PHARMACOLOGIC AGT CDM","code_information":[{"code":"Px00098100070","type":"CDM"},{"code":"54235","type":"HCPCS"}],"standard_charges":[{"gross_charge":521.0,"discounted_cash":390.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 54450 PREPUTIAL STRETCHING CDM","code_information":[{"code":"Px00098100071","type":"CDM"},{"code":"54450","type":"HCPCS"}],"standard_charges":[{"gross_charge":402.0,"discounted_cash":301.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 15853 REMOVAL SUTURES/STAPLES NOT REQUIRING ANESTHESIA CDM","code_information":[{"code":"Px00098100097","type":"CDM"},{"code":"15853","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.0,"discounted_cash":60.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 15854 REMOVAL SUTURES&STAPLES NOT REQUIRING ANESTHESIA CDM","code_information":[{"code":"Px00098100098","type":"CDM"},{"code":"15854","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":85.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 76642 ULTRASOUND UNI BREAST LIMITED CDM","code_information":[{"code":"Px00098100107","type":"CDM"},{"code":"76642","type":"HCPCS"}],"standard_charges":[{"gross_charge":607.0,"discounted_cash":455.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 99408 ALCOHOL/DRUG SCREEN 15-30 MIN CDM","code_information":[{"code":"Px00098110003","type":"CDM"},{"code":"99408","type":"HCPCS"}],"standard_charges":[{"gross_charge":224.0,"discounted_cash":168.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 99409 ALCOHOL/DRUG SCREEN > 30 MIN CDM","code_information":[{"code":"Px00098110005","type":"CDM"},{"code":"99409","type":"HCPCS"}],"standard_charges":[{"gross_charge":447.0,"discounted_cash":335.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 99283 VISIT LOW MDM CDM","code_information":[{"code":"Px00098110009","type":"CDM"},{"code":"99283","type":"HCPCS"}],"standard_charges":[{"gross_charge":507.0,"discounted_cash":380.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 99284 VISIT MODERATE MDM CDM","code_information":[{"code":"Px00098110012","type":"CDM"},{"code":"99284","type":"HCPCS"}],"standard_charges":[{"gross_charge":852.0,"discounted_cash":639.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 99285 VISIT HIGH MDM CDM","code_information":[{"code":"Px00098110016","type":"CDM"},{"code":"99285","type":"HCPCS"}],"standard_charges":[{"gross_charge":1240.0,"discounted_cash":930.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 92511 NASPHARYNGOSCOPY CDM","code_information":[{"code":"Px00098110018","type":"CDM"},{"code":"92511","type":"HCPCS"}],"standard_charges":[{"gross_charge":267.0,"discounted_cash":200.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 99291 CRITICAL CARE FIRST HOUR CDM","code_information":[{"code":"Px00098110021","type":"CDM"},{"code":"99291","type":"HCPCS"}],"standard_charges":[{"gross_charge":1502.0,"discounted_cash":1126.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 99292 CRITICAL CARE ADDL 30 MIN CDM","code_information":[{"code":"Px00098110023","type":"CDM"},{"code":"99292","type":"HCPCS"}],"standard_charges":[{"gross_charge":754.0,"discounted_cash":565.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 33016 PERICARDIOCENTESIS W/IMG GUIDANCE WHEN PERFORMED CDM","code_information":[{"code":"Px00098110030","type":"CDM"},{"code":"33016","type":"HCPCS"}],"standard_charges":[{"gross_charge":1633.0,"discounted_cash":1224.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 33017 PERQ PRCRD DRG GTE 6YR W/O CONGENITAL CAR ANOMALY CDM","code_information":[{"code":"Px00098110031","type":"CDM"},{"code":"33017","type":"HCPCS"}],"standard_charges":[{"gross_charge":1714.0,"discounted_cash":1285.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 33018 PERQ PRCRD DRG 0-5YR/ANY AGE W/CGEN CAR ANOMALY CDM","code_information":[{"code":"Px00098110032","type":"CDM"},{"code":"33018","type":"HCPCS"}],"standard_charges":[{"gross_charge":2011.0,"discounted_cash":1508.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 33019 PERQ PERICARDIAL DRG W/INSJ NDWELLG CATH W/CT CDM","code_information":[{"code":"Px00098110033","type":"CDM"},{"code":"33019","type":"HCPCS"}],"standard_charges":[{"gross_charge":1478.0,"discounted_cash":1108.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 64999 NERVE BLOCK INJ FACIAL CDM","code_information":[{"code":"Px00098110034","type":"CDM"},{"code":"64999","type":"HCPCS"}],"standard_charges":[{"gross_charge":918.0,"discounted_cash":688.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 20560 NEEDLE INSERTION WO INJECTION 1 OR 2 MUSCLES CDM","code_information":[{"code":"Px00098110035","type":"CDM"},{"code":"20560","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":78.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 20561 NEEDLE INSERTION WO INJECTION 3 OR MORE MUSCLES CDM","code_information":[{"code":"Px00098110036","type":"CDM"},{"code":"20561","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":117.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 92532 POSITIONAL NYSTAGMUS TEST CDM","code_information":[{"code":"Px00098110054","type":"CDM"},{"code":"92532","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.0,"discounted_cash":134.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 42999 THROAT SURGERY PROCEDURE CDM","code_information":[{"code":"Px00098110089","type":"CDM"},{"code":"42999","type":"HCPCS"}],"standard_charges":[{"gross_charge":650.0,"discounted_cash":487.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 51705 CHANGE OF BLADDER TUBE, SIMPLE CDM","code_information":[{"code":"Px00098110091","type":"CDM"},{"code":"51705","type":"HCPCS"}],"standard_charges":[{"gross_charge":367.0,"discounted_cash":275.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 92953 TEMP TRANSCUTANEOUS EXT PACING CDM","code_information":[{"code":"Px00098110101","type":"CDM"},{"code":"92953","type":"HCPCS"}],"standard_charges":[{"gross_charge":7.0,"discounted_cash":5.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 92960 CARDIOVERSION ELECTIVE EXTERNAL CDM","code_information":[{"code":"Px00098110102","type":"CDM"},{"code":"92960","type":"HCPCS"}],"standard_charges":[{"gross_charge":759.0,"discounted_cash":569.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 92971 CARDIOASSIST EXTERNAL CDM","code_information":[{"code":"Px00098110103","type":"CDM"},{"code":"92971","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.0,"discounted_cash":522.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 95992 CANALITH REPOSITIONING PROCEDURE CDM","code_information":[{"code":"Px00098110112","type":"CDM"},{"code":"95992","type":"HCPCS"}],"standard_charges":[{"gross_charge":255.0,"discounted_cash":191.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 76775 US EXAM ABDO BACK WALL LIM CDM","code_information":[{"code":"Px00098110122","type":"CDM"},{"code":"76775","type":"HCPCS"}],"standard_charges":[{"gross_charge":421.0,"discounted_cash":315.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 76882 US LMTD JT/FCL EVAL NONVASC XTR STRUX R-T W/IMG CDM","code_information":[{"code":"Px00098110123","type":"CDM"},{"code":"76882","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":225.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 27197 CLOSED TX PELVIC RING FX W/O MANIP CDM","code_information":[{"code":"Px00098110141","type":"CDM"},{"code":"27197","type":"HCPCS"}],"standard_charges":[{"gross_charge":957.0,"discounted_cash":717.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 27198 CLOSED TX PELVIC RING FX W/MANIP CDM","code_information":[{"code":"Px00098110142","type":"CDM"},{"code":"27198","type":"HCPCS"}],"standard_charges":[{"gross_charge":2247.0,"discounted_cash":1685.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 76706 US ABD AORTA SCRN AAA CDM","code_information":[{"code":"Px00098110143","type":"CDM"},{"code":"76706","type":"HCPCS"}],"standard_charges":[{"gross_charge":764.0,"discounted_cash":573.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 99151 MOD SED SAME PHYS/QHP INITIAL 15 MINS/YOUNGER THAN 5YRS CDM","code_information":[{"code":"Px00098110144","type":"CDM"},{"code":"99151","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.0,"discounted_cash":128.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 99152 MOD SED SAME PHYS/QHP 5/>YRS 1ST 15 MIN CDM","code_information":[{"code":"Px00098110145","type":"CDM"},{"code":"99152","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":66.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 99153 MOD SED SAME PHYS/QHP EA ADDL 15 MIN CDM","code_information":[{"code":"Px00098110146","type":"CDM"},{"code":"99153","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":59.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 99155 MOD SED OTHER PHYS/QHP INITIAL 15 MINS/YOUNGER THAN 5YRS CDM","code_information":[{"code":"Px00098110147","type":"CDM"},{"code":"99155","type":"HCPCS"}],"standard_charges":[{"gross_charge":581.0,"discounted_cash":435.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 99157 MOD SED OTHER PHYS/QHP EA ADDL 15 MIN CDM","code_information":[{"code":"Px00098110148","type":"CDM"},{"code":"99157","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.0,"discounted_cash":327.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 99156 MOD SED OTH PHYS/QHP 5/>YRS 1ST 15 MIN CDM","code_information":[{"code":"Px00098110149","type":"CDM"},{"code":"99156","type":"HCPCS"}],"standard_charges":[{"gross_charge":533.0,"discounted_cash":399.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 54700 DRAINAGE OF SCROTUM CDM","code_information":[{"code":"Px00098110150","type":"CDM"},{"code":"54700","type":"HCPCS"}],"standard_charges":[{"gross_charge":1526.0,"discounted_cash":1144.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 76604 US EXAM CHEST CDM","code_information":[{"code":"Px00098110151","type":"CDM"},{"code":"76604","type":"HCPCS"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":303.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 64405 NERVE BLOCK INJ OCCIPITAL CDM","code_information":[{"code":"Px00098110155","type":"CDM"},{"code":"64405","type":"HCPCS"}],"standard_charges":[{"gross_charge":374.0,"discounted_cash":280.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 97597 DEBRIDEMENT OPEN WOUND FIRST 20 SQ CM/OR LESS","code_information":[{"code":"Px00098110157","type":"CDM"},{"code":"97597","type":"HCPCS"}],"standard_charges":[{"gross_charge":250.0,"discounted_cash":187.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 36555 INSJ NON-TUNNELED CENTRAL VENOUS CATH/YOUNGER THAN 5 YRS CDM","code_information":[{"code":"Px00098110224","type":"CDM"},{"code":"36555","type":"HCPCS"}],"standard_charges":[{"gross_charge":593.0,"discounted_cash":444.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 36680 INSERT NEEDLE BONE CAVITY CDM","code_information":[{"code":"Px00098110226","type":"CDM"},{"code":"36680","type":"HCPCS"}],"standard_charges":[{"gross_charge":419.0,"discounted_cash":314.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 10060 DRAINAGE OF SKIN ABSCESS SIMPLE OR SINGLE CDM","code_information":[{"code":"Px00098110229","type":"CDM"},{"code":"10060","type":"HCPCS"}],"standard_charges":[{"gross_charge":747.0,"discounted_cash":560.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 10061 DRAINAGE OF SKIN ABSCESS COMPLICATED OR MULTIPLE CDM","code_information":[{"code":"Px00098110231","type":"CDM"},{"code":"10061","type":"HCPCS"}],"standard_charges":[{"gross_charge":1302.0,"discounted_cash":976.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 10080 DRAINAGE OF PILONIDAL CYST SIMPLE CDM","code_information":[{"code":"Px00098110232","type":"CDM"},{"code":"10080","type":"HCPCS"}],"standard_charges":[{"gross_charge":743.0,"discounted_cash":557.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 10081 DRAINAGE OF PILONIDAL CYST COMPLICATED CDM","code_information":[{"code":"Px00098110233","type":"CDM"},{"code":"10081","type":"HCPCS"}],"standard_charges":[{"gross_charge":1214.0,"discounted_cash":910.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 10120 REMOVE FOREIGN BODY SIMPLE CDM","code_information":[{"code":"Px00098110234","type":"CDM"},{"code":"10120","type":"HCPCS"}],"standard_charges":[{"gross_charge":747.0,"discounted_cash":560.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 10121 REMOVE FOREIGN BODY COMPLICATED CDM","code_information":[{"code":"Px00098110235","type":"CDM"},{"code":"10121","type":"HCPCS"}],"standard_charges":[{"gross_charge":1302.0,"discounted_cash":976.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 10140 DRAINAGE OF HEMATOMA/FLUID CDM","code_information":[{"code":"Px00098110236","type":"CDM"},{"code":"10140","type":"HCPCS"}],"standard_charges":[{"gross_charge":835.0,"discounted_cash":626.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 10160 PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST CDM","code_information":[{"code":"Px00098110238","type":"CDM"},{"code":"10160","type":"HCPCS"}],"standard_charges":[{"gross_charge":685.0,"discounted_cash":513.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 10180 COMPLEX DRAINAGE WOUND CDM","code_information":[{"code":"Px00098110239","type":"CDM"},{"code":"10180","type":"HCPCS"}],"standard_charges":[{"gross_charge":1271.0,"discounted_cash":953.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 11000 DEBRIDE INFECTED SKIN CDM","code_information":[{"code":"Px00098110240","type":"CDM"},{"code":"11000","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.0,"discounted_cash":142.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 11042 DEB SUBQ TISSUE FIRST 20 SQ CM OR LESS CDM","code_information":[{"code":"Px00098110242","type":"CDM"},{"code":"11042","type":"HCPCS"}],"standard_charges":[{"gross_charge":421.0,"discounted_cash":315.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 11044 DEBRIDEMENT BONE 1ST 20 SQ CM/OR LESS CDM","code_information":[{"code":"Px00098110244","type":"CDM"},{"code":"11044","type":"HCPCS"}],"standard_charges":[{"gross_charge":1587.0,"discounted_cash":1190.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 11401 EXC TR-EXT B9+MARG 0.6-1 CM CDM","code_information":[{"code":"Px00098110249","type":"CDM"},{"code":"11401","type":"HCPCS"}],"standard_charges":[{"gross_charge":754.0,"discounted_cash":565.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 11720 DEBRIDE NAIL 1-5 CDM","code_information":[{"code":"Px00098110250","type":"CDM"},{"code":"11720","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":76.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 11730 REMOVAL OF NAIL PLATE CDM","code_information":[{"code":"Px00098110251","type":"CDM"},{"code":"11730","type":"HCPCS"}],"standard_charges":[{"gross_charge":378.0,"discounted_cash":283.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 11740 DRAIN BLOOD FROM UNDER NAIL CDM","code_information":[{"code":"Px00098110253","type":"CDM"},{"code":"11740","type":"HCPCS"}],"standard_charges":[{"gross_charge":226.0,"discounted_cash":169.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 11750 REMOVAL OF NAIL BED CDM","code_information":[{"code":"Px00098110254","type":"CDM"},{"code":"11750","type":"HCPCS"}],"standard_charges":[{"gross_charge":712.0,"discounted_cash":534.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 11760 REPAIR OF NAIL BED CDM","code_information":[{"code":"Px00098110256","type":"CDM"},{"code":"11760","type":"HCPCS"}],"standard_charges":[{"gross_charge":783.0,"discounted_cash":587.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 11762 RECONSTRUCTION OF NAIL BED CDM","code_information":[{"code":"Px00098110257","type":"CDM"},{"code":"11762","type":"HCPCS"}],"standard_charges":[{"gross_charge":1321.0,"discounted_cash":990.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 11765 EXCISION OF NAIL FOLD TOE CDM","code_information":[{"code":"Px00098110258","type":"CDM"},{"code":"11765","type":"HCPCS"}],"standard_charges":[{"gross_charge":652.0,"discounted_cash":489.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 12001 SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/OR LESS CDM","code_information":[{"code":"Px00098110259","type":"CDM"},{"code":"12001","type":"HCPCS"}],"standard_charges":[{"gross_charge":319.0,"discounted_cash":239.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 12002 REPAIR SUPERFIC WOUND(S) 2.6 TO 7.5CM SLP NK AX EXGEN T CDM","code_information":[{"code":"Px00098110260","type":"CDM"},{"code":"12002","type":"HCPCS"}],"standard_charges":[{"gross_charge":417.0,"discounted_cash":312.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 12004 REPAIR SUPERFIC WOUND(S)7.6 TO 12.5CM SLP NK AX EXGEN T CDM","code_information":[{"code":"Px00098110261","type":"CDM"},{"code":"12004","type":"HCPCS"}],"standard_charges":[{"gross_charge":516.0,"discounted_cash":387.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 12005 REPAIR SUPERFIC WOUND(S)12.6 TO 20.0CM SLP NK AX EXGEN CDM","code_information":[{"code":"Px00098110262","type":"CDM"},{"code":"12005","type":"HCPCS"}],"standard_charges":[{"gross_charge":669.0,"discounted_cash":501.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 12006 REPAIR SUPERFIC WOUND(S) 20.1-30.0CM SLP NK AX EXGEN TR CDM","code_information":[{"code":"Px00098110263","type":"CDM"},{"code":"12006","type":"HCPCS"}],"standard_charges":[{"gross_charge":823.0,"discounted_cash":617.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 12007 REPAIR SUPERFIC WOUND(S) >30CM SLP NK AX EXGEN TRNK EXT CDM","code_information":[{"code":"Px00098110264","type":"CDM"},{"code":"12007","type":"HCPCS"}],"standard_charges":[{"gross_charge":1023.0,"discounted_cash":767.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 12011 SIMPLE REPAIR F/E/E/N/L/M 2.5CM/OR LESS CDM","code_information":[{"code":"Px00098110265","type":"CDM"},{"code":"12011","type":"HCPCS"}],"standard_charges":[{"gross_charge":390.0,"discounted_cash":292.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 12013 REPAIR SUPERFIC WOUND(S) 2.6 TO 5.0CM FACE ERS EYLD NSE CDM","code_information":[{"code":"Px00098110266","type":"CDM"},{"code":"12013","type":"HCPCS"}],"standard_charges":[{"gross_charge":414.0,"discounted_cash":310.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 12014 REPAIR SUPERFIC WOUND(S) 5.1 TO 7.5CM FACE ERS EYLD NSE CDM","code_information":[{"code":"Px00098110267","type":"CDM"},{"code":"12014","type":"HCPCS"}],"standard_charges":[{"gross_charge":528.0,"discounted_cash":396.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 12015 REPAIR SUPERFIC WOUND(S) 7.6 TO 12.5CM FACE ERS EYLD NS CDM","code_information":[{"code":"Px00098110268","type":"CDM"},{"code":"12015","type":"HCPCS"}],"standard_charges":[{"gross_charge":666.0,"discounted_cash":499.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 12016 REPAIR SUPERFIC WOUND(S) 12.6 TO 20.0CM FACE ERS EYLD N CDM","code_information":[{"code":"Px00098110269","type":"CDM"},{"code":"12016","type":"HCPCS"}],"standard_charges":[{"gross_charge":904.0,"discounted_cash":678.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 12017 REPAIR SUPERFIC WOUND(S) 20.1 TO 30.0CM FACE ERS EYLD N CDM","code_information":[{"code":"Px00098110270","type":"CDM"},{"code":"12017","type":"HCPCS"}],"standard_charges":[{"gross_charge":1088.0,"discounted_cash":816.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 12018 REPAIR SUPERFIC WOUND(S) >30.0 CM FACE ERS EYLD NSE LP CDM","code_information":[{"code":"Px00098110271","type":"CDM"},{"code":"12018","type":"HCPCS"}],"standard_charges":[{"gross_charge":1228.0,"discounted_cash":921.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 12020 CLOSURE OF SPLIT WOUND SIMPLE CLOSURE CDM","code_information":[{"code":"Px00098110272","type":"CDM"},{"code":"12020","type":"HCPCS"}],"standard_charges":[{"gross_charge":1338.0,"discounted_cash":1003.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 12021 CLOSURE OF SPLIT WOUND W/PACKNG CDM","code_information":[{"code":"Px00098110273","type":"CDM"},{"code":"12021","type":"HCPCS"}],"standard_charges":[{"gross_charge":1002.0,"discounted_cash":751.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 12031 INTMD WND REPAIR S/TR/EXT UP TO 2.5CM CDM","code_information":[{"code":"Px00098110274","type":"CDM"},{"code":"12031","type":"HCPCS"}],"standard_charges":[{"gross_charge":1073.0,"discounted_cash":804.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 12032 INTMD WND REPAIR S/TR/EXT 2.6 TO 7.5CM CDM","code_information":[{"code":"Px00098110275","type":"CDM"},{"code":"12032","type":"HCPCS"}],"standard_charges":[{"gross_charge":1342.0,"discounted_cash":1006.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 12034 INTMD WND REPAIR S/TR/EXT 7.6 TO 12.5CM CDM","code_information":[{"code":"Px00098110276","type":"CDM"},{"code":"12034","type":"HCPCS"}],"standard_charges":[{"gross_charge":1452.0,"discounted_cash":1089.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 12035 INTMD WND REPAIR S/TR/EXT 12.6 TO 20.0CM CDM","code_information":[{"code":"Px00098110277","type":"CDM"},{"code":"12035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1709.0,"discounted_cash":1281.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 12036 INTMD WND REPAIR S/TR/EXT 20.1 TO 30.0CM CDM","code_information":[{"code":"Px00098110278","type":"CDM"},{"code":"12036","type":"HCPCS"}],"standard_charges":[{"gross_charge":1994.0,"discounted_cash":1495.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 12037 INTMD WND REPAIR S/TR/EXT > 30 CM. CDM","code_information":[{"code":"Px00098110279","type":"CDM"},{"code":"12037","type":"HCPCS"}],"standard_charges":[{"gross_charge":2318.0,"discounted_cash":1738.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 12041 INTMD WND REPAIR N-HF/GENIT UP TO 2.5CM CDM","code_information":[{"code":"Px00098110280","type":"CDM"},{"code":"12041","type":"HCPCS"}],"standard_charges":[{"gross_charge":1026.0,"discounted_cash":769.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 12042 INTMD WND REPAIR N-HG/GENIT 2.6 TO 7.5CM CDM","code_information":[{"code":"Px00098110281","type":"CDM"},{"code":"12042","type":"HCPCS"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":1035.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 12044 INTMD WND REPAIR N-HG/GENIT 7.6 TO 12.5CM CDM","code_information":[{"code":"Px00098110282","type":"CDM"},{"code":"12044","type":"HCPCS"}],"standard_charges":[{"gross_charge":1511.0,"discounted_cash":1133.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 12045 INTMD WND REPAIR N-HG/GENIT 12.6 TO 20.0CM CDM","code_information":[{"code":"Px00098110284","type":"CDM"},{"code":"12045","type":"HCPCS"}],"standard_charges":[{"gross_charge":1949.0,"discounted_cash":1461.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 12046 INTMD WND REPAIR N-HG/GENIT 20.1-30.0CM CDM","code_information":[{"code":"Px00098110285","type":"CDM"},{"code":"12046","type":"HCPCS"}],"standard_charges":[{"gross_charge":2259.0,"discounted_cash":1694.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 12047 INTMD WND REPAIR N-HG/GENIT >30.0CM CDM","code_information":[{"code":"Px00098110286","type":"CDM"},{"code":"12047","type":"HCPCS"}],"standard_charges":[{"gross_charge":2511.0,"discounted_cash":1883.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 12051 REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/OR LESS CDM","code_information":[{"code":"Px00098110287","type":"CDM"},{"code":"12051","type":"HCPCS"}],"standard_charges":[{"gross_charge":1200.0,"discounted_cash":900.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 12052 INTMD WND REPAIR FACE/MM 2.6 TO 5.0CM CDM","code_information":[{"code":"Px00098110288","type":"CDM"},{"code":"12052","type":"HCPCS"}],"standard_charges":[{"gross_charge":1411.0,"discounted_cash":1058.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 12053 INTMD WND REPAIR FACE/MM 5.1 TO 7.5CM CDM","code_information":[{"code":"Px00098110289","type":"CDM"},{"code":"12053","type":"HCPCS"}],"standard_charges":[{"gross_charge":1523.0,"discounted_cash":1142.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 12054 INTMD WND REPAIR FACE/MM 7.5 TO 12.5CM CDM","code_information":[{"code":"Px00098110290","type":"CDM"},{"code":"12054","type":"HCPCS"}],"standard_charges":[{"gross_charge":1557.0,"discounted_cash":1167.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 12055 INTMD WND REPAIR FACE/MM 12.6 TO 20.0CM CDM","code_information":[{"code":"Px00098110291","type":"CDM"},{"code":"12055","type":"HCPCS"}],"standard_charges":[{"gross_charge":2128.0,"discounted_cash":1596.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 12057 INTMD WND REPAIR FACE/MM >30CM CDM","code_information":[{"code":"Px00098110293","type":"CDM"},{"code":"12057","type":"HCPCS"}],"standard_charges":[{"gross_charge":2975.0,"discounted_cash":2231.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 13100 REPAIR OF WOUND OR LESION 1.1 TO 2.5CM COMPLEX, TRUNK CDM","code_information":[{"code":"Px00098110294","type":"CDM"},{"code":"13100","type":"HCPCS"}],"standard_charges":[{"gross_charge":1416.0,"discounted_cash":1062.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 13101 REPAIR OF WOUND OR LESION 2.6 TO 7.5CM COMPLEX, TRUNK CDM","code_information":[{"code":"Px00098110295","type":"CDM"},{"code":"13101","type":"HCPCS"}],"standard_charges":[{"gross_charge":1747.0,"discounted_cash":1310.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 13102 REPAIR WOUND/LESION ADD-ON EA ADD 5CM COMPLEX, TRUNK CDM","code_information":[{"code":"Px00098110296","type":"CDM"},{"code":"13102","type":"HCPCS"}],"standard_charges":[{"gross_charge":505.0,"discounted_cash":378.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 13120 REPAIR OF WOUND OR LESION 1.1 TO 2.5CM CPLX SCLP ARM L CDM","code_information":[{"code":"Px00098110297","type":"CDM"},{"code":"13120","type":"HCPCS"}],"standard_charges":[{"gross_charge":1640.0,"discounted_cash":1230.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 13121 REPAIR OF WOUND OR LESION 2.6 TO 7.5CM CPLX SCLP ARM L CDM","code_information":[{"code":"Px00098110298","type":"CDM"},{"code":"13121","type":"HCPCS"}],"standard_charges":[{"gross_charge":1814.0,"discounted_cash":1360.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 13122 REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/OR LESS CDM","code_information":[{"code":"Px00098110299","type":"CDM"},{"code":"13122","type":"HCPCS"}],"standard_charges":[{"gross_charge":583.0,"discounted_cash":437.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 92100 SERIAL TONOMETRY EXAM(S) CDM","code_information":[{"code":"Px00098110302","type":"CDM"},{"code":"92100","type":"HCPCS"}],"standard_charges":[{"gross_charge":226.0,"discounted_cash":169.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 99080 SPECIAL REPORTS OR FORMS CDM","code_information":[{"code":"Px00098110307","type":"CDM"},{"code":"99080","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":40.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 30300 REMOVE NASAL FOREIGN BODY CDM","code_information":[{"code":"Px00098110316","type":"CDM"},{"code":"30300","type":"HCPCS"}],"standard_charges":[{"gross_charge":893.0,"discounted_cash":669.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 30901 CONTROL OF NOSEBLEED SIMPLE CDM","code_information":[{"code":"Px00098110317","type":"CDM"},{"code":"30901","type":"HCPCS"}],"standard_charges":[{"gross_charge":402.0,"discounted_cash":301.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 30903 CONTROL OF NOSEBLEED COMPLEX CDM","code_information":[{"code":"Px00098110319","type":"CDM"},{"code":"30903","type":"HCPCS"}],"standard_charges":[{"gross_charge":550.0,"discounted_cash":412.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 30905 CONTROL OF NOSEBLEED POSTERIOR CDM","code_information":[{"code":"Px00098110321","type":"CDM"},{"code":"30905","type":"HCPCS"}],"standard_charges":[{"gross_charge":752.0,"discounted_cash":564.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 30906 REPEAT CONTROL OF NOSEBLEED CDM","code_information":[{"code":"Px00098110322","type":"CDM"},{"code":"30906","type":"HCPCS"}],"standard_charges":[{"gross_charge":945.0,"discounted_cash":708.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 31231 NASAL ENDOSCOPY DX CDM","code_information":[{"code":"Px00098110323","type":"CDM"},{"code":"31231","type":"HCPCS"}],"standard_charges":[{"gross_charge":459.0,"discounted_cash":344.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 31500 INS EMERGENCY AIRWAY CDM","code_information":[{"code":"Px00098110324","type":"CDM"},{"code":"31500","type":"HCPCS"}],"standard_charges":[{"gross_charge":992.0,"discounted_cash":744.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 31502 CHANGE OF WINDPIPE AIRWAY CDM","code_information":[{"code":"Px00098110325","type":"CDM"},{"code":"31502","type":"HCPCS"}],"standard_charges":[{"gross_charge":248.0,"discounted_cash":186.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 31505 DIAGNOSTIC LARYNGOSCOPY INDIRECT CDM","code_information":[{"code":"Px00098110326","type":"CDM"},{"code":"31505","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.0,"discounted_cash":262.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 31511 REMOVE FOREIGN BODY LARYNX CDM","code_information":[{"code":"Px00098110328","type":"CDM"},{"code":"31511","type":"HCPCS"}],"standard_charges":[{"gross_charge":950.0,"discounted_cash":712.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 31515 LARYNGOSCOPY FOR ASPIRATION CDM","code_information":[{"code":"Px00098110329","type":"CDM"},{"code":"31515","type":"HCPCS"}],"standard_charges":[{"gross_charge":790.0,"discounted_cash":592.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 31520 DX LARYNGOSCOPY NEWBORN CDM","code_information":[{"code":"Px00098110330","type":"CDM"},{"code":"31520","type":"HCPCS"}],"standard_charges":[{"gross_charge":1104.0,"discounted_cash":828.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 31525 DX LARYNGOSCOPY EXCL NEWBORN CDM","code_information":[{"code":"Px00098110331","type":"CDM"},{"code":"31525","type":"HCPCS"}],"standard_charges":[{"gross_charge":1128.0,"discounted_cash":846.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 31530 LARYNGOSCOPY W/FB REMOVAL CDM","code_information":[{"code":"Px00098110332","type":"CDM"},{"code":"31530","type":"HCPCS"}],"standard_charges":[{"gross_charge":1407.0,"discounted_cash":1055.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 31575 DIAGNOSTIC LARYNGOSCOPY CDM","code_information":[{"code":"Px00098110333","type":"CDM"},{"code":"31575","type":"HCPCS"}],"standard_charges":[{"gross_charge":483.0,"discounted_cash":362.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 31577 REMOVE FOREIGN BODY LARYNX FLEXIBLE FIBEROPTIC CDM","code_information":[{"code":"Px00098110334","type":"CDM"},{"code":"31577","type":"HCPCS"}],"standard_charges":[{"gross_charge":950.0,"discounted_cash":712.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 31603 TRACHEOSTOMY CDM","code_information":[{"code":"Px00098110335","type":"CDM"},{"code":"31603","type":"HCPCS"}],"standard_charges":[{"gross_charge":2263.0,"discounted_cash":1697.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 31605 CRICOTHYROIDOTOMY CDM","code_information":[{"code":"Px00098110336","type":"CDM"},{"code":"31605","type":"HCPCS"}],"standard_charges":[{"gross_charge":2344.0,"discounted_cash":1758.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 32110 EXPLORE/REPAIR CHEST CDM","code_information":[{"code":"Px00098110337","type":"CDM"},{"code":"32110","type":"HCPCS"}],"standard_charges":[{"gross_charge":10339.0,"discounted_cash":7754.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 32160 OPEN CHEST HEART MASSAGE CDM","code_information":[{"code":"Px00098110338","type":"CDM"},{"code":"32160","type":"HCPCS"}],"standard_charges":[{"gross_charge":5614.0,"discounted_cash":4210.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 32551 INSERTION OF CHEST TUBE CDM","code_information":[{"code":"Px00098110342","type":"CDM"},{"code":"32551","type":"HCPCS"}],"standard_charges":[{"gross_charge":1090.0,"discounted_cash":817.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 36000 PLACE NEEDLE IN VEIN CDM","code_information":[{"code":"Px00098110348","type":"CDM"},{"code":"36000","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":48.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 40650 REPAIR LIP, FULL THICKNESS VERMILION ONLY CDM","code_information":[{"code":"Px00098110349","type":"CDM"},{"code":"40650","type":"HCPCS"}],"standard_charges":[{"gross_charge":2249.0,"discounted_cash":1686.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 40652 REPAIR LIP, FULL THICKNESS UP TO HALF VERTICAL HEIGHT CDM","code_information":[{"code":"Px00098110350","type":"CDM"},{"code":"40652","type":"HCPCS"}],"standard_charges":[{"gross_charge":2582.0,"discounted_cash":1936.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 40654 REPAIR LIP FULL THICKNESS OVER ONE-HALF VERTICAL HEIGHT CDM","code_information":[{"code":"Px00098110351","type":"CDM"},{"code":"40654","type":"HCPCS"}],"standard_charges":[{"gross_charge":3042.0,"discounted_cash":2281.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 40800 DRAINAGE OF MOUTH LESION, SIMPLE CDM","code_information":[{"code":"Px00098110352","type":"CDM"},{"code":"40800","type":"HCPCS"}],"standard_charges":[{"gross_charge":843.0,"discounted_cash":632.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 40804 REMOVAL FOREIGN BODY MOUTH, SIMPLE CDM","code_information":[{"code":"Px00098110353","type":"CDM"},{"code":"40804","type":"HCPCS"}],"standard_charges":[{"gross_charge":804.0,"discounted_cash":603.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 40830 CLOSURE LACERATION VESTIBULE MOUTH 2.5 CM/OR LESS CDM","code_information":[{"code":"Px00098110354","type":"CDM"},{"code":"40830","type":"HCPCS"}],"standard_charges":[{"gross_charge":1038.0,"discounted_cash":778.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 40831 REPAIR MOUTH LACERATION >2.5CM CDM","code_information":[{"code":"Px00098110355","type":"CDM"},{"code":"40831","type":"HCPCS"}],"standard_charges":[{"gross_charge":1433.0,"discounted_cash":1074.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 41000 DRAINAGE OF MOUTH LESION, LINGUAL CDM","code_information":[{"code":"Px00098110356","type":"CDM"},{"code":"41000","type":"HCPCS"}],"standard_charges":[{"gross_charge":752.0,"discounted_cash":564.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 41250 RPR LAC LTE 2.5 CM MOUTH &/ ANT TWO-THIRDS TONGUE CDM","code_information":[{"code":"Px00098110357","type":"CDM"},{"code":"41250","type":"HCPCS"}],"standard_charges":[{"gross_charge":1097.0,"discounted_cash":822.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 41251 RPR LAC LTE 2.5 CM POSTERIOR ONE-THIRD TONGUE CDM","code_information":[{"code":"Px00098110358","type":"CDM"},{"code":"41251","type":"HCPCS"}],"standard_charges":[{"gross_charge":1311.0,"discounted_cash":983.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 41252 REPAIR OF LACER OF TONGUE FLOOR OF MOUTH >2.6 C CDM","code_information":[{"code":"Px00098110359","type":"CDM"},{"code":"41252","type":"HCPCS"}],"standard_charges":[{"gross_charge":1495.0,"discounted_cash":1121.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 41800 DRAINAGE OF GUM LESION CDM","code_information":[{"code":"Px00098110360","type":"CDM"},{"code":"41800","type":"HCPCS"}],"standard_charges":[{"gross_charge":1100.0,"discounted_cash":825.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 42000 DRAINAGE MOUTH ROOF LESION CDM","code_information":[{"code":"Px00098110361","type":"CDM"},{"code":"42000","type":"HCPCS"}],"standard_charges":[{"gross_charge":778.0,"discounted_cash":583.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 42180 REPAIR, LACERATION OF PALATE UP TO 2 CM CDM","code_information":[{"code":"Px00098110362","type":"CDM"},{"code":"42180","type":"HCPCS"}],"standard_charges":[{"gross_charge":1340.0,"discounted_cash":1005.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 42182 REPAIR, LACERATION OF PALATE OVER 2 CM OR COMPLEX CDM","code_information":[{"code":"Px00098110363","type":"CDM"},{"code":"42182","type":"HCPCS"}],"standard_charges":[{"gross_charge":1845.0,"discounted_cash":1383.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 42300 DRAINAGE OF SALIVARY GLAND, SIMPLE CDM","code_information":[{"code":"Px00098110364","type":"CDM"},{"code":"42300","type":"HCPCS"}],"standard_charges":[{"gross_charge":1121.0,"discounted_cash":840.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 42310 DRAINAGE OF SALIVARY GLAND, SUBLINGUAL CDM","code_information":[{"code":"Px00098110365","type":"CDM"},{"code":"42310","type":"HCPCS"}],"standard_charges":[{"gross_charge":966.0,"discounted_cash":724.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 42700 DRAINAGE OF TONSIL ABSCESS CDM","code_information":[{"code":"Px00098110366","type":"CDM"},{"code":"42700","type":"HCPCS"}],"standard_charges":[{"gross_charge":973.0,"discounted_cash":729.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 42809 REMOVE PHARYNX FOREIGN BODY CDM","code_information":[{"code":"Px00098110368","type":"CDM"},{"code":"42809","type":"HCPCS"}],"standard_charges":[{"gross_charge":902.0,"discounted_cash":676.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 42960 CONTROL THROAT BLEEDING, SIMPLE CDM","code_information":[{"code":"Px00098110372","type":"CDM"},{"code":"42960","type":"HCPCS"}],"standard_charges":[{"gross_charge":1147.0,"discounted_cash":860.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 42970 CONTROL NOSE/THROAT BLEEDING CDM","code_information":[{"code":"Px00098110373","type":"CDM"},{"code":"42970","type":"HCPCS"}],"standard_charges":[{"gross_charge":2946.0,"discounted_cash":2209.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 43753 TX GASTRO INTUB W/ASP CDM","code_information":[{"code":"Px00098110375","type":"CDM"},{"code":"43753","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":114.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 45005 DRAINAGE OF RECTAL ABSCESS CDM","code_information":[{"code":"Px00098110377","type":"CDM"},{"code":"45005","type":"HCPCS"}],"standard_charges":[{"gross_charge":1192.0,"discounted_cash":894.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 45300 PROCTOSIGMOIDOSCOPY DX CDM","code_information":[{"code":"Px00098110378","type":"CDM"},{"code":"45300","type":"HCPCS"}],"standard_charges":[{"gross_charge":340.0,"discounted_cash":255.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 45307 PROCTOSIGMOIDOSCOPY FB CDM","code_information":[{"code":"Px00098110379","type":"CDM"},{"code":"45307","type":"HCPCS"}],"standard_charges":[{"gross_charge":709.0,"discounted_cash":531.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 45915 REMOVE RECTAL OBSTRUCTION W GEN ANESTH CDM","code_information":[{"code":"Px00098110380","type":"CDM"},{"code":"45915","type":"HCPCS"}],"standard_charges":[{"gross_charge":1633.0,"discounted_cash":1224.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 46040 INCISION OF RECTAL ABSCESS CDM","code_information":[{"code":"Px00098110381","type":"CDM"},{"code":"46040","type":"HCPCS"}],"standard_charges":[{"gross_charge":3042.0,"discounted_cash":2281.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 46050 INCISION OF ANAL ABSCESS CDM","code_information":[{"code":"Px00098110382","type":"CDM"},{"code":"46050","type":"HCPCS"}],"standard_charges":[{"gross_charge":724.0,"discounted_cash":543.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 46083 INCISE EXTERNAL HEMORRHOID CDM","code_information":[{"code":"Px00098110383","type":"CDM"},{"code":"46083","type":"HCPCS"}],"standard_charges":[{"gross_charge":783.0,"discounted_cash":587.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 46221 LIGATION OF HEMORRHOID(S) CDM","code_information":[{"code":"Px00098110384","type":"CDM"},{"code":"46221","type":"HCPCS"}],"standard_charges":[{"gross_charge":1373.0,"discounted_cash":1029.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 46230 REMOVAL OF ANAL TAGS CDM","code_information":[{"code":"Px00098110385","type":"CDM"},{"code":"46230","type":"HCPCS"}],"standard_charges":[{"gross_charge":1233.0,"discounted_cash":924.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 46320 REMOVAL OF HEMORRHOID CLOT CDM","code_information":[{"code":"Px00098110386","type":"CDM"},{"code":"46320","type":"HCPCS"}],"standard_charges":[{"gross_charge":804.0,"discounted_cash":603.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 46600 DIAGNOSTIC ANOSCOPY CDM","code_information":[{"code":"Px00098110387","type":"CDM"},{"code":"46600","type":"HCPCS"}],"standard_charges":[{"gross_charge":293.0,"discounted_cash":219.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 46614 ANOSCOPY CONTROL BLEEDING CDM","code_information":[{"code":"Px00098110389","type":"CDM"},{"code":"46614","type":"HCPCS"}],"standard_charges":[{"gross_charge":457.0,"discounted_cash":342.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 51100 DRAIN BLADDER BY NEEDLE CDM","code_information":[{"code":"Px00098110392","type":"CDM"},{"code":"51100","type":"HCPCS"}],"standard_charges":[{"gross_charge":274.0,"discounted_cash":205.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 51102 DRAIN BL W/CATH INSERTION CDM","code_information":[{"code":"Px00098110394","type":"CDM"},{"code":"51102","type":"HCPCS"}],"standard_charges":[{"gross_charge":1004.0,"discounted_cash":753.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 51700 IRRIGATION OF BLADDER CDM","code_information":[{"code":"Px00098110395","type":"CDM"},{"code":"51700","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.0,"discounted_cash":159.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 51702 INSERT TEMP BLADDER CATHETER CDM","code_information":[{"code":"Px00098110396","type":"CDM"},{"code":"51702","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.0,"discounted_cash":132.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 51703 INSERT BLADDER CATHETER COMPLEX CDM","code_information":[{"code":"Px00098110397","type":"CDM"},{"code":"51703","type":"HCPCS"}],"standard_charges":[{"gross_charge":536.0,"discounted_cash":402.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 54220 IRRIGATION OF CORPORA CAVERNOSA FOR PRIAPISM CDM","code_information":[{"code":"Px00098110398","type":"CDM"},{"code":"54220","type":"HCPCS"}],"standard_charges":[{"gross_charge":938.0,"discounted_cash":703.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 55100 DRAINAGE OF SCROTUM ABSCESS CDM","code_information":[{"code":"Px00098110399","type":"CDM"},{"code":"55100","type":"HCPCS"}],"standard_charges":[{"gross_charge":1185.0,"discounted_cash":888.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 55120 REMOVAL OF SCROTUM LESION CDM","code_information":[{"code":"Px00098110400","type":"CDM"},{"code":"55120","type":"HCPCS"}],"standard_charges":[{"gross_charge":2506.0,"discounted_cash":1879.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 27786 CLOSED TREATMENT OF ANKLE FRACTURE W/O MANIP CDM","code_information":[{"code":"Px00098110402","type":"CDM"},{"code":"27786","type":"HCPCS"}],"standard_charges":[{"gross_charge":2102.0,"discounted_cash":1576.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 27788 CLOSED TREATMENT OF ANKLE FRACTURE W/MANIP CDM","code_information":[{"code":"Px00098110405","type":"CDM"},{"code":"27788","type":"HCPCS"}],"standard_charges":[{"gross_charge":2806.0,"discounted_cash":2104.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 27808 TREATMENT OF ANKLE FRACTURE BIMAL W/O MANIP CDM","code_information":[{"code":"Px00098110406","type":"CDM"},{"code":"27808","type":"HCPCS"}],"standard_charges":[{"gross_charge":2237.0,"discounted_cash":1677.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 27810 TREATMENT OF ANKLE FRACTURE W/MANIPULATION CDM","code_information":[{"code":"Px00098110409","type":"CDM"},{"code":"27810","type":"HCPCS"}],"standard_charges":[{"gross_charge":3111.0,"discounted_cash":2333.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 27816 CLTX TRIMALLEOLAR ANKLE FX W/O MANIPULATION CDM","code_information":[{"code":"Px00098110410","type":"CDM"},{"code":"27816","type":"HCPCS"}],"standard_charges":[{"gross_charge":2147.0,"discounted_cash":1610.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 27818 CLOSED TX OF ANKLE FRACTURE TRIMALL W/MANIP CDM","code_information":[{"code":"Px00098110413","type":"CDM"},{"code":"27818","type":"HCPCS"}],"standard_charges":[{"gross_charge":3196.0,"discounted_cash":2397.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 27824 CLOSED TREAT LOWER LEG FRACTURE W/O MANIP CDM","code_information":[{"code":"Px00098110414","type":"CDM"},{"code":"27824","type":"HCPCS"}],"standard_charges":[{"gross_charge":2232.0,"discounted_cash":1674.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 27830 CLOSED TREAT PROX TIB/FIB DISLOC CDM","code_information":[{"code":"Px00098110415","type":"CDM"},{"code":"27830","type":"HCPCS"}],"standard_charges":[{"gross_charge":2628.0,"discounted_cash":1971.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 27840 CLOSED TREATMENT OF ANKLE DISLOCATION W/O ANESTH CDM","code_information":[{"code":"Px00098110417","type":"CDM"},{"code":"27840","type":"HCPCS"}],"standard_charges":[{"gross_charge":2813.0,"discounted_cash":2109.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 27842 CLOSED TREAT ANKLE DISLOCATION W/ANESTH CDM","code_information":[{"code":"Px00098110418","type":"CDM"},{"code":"27842","type":"HCPCS"}],"standard_charges":[{"gross_charge":3544.0,"discounted_cash":2658.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 28192 REMOVAL OF FOOT FOREIGN BODY DEEP CDM","code_information":[{"code":"Px00098110419","type":"CDM"},{"code":"28192","type":"HCPCS"}],"standard_charges":[{"gross_charge":2197.0,"discounted_cash":1647.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 28193 REMOVAL OF FOOT FOREIGN BODY COMPLEX CDM","code_information":[{"code":"Px00098110420","type":"CDM"},{"code":"28193","type":"HCPCS"}],"standard_charges":[{"gross_charge":2592.0,"discounted_cash":1944.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 28208 REPAIR OF FOOT TENDON EXTENSOR TENDON CDM","code_information":[{"code":"Px00098110422","type":"CDM"},{"code":"28208","type":"HCPCS"}],"standard_charges":[{"gross_charge":2294.0,"discounted_cash":1720.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 28400 TREATMENT OF HEEL FRACTURE W/O MANIPULATION CDM","code_information":[{"code":"Px00098110424","type":"CDM"},{"code":"28400","type":"HCPCS"}],"standard_charges":[{"gross_charge":1668.0,"discounted_cash":1251.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 28405 TREATMENT OF HEEL FRACTURE W/MANIPULATION CDM","code_information":[{"code":"Px00098110426","type":"CDM"},{"code":"28405","type":"HCPCS"}],"standard_charges":[{"gross_charge":2944.0,"discounted_cash":2208.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 28430 TREATMENT OF TALUS FRACTURE W/O MANIPULATION CDM","code_information":[{"code":"Px00098110429","type":"CDM"},{"code":"28430","type":"HCPCS"}],"standard_charges":[{"gross_charge":1530.0,"discounted_cash":1147.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 28435 TREATMENT OF ANKLE FRACTURE W/MANIPULATION CDM","code_information":[{"code":"Px00098110431","type":"CDM"},{"code":"28435","type":"HCPCS"}],"standard_charges":[{"gross_charge":2387.0,"discounted_cash":1790.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 28450 TREAT MIDFOOT FRACTURE EACH W/O MANIPULATION CDM","code_information":[{"code":"Px00098110432","type":"CDM"},{"code":"28450","type":"HCPCS"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":1035.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 28455 TREAT MIDFOOT FRACTURE EACH W/MANIPULATION CDM","code_information":[{"code":"Px00098110434","type":"CDM"},{"code":"28455","type":"HCPCS"}],"standard_charges":[{"gross_charge":1885.0,"discounted_cash":1413.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 28470 TREAT METATARSAL FRACTURE W/O MANIPULATION CDM","code_information":[{"code":"Px00098110436","type":"CDM"},{"code":"28470","type":"HCPCS"}],"standard_charges":[{"gross_charge":1483.0,"discounted_cash":1112.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 28475 CLOSED TREAT METATARSAL FRACTURE W/MANIP CDM","code_information":[{"code":"Px00098110438","type":"CDM"},{"code":"28475","type":"HCPCS"}],"standard_charges":[{"gross_charge":1637.0,"discounted_cash":1227.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 28490 CLOSED TREAT BIG TOE FRACTURE W/O MANIP CDM","code_information":[{"code":"Px00098110440","type":"CDM"},{"code":"28490","type":"HCPCS"}],"standard_charges":[{"gross_charge":904.0,"discounted_cash":678.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 28495 TREAT BIG TOE FRACTURE W/MANIPULATION CDM","code_information":[{"code":"Px00098110443","type":"CDM"},{"code":"28495","type":"HCPCS"}],"standard_charges":[{"gross_charge":1071.0,"discounted_cash":803.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 28510 TREATMENT OF TOE FRACTURE PHALANX CDM","code_information":[{"code":"Px00098110445","type":"CDM"},{"code":"28510","type":"HCPCS"}],"standard_charges":[{"gross_charge":869.0,"discounted_cash":651.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 28515 TREATMENT OF TOE FRACTURE PHALANX W/MANIP CDM","code_information":[{"code":"Px00098110448","type":"CDM"},{"code":"28515","type":"HCPCS"}],"standard_charges":[{"gross_charge":1033.0,"discounted_cash":774.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 28540 CLOSED TREAT TARSAL DISLOCATION CDM","code_information":[{"code":"Px00098110452","type":"CDM"},{"code":"28540","type":"HCPCS"}],"standard_charges":[{"gross_charge":1259.0,"discounted_cash":944.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 28570 TREAT FOOT DISLOCATION CDM","code_information":[{"code":"Px00098110455","type":"CDM"},{"code":"28570","type":"HCPCS"}],"standard_charges":[{"gross_charge":1433.0,"discounted_cash":1074.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 28575 TREAT FOOT DISLOCATION W/ANESTH CDM","code_information":[{"code":"Px00098110456","type":"CDM"},{"code":"28575","type":"HCPCS"}],"standard_charges":[{"gross_charge":2468.0,"discounted_cash":1851.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 28630 TREAT METATARSOPHAL DISLOCATION CDM","code_information":[{"code":"Px00098110460","type":"CDM"},{"code":"28630","type":"HCPCS"}],"standard_charges":[{"gross_charge":790.0,"discounted_cash":592.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 28660 CLOSED TREAT TOE DISLOCATION CDM","code_information":[{"code":"Px00098110462","type":"CDM"},{"code":"28660","type":"HCPCS"}],"standard_charges":[{"gross_charge":666.0,"discounted_cash":499.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 29065 LONG ARM CAST APPLICATION CDM","code_information":[{"code":"Px00098110466","type":"CDM"},{"code":"29065","type":"HCPCS"}],"standard_charges":[{"gross_charge":486.0,"discounted_cash":364.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 29075 APPLICATION CAST ELBOW FINGER SHORT ARM CDM","code_information":[{"code":"Px00098110467","type":"CDM"},{"code":"29075","type":"HCPCS"}],"standard_charges":[{"gross_charge":447.0,"discounted_cash":335.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 29105 LONG ARM SPLINT APPLICATION CDM","code_information":[{"code":"Px00098110468","type":"CDM"},{"code":"29105","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":225.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 29125 SHORT ARM SPLINT APPLICATION CDM","code_information":[{"code":"Px00098110469","type":"CDM"},{"code":"29125","type":"HCPCS"}],"standard_charges":[{"gross_charge":288.0,"discounted_cash":216.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 29200 STRAPPING OF CHEST DYN CDM","code_information":[{"code":"Px00098110471","type":"CDM"},{"code":"29200","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 29240 STRAPPING SHOULDER CDM","code_information":[{"code":"Px00098110472","type":"CDM"},{"code":"29240","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":96.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 29260 STRAPPING OF ELBOW OR WRIST CDM","code_information":[{"code":"Px00098110473","type":"CDM"},{"code":"29260","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.0,"discounted_cash":102.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 29280 STRAPPING OF HAND OR FINGER CDM","code_information":[{"code":"Px00098110475","type":"CDM"},{"code":"29280","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":105.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 29405 SHORT LEG CAST APPLICATION CDM","code_information":[{"code":"Px00098110476","type":"CDM"},{"code":"29405","type":"HCPCS"}],"standard_charges":[{"gross_charge":414.0,"discounted_cash":310.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 29505 APPLICATION LONG LEG SPLINT CDM","code_information":[{"code":"Px00098110479","type":"CDM"},{"code":"29505","type":"HCPCS"}],"standard_charges":[{"gross_charge":369.0,"discounted_cash":276.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 29515 SHORT LEG SPLINT APPLICATION CDM","code_information":[{"code":"Px00098110480","type":"CDM"},{"code":"29515","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.0,"discounted_cash":262.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 29540 STRAPPING OF ANKLE AND/OR FT CDM","code_information":[{"code":"Px00098110481","type":"CDM"},{"code":"29540","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":93.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 29580 APPLICATION OF UNABOOT CDM","code_information":[{"code":"Px00098110482","type":"CDM"},{"code":"29580","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":139.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 29705 REMOVE OR BIVALVE CAST-FULL ARM OR LEG CDM","code_information":[{"code":"Px00098110483","type":"CDM"},{"code":"29705","type":"HCPCS"}],"standard_charges":[{"gross_charge":317.0,"discounted_cash":237.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 29730 WINDOWING OF CAST CDM","code_information":[{"code":"Px00098110484","type":"CDM"},{"code":"29730","type":"HCPCS"}],"standard_charges":[{"gross_charge":314.0,"discounted_cash":235.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 28190 REMOVAL OF FOOT FOREIGN BODY CDM","code_information":[{"code":"Px00098110485","type":"CDM"},{"code":"28190","type":"HCPCS"}],"standard_charges":[{"gross_charge":935.0,"discounted_cash":701.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 29345 APPLICATION/LONG LEG CAST CDM","code_information":[{"code":"Px00098110486","type":"CDM"},{"code":"29345","type":"HCPCS"}],"standard_charges":[{"gross_charge":707.0,"discounted_cash":530.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 99282 VISIT STRAIGHTFORWARD MDM CDM","code_information":[{"code":"Px00098110489","type":"CDM"},{"code":"99282","type":"HCPCS"}],"standard_charges":[{"gross_charge":295.0,"discounted_cash":221.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 36010 PLACE CATHETER IN VEIN CDM","code_information":[{"code":"Px00098110492","type":"CDM"},{"code":"36010","type":"HCPCS"}],"standard_charges":[{"gross_charge":752.0,"discounted_cash":564.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 36556 INSERT NON-TUNNEL CV CATH > 5 CDM","code_information":[{"code":"Px00098110494","type":"CDM"},{"code":"36556","type":"HCPCS"}],"standard_charges":[{"gross_charge":590.0,"discounted_cash":442.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 36569 INSERTION PICC W/O IMG GDN 5 YR/> CDM","code_information":[{"code":"Px00098110496","type":"CDM"},{"code":"36569","type":"HCPCS"}],"standard_charges":[{"gross_charge":655.0,"discounted_cash":491.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 36620 INSERTION CATHETER ARTERY CDM","code_information":[{"code":"Px00098110499","type":"CDM"},{"code":"36620","type":"HCPCS"}],"standard_charges":[{"gross_charge":312.0,"discounted_cash":234.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 36625 INSERT CATH ARTERY CUTDOWN CDM","code_information":[{"code":"Px00098110500","type":"CDM"},{"code":"36625","type":"HCPCS"}],"standard_charges":[{"gross_charge":740.0,"discounted_cash":555.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 13131 REPAIR OF WOUND OR LESION 1.1 TO 2.5CM CPLX FRHD CKS SHN CDM","code_information":[{"code":"Px00098110501","type":"CDM"},{"code":"13131","type":"HCPCS"}],"standard_charges":[{"gross_charge":1704.0,"discounted_cash":1278.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 13132 REPAIR OF WOUND OR LESION 2.6 TO 7.5CM CPLX FRHD CKS SHN CDM","code_information":[{"code":"Px00098110502","type":"CDM"},{"code":"13132","type":"HCPCS"}],"standard_charges":[{"gross_charge":2135.0,"discounted_cash":1601.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 13133 REPAIR WOUND/LESION ADD ON 5CM CMPLX FRHD CKS SHN MTH NK CDM","code_information":[{"code":"Px00098110503","type":"CDM"},{"code":"13133","type":"HCPCS"}],"standard_charges":[{"gross_charge":878.0,"discounted_cash":658.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 13151 REPAIR OF WND OR LESN 1.1 TO 2.5CM CMPLX EYLD NS ERS LPS CDM","code_information":[{"code":"Px00098110505","type":"CDM"},{"code":"13151","type":"HCPCS"}],"standard_charges":[{"gross_charge":1964.0,"discounted_cash":1473.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 13152 REPAIR OF WND OR LES 2.6 TO 7.5CM CMPLX EYLD NS ERS LPS CDM","code_information":[{"code":"Px00098110506","type":"CDM"},{"code":"13152","type":"HCPCS"}],"standard_charges":[{"gross_charge":2366.0,"discounted_cash":1774.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 13153 REPAIR WOUND/LESION ADD-ON 5CM CMPLX EYLD NS ERS LIP CDM","code_information":[{"code":"Px00098110507","type":"CDM"},{"code":"13153","type":"HCPCS"}],"standard_charges":[{"gross_charge":964.0,"discounted_cash":723.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 16000 INITIAL TREATMENT OF BURN(S) 1ST DEG LOCAL TX CDM","code_information":[{"code":"Px00098110509","type":"CDM"},{"code":"16000","type":"HCPCS"}],"standard_charges":[{"gross_charge":324.0,"discounted_cash":243.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 16020 DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ SMALL CDM","code_information":[{"code":"Px00098110510","type":"CDM"},{"code":"16020","type":"HCPCS"}],"standard_charges":[{"gross_charge":393.0,"discounted_cash":294.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 16025 DRESS/DEBRID P-THICK BURN M 5-10% TBSA CDM","code_information":[{"code":"Px00098110511","type":"CDM"},{"code":"16025","type":"HCPCS"}],"standard_charges":[{"gross_charge":781.0,"discounted_cash":585.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 16030 DRESS/DEBRID P-THICK BURN L >10% TBSA CDM","code_information":[{"code":"Px00098110512","type":"CDM"},{"code":"16030","type":"HCPCS"}],"standard_charges":[{"gross_charge":931.0,"discounted_cash":698.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 19000 DRAINAGE OF BREAST LESION CDM","code_information":[{"code":"Px00098110514","type":"CDM"},{"code":"19000","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":225.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 20100 EXPLORE WOUND NECK CDM","code_information":[{"code":"Px00098110517","type":"CDM"},{"code":"20100","type":"HCPCS"}],"standard_charges":[{"gross_charge":4251.0,"discounted_cash":3188.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 20101 EXPLORE WOUND CHEST CDM","code_information":[{"code":"Px00098110518","type":"CDM"},{"code":"20101","type":"HCPCS"}],"standard_charges":[{"gross_charge":1492.0,"discounted_cash":1119.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 20102 EXPLORE WOUND ABDOMEN CDM","code_information":[{"code":"Px00098110519","type":"CDM"},{"code":"20102","type":"HCPCS"}],"standard_charges":[{"gross_charge":1804.0,"discounted_cash":1353.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 20103 EXPLORE WOUND EXTREMITY CDM","code_information":[{"code":"Px00098110520","type":"CDM"},{"code":"20103","type":"HCPCS"}],"standard_charges":[{"gross_charge":2451.0,"discounted_cash":1838.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 20520 REMOVAL OF FOREIGN BODY MUSC, SIMP CDM","code_information":[{"code":"Px00098110521","type":"CDM"},{"code":"20520","type":"HCPCS"}],"standard_charges":[{"gross_charge":1047.0,"discounted_cash":785.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 20525 REMOVAL OF FOREIGN BODY COMPLEX CDM","code_information":[{"code":"Px00098110522","type":"CDM"},{"code":"20525","type":"HCPCS"}],"standard_charges":[{"gross_charge":1759.0,"discounted_cash":1319.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 20550 INJ TENDON SHEATH/LIGAMENT CDM","code_information":[{"code":"Px00098110523","type":"CDM"},{"code":"20550","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.0,"discounted_cash":207.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 20551 INJ TENDON ORIGIN/INSERTION CDM","code_information":[{"code":"Px00098110524","type":"CDM"},{"code":"20551","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.0,"discounted_cash":207.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 20552 INJ TRIGGER POINT 1/2 MUSCL CDM","code_information":[{"code":"Px00098110525","type":"CDM"},{"code":"20552","type":"HCPCS"}],"standard_charges":[{"gross_charge":262.0,"discounted_cash":196.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 20553 INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES CD","code_information":[{"code":"Px00098110526","type":"CDM"},{"code":"20553","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":225.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 20600 DRAIN/INJECT JOINT/BURSA SMALL W/O ULTRASOUND GUIDANCE CDM","code_information":[{"code":"Px00098110528","type":"CDM"},{"code":"20600","type":"HCPCS"}],"standard_charges":[{"gross_charge":250.0,"discounted_cash":187.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 20605 DRAIN/INJECT JOINT/BURSA INTERM W/O ULTRASOUND GUIDANCE CDM","code_information":[{"code":"Px00098110529","type":"CDM"},{"code":"20605","type":"HCPCS"}],"standard_charges":[{"gross_charge":262.0,"discounted_cash":196.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 20610 DRAIN/INJECT JOINT/BURSA MAJOR JOINT W/O US GUIDANCE CDM","code_information":[{"code":"Px00098110530","type":"CDM"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":319.0,"discounted_cash":239.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 20610 DRAIN/INJECT JOINT/BURSA MAJOR CDM","code_information":[{"code":"Px00098110531","type":"CDM"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":319.0,"discounted_cash":239.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 20950 FLUID PRESSURE MUSCLE CDM","code_information":[{"code":"Px00098110532","type":"CDM"},{"code":"20950","type":"HCPCS"}],"standard_charges":[{"gross_charge":621.0,"discounted_cash":465.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 21315 TREATMENT OF NOSE FRACTURE W/O STABILIZATION CDM","code_information":[{"code":"Px00098110534","type":"CDM"},{"code":"21315","type":"HCPCS"}],"standard_charges":[{"gross_charge":428.0,"discounted_cash":321.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 21355 TREAT CHEEK BONE FRACTURE CDM","code_information":[{"code":"Px00098110537","type":"CDM"},{"code":"21355","type":"HCPCS"}],"standard_charges":[{"gross_charge":2359.0,"discounted_cash":1769.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 21360 LEFORT 1, DEP OP RED CDM","code_information":[{"code":"Px00098110538","type":"CDM"},{"code":"21360","type":"HCPCS"}],"standard_charges":[{"gross_charge":3756.0,"discounted_cash":2817.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 21450 TREAT LOWER JAW FRACTURE W/O MANIPULATION CDM","code_information":[{"code":"Px00098110540","type":"CDM"},{"code":"21450","type":"HCPCS"}],"standard_charges":[{"gross_charge":3441.0,"discounted_cash":2580.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 21480 RESET DISLOCATED JAW UNCOMPLICATED CDM","code_information":[{"code":"Px00098110541","type":"CDM"},{"code":"21480","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.0,"discounted_cash":165.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 21820 TREAT STERNUM FRACTURE CDM","code_information":[{"code":"Px00098110544","type":"CDM"},{"code":"21820","type":"HCPCS"}],"standard_charges":[{"gross_charge":1076.0,"discounted_cash":807.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 22310 TREAT SPINE FRACTURE CDM","code_information":[{"code":"Px00098110547","type":"CDM"},{"code":"22310","type":"HCPCS"}],"standard_charges":[{"gross_charge":2140.0,"discounted_cash":1605.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 23031 DRAIN SHOULDER BURSA CDM","code_information":[{"code":"Px00098110549","type":"CDM"},{"code":"23031","type":"HCPCS"}],"standard_charges":[{"gross_charge":1592.0,"discounted_cash":1194.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 23330 REMOVE SHOULDER FOREIGN BODY CDM","code_information":[{"code":"Px00098110550","type":"CDM"},{"code":"23330","type":"HCPCS"}],"standard_charges":[{"gross_charge":1197.0,"discounted_cash":897.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 23500 TREAT CLAVICLE FRACTURE W/O MANIP CDM","code_information":[{"code":"Px00098110551","type":"CDM"},{"code":"23500","type":"HCPCS"}],"standard_charges":[{"gross_charge":1678.0,"discounted_cash":1258.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 23505 TREAT CLAVICLE FRACTURE W/MANIP CDM","code_information":[{"code":"Px00098110553","type":"CDM"},{"code":"23505","type":"HCPCS"}],"standard_charges":[{"gross_charge":2435.0,"discounted_cash":1826.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 23520 TREAT CLAVICLE DISLOCATION W/O MANI CDM","code_information":[{"code":"Px00098110555","type":"CDM"},{"code":"23520","type":"HCPCS"}],"standard_charges":[{"gross_charge":1747.0,"discounted_cash":1310.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 23540 TREAT CLAVICLE DISLOCATIONAC JT DISLO W/O MAN CDM","code_information":[{"code":"Px00098110558","type":"CDM"},{"code":"23540","type":"HCPCS"}],"standard_charges":[{"gross_charge":1737.0,"discounted_cash":1302.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 23545 TREAT CLAVICLE DISLOCATION AC JT DISLO W/MAN CDM","code_information":[{"code":"Px00098110559","type":"CDM"},{"code":"23545","type":"HCPCS"}],"standard_charges":[{"gross_charge":2363.0,"discounted_cash":1772.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 23570 TREAT SHOULDER BLADE FX W/O MANIP CDM","code_information":[{"code":"Px00098110561","type":"CDM"},{"code":"23570","type":"HCPCS"}],"standard_charges":[{"gross_charge":1775.0,"discounted_cash":1331.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 23575 TREAT SHOULDER BLADE FX W/MANIP CDM","code_information":[{"code":"Px00098110562","type":"CDM"},{"code":"23575","type":"HCPCS"}],"standard_charges":[{"gross_charge":2766.0,"discounted_cash":2074.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 23600 TREAT HUMERUS FRACTURE W/O MANIP CDM","code_information":[{"code":"Px00098110563","type":"CDM"},{"code":"23600","type":"HCPCS"}],"standard_charges":[{"gross_charge":2316.0,"discounted_cash":1737.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 23605 TREAT HUMERUS FRACTURE W/MANIP CDM","code_information":[{"code":"Px00098110564","type":"CDM"},{"code":"23605","type":"HCPCS"}],"standard_charges":[{"gross_charge":3111.0,"discounted_cash":2333.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 23620 TREAT HUMERUS FRACTURE TUBEROSITY W/O MAN CDM","code_information":[{"code":"Px00098110566","type":"CDM"},{"code":"23620","type":"HCPCS"}],"standard_charges":[{"gross_charge":1909.0,"discounted_cash":1431.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 23625 TREAT HUMERUS FRACTURE TUBEROSITY W/MAN CDM","code_information":[{"code":"Px00098110568","type":"CDM"},{"code":"23625","type":"HCPCS"}],"standard_charges":[{"gross_charge":2597.0,"discounted_cash":1947.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 23650 TREAT SHOULDER DISLOCATION W/MANIP CDM","code_information":[{"code":"Px00098110570","type":"CDM"},{"code":"23650","type":"HCPCS"}],"standard_charges":[{"gross_charge":2192.0,"discounted_cash":1644.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 23655 TREAT SHOULDER DISLOCATION W/MANIP & ANNES CDM","code_information":[{"code":"Px00098110572","type":"CDM"},{"code":"23655","type":"HCPCS"}],"standard_charges":[{"gross_charge":2958.0,"discounted_cash":2218.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 23665 CLTX SHOULDER DISLC W/FX HUMERAL TUBRST W/MANJ CDM","code_information":[{"code":"Px00098110574","type":"CDM"},{"code":"23665","type":"HCPCS"}],"standard_charges":[{"gross_charge":2908.0,"discounted_cash":2181.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 23930 I&D UPPER ARM/ELBOW DEEP ABSCESS/HEMATOMA CDM","code_information":[{"code":"Px00098110577","type":"CDM"},{"code":"23930","type":"HCPCS"}],"standard_charges":[{"gross_charge":1542.0,"discounted_cash":1156.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 23931 DRAINAGE OF ARM BURSA CDM","code_information":[{"code":"Px00098110578","type":"CDM"},{"code":"23931","type":"HCPCS"}],"standard_charges":[{"gross_charge":1157.0,"discounted_cash":867.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 12056 INTMD WND REPAIR FACE/MM 20.1 TO 30.0CM CDM","code_information":[{"code":"Px00098110579","type":"CDM"},{"code":"12056","type":"HCPCS"}],"standard_charges":[{"gross_charge":2730.0,"discounted_cash":2047.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 11732 AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL CDM","code_information":[{"code":"Px00098110581","type":"CDM"},{"code":"11732","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":90.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 21400 TREAT EYE SOCKET FRACTURE NON BLOWOUT W/O MANIPULATION CDM","code_information":[{"code":"Px00098110583","type":"CDM"},{"code":"21400","type":"HCPCS"}],"standard_charges":[{"gross_charge":1202.0,"discounted_cash":901.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 24200 REMOVAL OF ARM FOREIGN BODY CDM","code_information":[{"code":"Px00098110584","type":"CDM"},{"code":"24200","type":"HCPCS"}],"standard_charges":[{"gross_charge":997.0,"discounted_cash":747.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 36600 WITHDRAWAL OF ARTERIAL BLOOD CDM","code_information":[{"code":"Px00098110587","type":"CDM"},{"code":"36600","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":78.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 36405 VNPNXR/YOUNGER THAN 3 YRS PHYS/QHP SKILL SCALP VEIN CDM","code_information":[{"code":"Px00098110590","type":"CDM"},{"code":"36405","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":78.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 36410 NON-ROUTINE BL DRAW > 3 YRS CDM","code_information":[{"code":"Px00098110592","type":"CDM"},{"code":"36410","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":48.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 36420 VENIPUNCTURE CUTDOWN YOUNGER THAN 1 YR CDM","code_information":[{"code":"Px00098110593","type":"CDM"},{"code":"36420","type":"HCPCS"}],"standard_charges":[{"gross_charge":336.0,"discounted_cash":252.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 36425 VEIN ACCESS CUTDOWN > 1 YR CDM","code_information":[{"code":"Px00098110594","type":"CDM"},{"code":"36425","type":"HCPCS"}],"standard_charges":[{"gross_charge":278.0,"discounted_cash":208.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 92950 CARDIOPULMONARY RESUSCITATION CDM","code_information":[{"code":"Px00098110596","type":"CDM"},{"code":"92950","type":"HCPCS"}],"standard_charges":[{"gross_charge":1280.0,"discounted_cash":960.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 59300 EPISIOTOMY OR VAGINAL REPAIR CDM","code_information":[{"code":"Px00098110601","type":"CDM"},{"code":"59300","type":"HCPCS"}],"standard_charges":[{"gross_charge":1050.0,"discounted_cash":787.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 59409 VAGINAL DELIVERY CDM","code_information":[{"code":"Px00098110602","type":"CDM"},{"code":"59409","type":"HCPCS"}],"standard_charges":[{"gross_charge":5702.0,"discounted_cash":4276.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 59414 DELIVER PLACENTA CDM","code_information":[{"code":"Px00098110603","type":"CDM"},{"code":"59414","type":"HCPCS"}],"standard_charges":[{"gross_charge":645.0,"discounted_cash":483.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 99281 VISIT MINOR PROBLEM MAY NOT REQ PHYS/QHP CDM","code_information":[{"code":"Px00098110604","type":"CDM"},{"code":"99281","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":62.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 36660 IV CATH UMBILICAL CDM","code_information":[{"code":"Px00098110607","type":"CDM"},{"code":"36660","type":"HCPCS"}],"standard_charges":[{"gross_charge":478.0,"discounted_cash":358.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 37195 THROMBOLYTIC THERAPY STROKE CDM","code_information":[{"code":"Px00098110608","type":"CDM"},{"code":"37195","type":"HCPCS"}],"standard_charges":[{"gross_charge":613.0,"discounted_cash":459.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 37617 LIGATION OF ABDOMEN ARTERY CDM","code_information":[{"code":"Px00098110610","type":"CDM"},{"code":"37617","type":"HCPCS"}],"standard_charges":[{"gross_charge":9268.0,"discounted_cash":6951.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 92977 DISSOLVE CLOT HEART VESSEL IV CDM","code_information":[{"code":"Px00098110612","type":"CDM"},{"code":"92977","type":"HCPCS"}],"standard_charges":[{"gross_charge":376.0,"discounted_cash":282.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 24620 CLOSED TX MONTEGGIA FX DISLOCATION ELBOW W/MANI CDM","code_information":[{"code":"Px00098110620","type":"CDM"},{"code":"24620","type":"HCPCS"}],"standard_charges":[{"gross_charge":4248.0,"discounted_cash":3186.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 25248 REMOVE FOREARM FOREIGN BODY -FOREARM WRST CDM","code_information":[{"code":"Px00098110621","type":"CDM"},{"code":"25248","type":"HCPCS"}],"standard_charges":[{"gross_charge":2999.0,"discounted_cash":2249.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 29550 STRAPPING OF TOES CDM","code_information":[{"code":"Px00098110625","type":"CDM"},{"code":"29550","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":59.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 29530 STRAPPING OF KNEE CDM","code_information":[{"code":"Px00098110626","type":"CDM"},{"code":"29530","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":96.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 27240 TREAT THIGH FRACTURE, CLOSED CDM","code_information":[{"code":"Px00098110643","type":"CDM"},{"code":"27240","type":"HCPCS"}],"standard_charges":[{"gross_charge":6838.0,"discounted_cash":5128.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 69209 REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT CDM","code_information":[{"code":"Px00098110645","type":"CDM"},{"code":"69209","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":81.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 24500 TREAT HUMERUS FX W/O MANIP CDM","code_information":[{"code":"Px00098110701","type":"CDM"},{"code":"24500","type":"HCPCS"}],"standard_charges":[{"gross_charge":2447.0,"discounted_cash":1835.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 24505 TREAT HUMERUS FX W/MANIP CDM","code_information":[{"code":"Px00098110703","type":"CDM"},{"code":"24505","type":"HCPCS"}],"standard_charges":[{"gross_charge":3292.0,"discounted_cash":2469.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 24530 TREAT HUMERUS FRACTURE CDM","code_information":[{"code":"Px00098110704","type":"CDM"},{"code":"24530","type":"HCPCS"}],"standard_charges":[{"gross_charge":2573.0,"discounted_cash":1929.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 24535 TREAT HUMERUS FRACTURE W/MANIPULATION CDM","code_information":[{"code":"Px00098110706","type":"CDM"},{"code":"24535","type":"HCPCS"}],"standard_charges":[{"gross_charge":4134.0,"discounted_cash":3100.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 24560 TREAT HUMERUS EPICOND FRACTURE CDM","code_information":[{"code":"Px00098110707","type":"CDM"},{"code":"24560","type":"HCPCS"}],"standard_charges":[{"gross_charge":2166.0,"discounted_cash":1624.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 24576 TREAT HUMERUS CONDYLAR FRACTURE CDM","code_information":[{"code":"Px00098110709","type":"CDM"},{"code":"24576","type":"HCPCS"}],"standard_charges":[{"gross_charge":2297.0,"discounted_cash":1722.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 24600 TREAT ELBOW DISLOCATION W/O ANESTH CDM","code_information":[{"code":"Px00098110713","type":"CDM"},{"code":"24600","type":"HCPCS"}],"standard_charges":[{"gross_charge":2501.0,"discounted_cash":1875.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 24605 TREAT ELBOW DISLOCATION W/ANESTH CDM","code_information":[{"code":"Px00098110714","type":"CDM"},{"code":"24605","type":"HCPCS"}],"standard_charges":[{"gross_charge":3465.0,"discounted_cash":2598.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 24640 CLOSED TREAT OF RADIAL HEAD SUBLUXATION W/MANIP CDM","code_information":[{"code":"Px00098110716","type":"CDM"},{"code":"24640","type":"HCPCS"}],"standard_charges":[{"gross_charge":569.0,"discounted_cash":426.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 24650 TREAT RADIUS FRACTURE CDM","code_information":[{"code":"Px00098110718","type":"CDM"},{"code":"24650","type":"HCPCS"}],"standard_charges":[{"gross_charge":1804.0,"discounted_cash":1353.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 24655 CLOSED TX RADIUS HD FRACTURE CDM","code_information":[{"code":"Px00098110720","type":"CDM"},{"code":"24655","type":"HCPCS"}],"standard_charges":[{"gross_charge":2949.0,"discounted_cash":2211.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 24670 TREAT ULNAR FRACTURE CDM","code_information":[{"code":"Px00098110722","type":"CDM"},{"code":"24670","type":"HCPCS"}],"standard_charges":[{"gross_charge":1966.0,"discounted_cash":1474.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 24675 TREAT ULNAR FRACTURE W/MANIPULATION CDM","code_information":[{"code":"Px00098110724","type":"CDM"},{"code":"24675","type":"HCPCS"}],"standard_charges":[{"gross_charge":3042.0,"discounted_cash":2281.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 25260 REPAIR FOREARM TENDON/MUSCLE CDM","code_information":[{"code":"Px00098110726","type":"CDM"},{"code":"25260","type":"HCPCS"}],"standard_charges":[{"gross_charge":4579.0,"discounted_cash":3434.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 25270 REPAIR FOREARM TENDON/MUSCLE SINGLE EA TENDON CDM","code_information":[{"code":"Px00098110728","type":"CDM"},{"code":"25270","type":"HCPCS"}],"standard_charges":[{"gross_charge":3570.0,"discounted_cash":2677.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 25505 TREAT FRACTURE OF RADIUS W/MANIPULATION CDM","code_information":[{"code":"Px00098110732","type":"CDM"},{"code":"25505","type":"HCPCS"}],"standard_charges":[{"gross_charge":3358.0,"discounted_cash":2518.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 25530 TREAT FRACTURE OF ULNA CDM","code_information":[{"code":"Px00098110734","type":"CDM"},{"code":"25530","type":"HCPCS"}],"standard_charges":[{"gross_charge":1783.0,"discounted_cash":1337.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 25535 TREATMENT OF FRACTURE OF ULNA W/MANIPULATION CDM","code_information":[{"code":"Px00098110736","type":"CDM"},{"code":"25535","type":"HCPCS"}],"standard_charges":[{"gross_charge":3330.0,"discounted_cash":2497.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 25560 TREAT FRACTURE OF RADIUS AND ULNA W/O MANIP CDM","code_information":[{"code":"Px00098110738","type":"CDM"},{"code":"25560","type":"HCPCS"}],"standard_charges":[{"gross_charge":1902.0,"discounted_cash":1426.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 25565 TREAT FRACTURE RADIUS & ULNA W/MANIPULATION CDM","code_information":[{"code":"Px00098110740","type":"CDM"},{"code":"25565","type":"HCPCS"}],"standard_charges":[{"gross_charge":3396.0,"discounted_cash":2547.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 25600 TREAT DISTAL RADIAL FRACTURE RADIUS/UNA W/O MANIP CDM","code_information":[{"code":"Px00098110742","type":"CDM"},{"code":"25600","type":"HCPCS"}],"standard_charges":[{"gross_charge":2378.0,"discounted_cash":1783.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 25605 CLTX DSTL RDL FX/EPIPHYSL SEP W/MANJ WHEN PERF CDM","code_information":[{"code":"Px00098110744","type":"CDM"},{"code":"25605","type":"HCPCS"}],"standard_charges":[{"gross_charge":3720.0,"discounted_cash":2790.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 25622 TREAT WRIST BONE FRACTURE CDM","code_information":[{"code":"Px00098110746","type":"CDM"},{"code":"25622","type":"HCPCS"}],"standard_charges":[{"gross_charge":2087.0,"discounted_cash":1565.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 25624 TREAT WRIST BONE FRACTURE W/MANIPULATION CDM","code_information":[{"code":"Px00098110748","type":"CDM"},{"code":"25624","type":"HCPCS"}],"standard_charges":[{"gross_charge":3246.0,"discounted_cash":2434.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 25630 TREAT CARPAL BONE FRACTURE W/O MANIP EACH BONE CDM","code_information":[{"code":"Px00098110750","type":"CDM"},{"code":"25630","type":"HCPCS"}],"standard_charges":[{"gross_charge":2087.0,"discounted_cash":1565.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 25635 TREAT CARPAL BONE FRACTURE W/MANIPULATOPM EACH BONE CDM","code_information":[{"code":"Px00098110752","type":"CDM"},{"code":"25635","type":"HCPCS"}],"standard_charges":[{"gross_charge":3082.0,"discounted_cash":2311.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 25650 TREAT ULNAR STYLOID FRACTURE CDM","code_information":[{"code":"Px00098110754","type":"CDM"},{"code":"25650","type":"HCPCS"}],"standard_charges":[{"gross_charge":2251.0,"discounted_cash":1688.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 25660 TREAT WRIST DISLOCATION W/MANIPULATION CDM","code_information":[{"code":"Px00098110756","type":"CDM"},{"code":"25660","type":"HCPCS"}],"standard_charges":[{"gross_charge":3265.0,"discounted_cash":2448.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 25675 TREAT DISTAL RADIOULNAR DISLOCATION W/MANIP CDM","code_information":[{"code":"Px00098110757","type":"CDM"},{"code":"25675","type":"HCPCS"}],"standard_charges":[{"gross_charge":3006.0,"discounted_cash":2254.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 25680 TREAT TRANS-SCAPHOPERIULNAR FRACTURE W/MANIP CDM","code_information":[{"code":"Px00098110759","type":"CDM"},{"code":"25680","type":"HCPCS"}],"standard_charges":[{"gross_charge":3846.0,"discounted_cash":2884.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 26010 DRAINAGE OF FINGER ABSCESS - SMPL CDM","code_information":[{"code":"Px00098110761","type":"CDM"},{"code":"26010","type":"HCPCS"}],"standard_charges":[{"gross_charge":1012.0,"discounted_cash":759.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 26011 DRAINAGE OF FINGER ABSCESS COMP CDM","code_information":[{"code":"Px00098110762","type":"CDM"},{"code":"26011","type":"HCPCS"}],"standard_charges":[{"gross_charge":1333.0,"discounted_cash":999.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 26350 REPAIR FINGER/HAND TENDON CDM","code_information":[{"code":"Px00098110763","type":"CDM"},{"code":"26350","type":"HCPCS"}],"standard_charges":[{"gross_charge":5412.0,"discounted_cash":4059.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 26410 REPAIR EXTENSOR TENDON HAND W/OGRAFT CDM","code_information":[{"code":"Px00098110765","type":"CDM"},{"code":"26410","type":"HCPCS"}],"standard_charges":[{"gross_charge":4370.0,"discounted_cash":3277.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 26418 REPAIR OF EXTENSOR TENDON FINGER W/O GRAFT CDM","code_information":[{"code":"Px00098110767","type":"CDM"},{"code":"26418","type":"HCPCS"}],"standard_charges":[{"gross_charge":4534.0,"discounted_cash":3400.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 26600 TREAT METACARPAL FRACTURE SINGLE W/O MANIP CDM","code_information":[{"code":"Px00098110770","type":"CDM"},{"code":"26600","type":"HCPCS"}],"standard_charges":[{"gross_charge":2104.0,"discounted_cash":1578.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 26600 TREAT METACARPAL FRACTURE SINGLE W/O MANIP CDM","code_information":[{"code":"Px00098110771","type":"CDM"},{"code":"26600","type":"HCPCS"}],"standard_charges":[{"gross_charge":2104.0,"discounted_cash":1578.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 26605 TREAT METACARPAL FRACTURE SINGLE W/MANIP CDM","code_information":[{"code":"Px00098110773","type":"CDM"},{"code":"26605","type":"HCPCS"}],"standard_charges":[{"gross_charge":2182.0,"discounted_cash":1636.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 26641 TREAT CARPOMETACARPAL DISLOCATION W/MANIP CDM","code_information":[{"code":"Px00098110775","type":"CDM"},{"code":"26641","type":"HCPCS"}],"standard_charges":[{"gross_charge":2787.0,"discounted_cash":2090.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 26645 TX CARPOMETACARPAL FRACTURE/DISLOCATION W/MANIP CDM","code_information":[{"code":"Px00098110777","type":"CDM"},{"code":"26645","type":"HCPCS"}],"standard_charges":[{"gross_charge":2880.0,"discounted_cash":2160.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 26670 CLTX CARPO/METACARPL DISLC NOT THMB MANJ EA W/O ANES CDM","code_information":[{"code":"Px00098110779","type":"CDM"},{"code":"26670","type":"HCPCS"}],"standard_charges":[{"gross_charge":2280.0,"discounted_cash":1710.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 26700 TREAT KNUCKLE DISLOCATION W/O ANESTH CDM","code_information":[{"code":"Px00098110781","type":"CDM"},{"code":"26700","type":"HCPCS"}],"standard_charges":[{"gross_charge":2294.0,"discounted_cash":1720.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 26705 TREAT KNUCKLE DISLOCATION W/ANESTH CDM","code_information":[{"code":"Px00098110782","type":"CDM"},{"code":"26705","type":"HCPCS"}],"standard_charges":[{"gross_charge":2894.0,"discounted_cash":2170.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 26720 CLOSED TX PHALANGEAL SHAFT FRACTURE FING OR THMB W/O MA CDM","code_information":[{"code":"Px00098110783","type":"CDM"},{"code":"26720","type":"HCPCS"}],"standard_charges":[{"gross_charge":1388.0,"discounted_cash":1041.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 26725 CLOSED TX PHALANGEAL SHAFT FRACTURE FING OR THMB W/MANI CDM","code_information":[{"code":"Px00098110786","type":"CDM"},{"code":"26725","type":"HCPCS"}],"standard_charges":[{"gross_charge":2230.0,"discounted_cash":1672.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 26740 CLOSED TX ARTICULAR FRACTURE W/O MANIP CDM","code_information":[{"code":"Px00098110788","type":"CDM"},{"code":"26740","type":"HCPCS"}],"standard_charges":[{"gross_charge":1618.0,"discounted_cash":1213.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 26742 CLOSED TX ARTICULAR FRACTURE W/MANIP CDM","code_information":[{"code":"Px00098110790","type":"CDM"},{"code":"26742","type":"HCPCS"}],"standard_charges":[{"gross_charge":2459.0,"discounted_cash":1844.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 26750 CLOSED TX DISTAL PHALANGEAL FRACTURE FING/THMB W/O MANI CDM","code_information":[{"code":"Px00098110792","type":"CDM"},{"code":"26750","type":"HCPCS"}],"standard_charges":[{"gross_charge":1395.0,"discounted_cash":1046.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 26755 CLOSED TX DISTAL PHALANGEAL FRACTURE FING/THMB W/MANIP CDM","code_information":[{"code":"Px00098110794","type":"CDM"},{"code":"26755","type":"HCPCS"}],"standard_charges":[{"gross_charge":2016.0,"discounted_cash":1512.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 26765 OPEN TX DISTAL PHALANGEAL FRACTURE FINGER/THUMB EA CDM","code_information":[{"code":"Px00098110795","type":"CDM"},{"code":"26765","type":"HCPCS"}],"standard_charges":[{"gross_charge":3637.0,"discounted_cash":2727.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 26770 CLOSED TX FINGER DISLOCATION W/O ANESTH CDM","code_information":[{"code":"Px00098110798","type":"CDM"},{"code":"26770","type":"HCPCS"}],"standard_charges":[{"gross_charge":1921.0,"discounted_cash":1440.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 26775 CLOSED TX FINGER DISLOCATION W/ANESTH CDM","code_information":[{"code":"Px00098110800","type":"CDM"},{"code":"26775","type":"HCPCS"}],"standard_charges":[{"gross_charge":2597.0,"discounted_cash":1947.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 56405 I & D OF VULVA/PERINEUM CDM","code_information":[{"code":"Px00098110802","type":"CDM"},{"code":"56405","type":"HCPCS"}],"standard_charges":[{"gross_charge":912.0,"discounted_cash":684.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 56420 DRAINAGE OF GLAND ABSCESS CDM","code_information":[{"code":"Px00098110803","type":"CDM"},{"code":"56420","type":"HCPCS"}],"standard_charges":[{"gross_charge":797.0,"discounted_cash":597.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 57020 DRAINAGE OF PELVIC FLUID CDM","code_information":[{"code":"Px00098110804","type":"CDM"},{"code":"57020","type":"HCPCS"}],"standard_charges":[{"gross_charge":564.0,"discounted_cash":423.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 57180 TREAT VAGINAL BLEEDING CDM","code_information":[{"code":"Px00098110806","type":"CDM"},{"code":"57180","type":"HCPCS"}],"standard_charges":[{"gross_charge":871.0,"discounted_cash":653.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 57510 CAUTERIZATION OF CERVIX CDM","code_information":[{"code":"Px00098110807","type":"CDM"},{"code":"57510","type":"HCPCS"}],"standard_charges":[{"gross_charge":800.0,"discounted_cash":600.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 58301 REMOVE INTRAUTERINE DEVICE CDM","code_information":[{"code":"Px00098110808","type":"CDM"},{"code":"58301","type":"HCPCS"}],"standard_charges":[{"gross_charge":469.0,"discounted_cash":351.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 61070 BRAIN CANAL SHUNT PROCEDURE CDM","code_information":[{"code":"Px00098110809","type":"CDM"},{"code":"61070","type":"HCPCS"}],"standard_charges":[{"gross_charge":400.0,"discounted_cash":300.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 62000 TREAT SKULL FRACTURE CDM","code_information":[{"code":"Px00098110810","type":"CDM"},{"code":"62000","type":"HCPCS"}],"standard_charges":[{"gross_charge":7468.0,"discounted_cash":5601.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 62270 SPINAL FLUID TAP DIAGNOSTIC CDM","code_information":[{"code":"Px00098110812","type":"CDM"},{"code":"62270","type":"HCPCS"}],"standard_charges":[{"gross_charge":443.0,"discounted_cash":332.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 64400 NERVE BLOCK INJ TRIGEMINAL CDM","code_information":[{"code":"Px00098110814","type":"CDM"},{"code":"64400","type":"HCPCS"}],"standard_charges":[{"gross_charge":357.0,"discounted_cash":267.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 64421 INJECTION AA&/STRD INTERCOSTAL NRV EA ADDL LVL CDM","code_information":[{"code":"Px00098110816","type":"CDM"},{"code":"64421","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.0,"discounted_cash":128.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 64450 NERVE BLOCK OTHER PERIPHERAL CDM","code_information":[{"code":"Px00098110817","type":"CDM"},{"code":"64450","type":"HCPCS"}],"standard_charges":[{"gross_charge":295.0,"discounted_cash":221.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 65205 REMOVE FOREIGN BODY FROM EYE SUPERFICIAL CDM","code_information":[{"code":"Px00098110818","type":"CDM"},{"code":"65205","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":153.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 65210 REMOVE FOREIGN BODY FROM EYE EMBEDDED CDM","code_information":[{"code":"Px00098110819","type":"CDM"},{"code":"65210","type":"HCPCS"}],"standard_charges":[{"gross_charge":252.0,"discounted_cash":189.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 65220 REMOVE FOREIGN BODY FROM EYE CORNEAL W/O SLIT LAMP CDM","code_information":[{"code":"Px00098110820","type":"CDM"},{"code":"65220","type":"HCPCS"}],"standard_charges":[{"gross_charge":293.0,"discounted_cash":219.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 65222 REMOVE FOREIGN BODY FROM EYE CORNEAL W/ SLIT LAMP CDM","code_information":[{"code":"Px00098110821","type":"CDM"},{"code":"65222","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.0,"discounted_cash":262.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 65290 REPAIR OF EYE SOCKET WOUND CDM","code_information":[{"code":"Px00098110822","type":"CDM"},{"code":"65290","type":"HCPCS"}],"standard_charges":[{"gross_charge":3432.0,"discounted_cash":2574.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 65435 CURETTE/TREAT CORNEA CDM","code_information":[{"code":"Px00098110823","type":"CDM"},{"code":"65435","type":"HCPCS"}],"standard_charges":[{"gross_charge":483.0,"discounted_cash":362.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 65600 REVISION OF CORNEA CDM","code_information":[{"code":"Px00098110824","type":"CDM"},{"code":"65600","type":"HCPCS"}],"standard_charges":[{"gross_charge":2380.0,"discounted_cash":1785.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 67700 DRAINAGE OF EYELID ABSCESS CDM","code_information":[{"code":"Px00098110825","type":"CDM"},{"code":"67700","type":"HCPCS"}],"standard_charges":[{"gross_charge":816.0,"discounted_cash":612.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 67938 REMOVE EYELID FOREIGN BODY CDM","code_information":[{"code":"Px00098110826","type":"CDM"},{"code":"67938","type":"HCPCS"}],"standard_charges":[{"gross_charge":831.0,"discounted_cash":623.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 69000 DRAIN EXTERNAL EAR LESION SIMPLE CDM","code_information":[{"code":"Px00098110827","type":"CDM"},{"code":"69000","type":"HCPCS"}],"standard_charges":[{"gross_charge":893.0,"discounted_cash":669.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 69005 DRAIN EXTERNAL EAR LESION COMPLICATED CDM","code_information":[{"code":"Px00098110828","type":"CDM"},{"code":"69005","type":"HCPCS"}],"standard_charges":[{"gross_charge":1145.0,"discounted_cash":858.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 69020 DRAIN OUTER EAR CANAL LESION CDM","code_information":[{"code":"Px00098110829","type":"CDM"},{"code":"69020","type":"HCPCS"}],"standard_charges":[{"gross_charge":1035.0,"discounted_cash":776.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 69200 CLEAR OUTER EAR CANAL W/O GENERAL ANESTHESIA CDM","code_information":[{"code":"Px00098110830","type":"CDM"},{"code":"69200","type":"HCPCS"}],"standard_charges":[{"gross_charge":336.0,"discounted_cash":252.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 69210 REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT CDM","code_information":[{"code":"Px00098110831","type":"CDM"},{"code":"69210","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.0,"discounted_cash":173.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 64420 NERVE BLOCK INJ INTERCOSTA SINGLE CDM","code_information":[{"code":"Px00098110833","type":"CDM"},{"code":"64420","type":"HCPCS"}],"standard_charges":[{"gross_charge":412.0,"discounted_cash":309.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 26951 AMPUTATE FINGER/THUMB SINGLE W/DIRECT CLOSURE CDM","code_information":[{"code":"Px00098110835","type":"CDM"},{"code":"26951","type":"HCPCS"}],"standard_charges":[{"gross_charge":5077.0,"discounted_cash":3807.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 27200 TREAT TAIL BONE FRACTURE CDM","code_information":[{"code":"Px00098110839","type":"CDM"},{"code":"27200","type":"HCPCS"}],"standard_charges":[{"gross_charge":1373.0,"discounted_cash":1029.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 27220 TREAT HIP SOCKET FRACTURE CDM","code_information":[{"code":"Px00098110841","type":"CDM"},{"code":"27220","type":"HCPCS"}],"standard_charges":[{"gross_charge":2975.0,"discounted_cash":2231.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 27230 TX THIGH FRACTURE PROX END NECK W/O MANIP CDM","code_information":[{"code":"Px00098110844","type":"CDM"},{"code":"27230","type":"HCPCS"}],"standard_charges":[{"gross_charge":3456.0,"discounted_cash":2592.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 27238 CLD TX INTER/PERI/OR SUB-TROCHANTERIC THIGH FX W/O MANIP CDM","code_information":[{"code":"Px00098110845","type":"CDM"},{"code":"27238","type":"HCPCS"}],"standard_charges":[{"gross_charge":3380.0,"discounted_cash":2535.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 27246 CLOSED TX GREATER TROCHANTERIC FRACTURE W/O MANIP CDM","code_information":[{"code":"Px00098110848","type":"CDM"},{"code":"27246","type":"HCPCS"}],"standard_charges":[{"gross_charge":2801.0,"discounted_cash":2100.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 27250 CLOSED TX HIP DISLOCATION W/O ANESTH CDM","code_information":[{"code":"Px00098110850","type":"CDM"},{"code":"27250","type":"HCPCS"}],"standard_charges":[{"gross_charge":1278.0,"discounted_cash":958.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 27252 CLOSED TX HIP DISLOCATION W/ANESTH CDM","code_information":[{"code":"Px00098110851","type":"CDM"},{"code":"27252","type":"HCPCS"}],"standard_charges":[{"gross_charge":5395.0,"discounted_cash":4046.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 27265 TX POST HIP ARTHROPLASTY DISLOCATION W/O ANESTH CDM","code_information":[{"code":"Px00098110854","type":"CDM"},{"code":"27265","type":"HCPCS"}],"standard_charges":[{"gross_charge":3015.0,"discounted_cash":2261.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 27266 TX POST HIP ARTHROPLASTY DISLOCATION W/ANESTH CDM","code_information":[{"code":"Px00098110855","type":"CDM"},{"code":"27266","type":"HCPCS"}],"standard_charges":[{"gross_charge":4205.0,"discounted_cash":3153.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 26952 AMPUTATE FINGER/THUMB SINGLE W/LOCAL ADV FLAPS CDM","code_information":[{"code":"Px00098110858","type":"CDM"},{"code":"26952","type":"HCPCS"}],"standard_charges":[{"gross_charge":4960.0,"discounted_cash":3720.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 24201 REMOVAL OF ARM FOREIGN BODY ARM/ELBOW CDM","code_information":[{"code":"Px00098110863","type":"CDM"},{"code":"24201","type":"HCPCS"}],"standard_charges":[{"gross_charge":2639.0,"discounted_cash":1979.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 27301 DRAIN THIGH/KNEE LESION CDM","code_information":[{"code":"Px00098110864","type":"CDM"},{"code":"27301","type":"HCPCS"}],"standard_charges":[{"gross_charge":3641.0,"discounted_cash":2730.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 27372 REMOVAL OF FOREIGN BODY DEEP CDM","code_information":[{"code":"Px00098110865","type":"CDM"},{"code":"27372","type":"HCPCS"}],"standard_charges":[{"gross_charge":2877.0,"discounted_cash":2157.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 27500 CLOSED TREAT FEMORAL SHAFT FRACTURE W/O MANIP CDM","code_information":[{"code":"Px00098110866","type":"CDM"},{"code":"27500","type":"HCPCS"}],"standard_charges":[{"gross_charge":3480.0,"discounted_cash":2610.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 27508 TREAT FEMORAL FRACTURE W/O MANIPULATION CDM","code_information":[{"code":"Px00098110871","type":"CDM"},{"code":"27508","type":"HCPCS"}],"standard_charges":[{"gross_charge":3606.0,"discounted_cash":2704.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 27520 CLOSED TX PATELLAR FRACTURE W/O MANIPULATION CDM","code_information":[{"code":"Px00098110873","type":"CDM"},{"code":"27520","type":"HCPCS"}],"standard_charges":[{"gross_charge":2206.0,"discounted_cash":1654.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 27530 CLTX TIBIAL FX PROXIMAL W/O MANIPULATION CDM","code_information":[{"code":"Px00098110876","type":"CDM"},{"code":"27530","type":"HCPCS"}],"standard_charges":[{"gross_charge":2118.0,"discounted_cash":1588.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 27550 TREAT KNEE DISLOCATION CDM","code_information":[{"code":"Px00098110878","type":"CDM"},{"code":"27550","type":"HCPCS"}],"standard_charges":[{"gross_charge":3432.0,"discounted_cash":2574.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 27552 CLOSED TREAT KNEE DISLOCATION W/ANESTH CDM","code_information":[{"code":"Px00098110879","type":"CDM"},{"code":"27552","type":"HCPCS"}],"standard_charges":[{"gross_charge":4560.0,"discounted_cash":3420.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 27560 CLOSED TREAT KNEE DISLOCATION W/O ANESTH CDM","code_information":[{"code":"Px00098110881","type":"CDM"},{"code":"27560","type":"HCPCS"}],"standard_charges":[{"gross_charge":2501.0,"discounted_cash":1875.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 27562 CLOSED TREAT PATELLA DISLOCATION W/ANSETH CDM","code_information":[{"code":"Px00098110882","type":"CDM"},{"code":"27562","type":"HCPCS"}],"standard_charges":[{"gross_charge":3549.0,"discounted_cash":2661.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 27603 DRAIN LOWER LEG LESION DEEP CDM","code_information":[{"code":"Px00098110884","type":"CDM"},{"code":"27603","type":"HCPCS"}],"standard_charges":[{"gross_charge":2801.0,"discounted_cash":2100.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 27750 CLOSED TREAT TIB SHAFT FRACTURE W/O MANIP CDM","code_information":[{"code":"Px00098110888","type":"CDM"},{"code":"27750","type":"HCPCS"}],"standard_charges":[{"gross_charge":2361.0,"discounted_cash":1770.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 27752 CLOSED TREAT TIBIAL FRACTURE W/MANIPULATION CDM","code_information":[{"code":"Px00098110890","type":"CDM"},{"code":"27752","type":"HCPCS"}],"standard_charges":[{"gross_charge":3558.0,"discounted_cash":2668.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 27760 CLOSED TX OF MEDIAL MALLEOLUS FRACTURE W/O MANIP CDM","code_information":[{"code":"Px00098110892","type":"CDM"},{"code":"27760","type":"HCPCS"}],"standard_charges":[{"gross_charge":2240.0,"discounted_cash":1680.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 27762 CLOSED TX OF MEDIAL MALLEOLUS FRACTURE W/MANIP CDM","code_information":[{"code":"Px00098110895","type":"CDM"},{"code":"27762","type":"HCPCS"}],"standard_charges":[{"gross_charge":3177.0,"discounted_cash":2382.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 27766 OPEN TREATMENT OF MEDIAL MALLEOLUS FRACTURE CDM","code_information":[{"code":"Px00098110896","type":"CDM"},{"code":"27766","type":"HCPCS"}],"standard_charges":[{"gross_charge":4360.0,"discounted_cash":3270.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 27780 CLOSED TX OF FIBULA FRACTURE PROX W/O MANIP CDM","code_information":[{"code":"Px00098110898","type":"CDM"},{"code":"27780","type":"HCPCS"}],"standard_charges":[{"gross_charge":2087.0,"discounted_cash":1565.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 27781 CLOSED TX OF FIBULA FRACTURE PROX W/MANIP CDM","code_information":[{"code":"Px00098110900","type":"CDM"},{"code":"27781","type":"HCPCS"}],"standard_charges":[{"gross_charge":2939.0,"discounted_cash":2204.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 99175 INDUCTION OF VOMITING CDM","code_information":[{"code":"Px00098110902","type":"CDM"},{"code":"99175","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":160.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 28600 TREAT FOOT DISLOCATION W/O ANESTH CDM","code_information":[{"code":"Px00098110905","type":"CDM"},{"code":"28600","type":"HCPCS"}],"standard_charges":[{"gross_charge":1345.0,"discounted_cash":1008.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 29130 APLICATION OF FINGER SPLINT STATIC CDM","code_information":[{"code":"Px00098110906","type":"CDM"},{"code":"29130","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":156.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 49082 ABD PARACENT W/O IMAG GUID CDM","code_information":[{"code":"Px00098110907","type":"CDM"},{"code":"49082","type":"HCPCS"}],"standard_charges":[{"gross_charge":514.0,"discounted_cash":385.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 49083 ABD PARACENT W/IMAG GUIDANCE CDM","code_information":[{"code":"Px00098110908","type":"CDM"},{"code":"49083","type":"HCPCS"}],"standard_charges":[{"gross_charge":743.0,"discounted_cash":557.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 32557 INSERT CATH PLEURA W/ IMAG GD CDM","code_information":[{"code":"Px00098110928","type":"CDM"},{"code":"32557","type":"HCPCS"}],"standard_charges":[{"gross_charge":1042.0,"discounted_cash":781.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 32556 INSERT CATH PLEURA W/O IMAG GD CDM","code_information":[{"code":"Px00098110929","type":"CDM"},{"code":"32556","type":"HCPCS"}],"standard_charges":[{"gross_charge":869.0,"discounted_cash":651.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 32555 THORACENTESIS/ASPIR W IMG GD CDM","code_information":[{"code":"Px00098110930","type":"CDM"},{"code":"32555","type":"HCPCS"}],"standard_charges":[{"gross_charge":764.0,"discounted_cash":573.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 32554 THORACENTESIS/ASPIR W/O IMG GD CDM","code_information":[{"code":"Px00098110931","type":"CDM"},{"code":"32554","type":"HCPCS"}],"standard_charges":[{"gross_charge":619.0,"discounted_cash":464.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 24565 ER CLOSED TX HUMERAL EPICOND FX ME/LA W/ CDM","code_information":[{"code":"Px00098110934","type":"CDM"},{"code":"24565","type":"HCPCS"}],"standard_charges":[{"gross_charge":3599.0,"discounted_cash":2699.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 65235 ER REMOVAL F/B INTRAOCULAR CDM","code_information":[{"code":"Px00098110935","type":"CDM"},{"code":"65235","type":"HCPCS"}],"standard_charges":[{"gross_charge":5191.0,"discounted_cash":3893.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 28635 TREAT TOE DISLOCATION W/MANIPULATION W/ANESTH CDM","code_information":[{"code":"Px00098110941","type":"CDM"},{"code":"28635","type":"HCPCS"}],"standard_charges":[{"gross_charge":957.0,"discounted_cash":717.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 76512 OPHTH US B W/NON-QUANT A CDM","code_information":[{"code":"Px00098110952","type":"CDM"},{"code":"76512","type":"HCPCS"}],"standard_charges":[{"gross_charge":340.0,"discounted_cash":255.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 76536 HEAD AND NECK SOFT TISSUES CDM","code_information":[{"code":"Px00098110955","type":"CDM"},{"code":"76536","type":"HCPCS"}],"standard_charges":[{"gross_charge":797.0,"discounted_cash":597.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 43460 PRESSURE TREATMENT ESOPHAGUS CDM","code_information":[{"code":"Px00098110956","type":"CDM"},{"code":"43460","type":"HCPCS"}],"standard_charges":[{"gross_charge":1483.0,"discounted_cash":1112.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 64415 INJECTION AA&/STRD BRACHIAL PLEXUS W/IMG GDN CDM","code_information":[{"code":"Px00098110982","type":"CDM"},{"code":"64415","type":"HCPCS"}],"standard_charges":[{"gross_charge":255.0,"discounted_cash":191.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 93248 EXTERNAL ECG REC/ GT 7 DAYS/ UP TO 15 DAYS R&I CDM","code_information":[{"code":"Px00098300183","type":"CDM"},{"code":"93248","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":71.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 93242 EXTERNAL ECG REC/ GT 48 HRS/ UP TO 7DAYS RECORDING CDM","code_information":[{"code":"Px00098300188","type":"CDM"},{"code":"93242","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":48.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 93356 MYOCRD STRAIN IMG SPECKLE TRCK ASSMT MYOCRD MECH CDM","code_information":[{"code":"Px00098300273","type":"CDM"},{"code":"93356","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":47.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 99203 NEW PT VISIT - LEVEL 3","code_information":[{"code":"Px00098310003","type":"CDM"},{"code":"99203","type":"HCPCS"}],"standard_charges":[{"gross_charge":328.0,"discounted_cash":246.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 99204 NEW PT VISIT - LEVEL 4","code_information":[{"code":"Px00098310004","type":"CDM"},{"code":"99204","type":"HCPCS"}],"standard_charges":[{"gross_charge":526.0,"discounted_cash":394.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 99212 ESTAB PT VISIT - LEVEL 2","code_information":[{"code":"Px00098310007","type":"CDM"},{"code":"99212","type":"HCPCS"}],"standard_charges":[{"gross_charge":127.0,"discounted_cash":95.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 99213 ESTAB PT VISIT - LEVEL 3","code_information":[{"code":"Px00098310008","type":"CDM"},{"code":"99213","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.0,"discounted_cash":175.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 99214 ESTAB PT VISIT - LEVEL 4","code_information":[{"code":"Px00098310009","type":"CDM"},{"code":"99214","type":"HCPCS"}],"standard_charges":[{"gross_charge":343.0,"discounted_cash":257.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 99450 PP EXAM BASIC LIFE AND/OR DISABILITY EXAMINATION","code_information":[{"code":"Px00098310012","type":"CDM"},{"code":"99450","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":87.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 99499 EXAM, INTERMEDIATE CNTR","code_information":[{"code":"Px00098310018","type":"CDM"},{"code":"99499","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":71.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 64435 N BLOCK INJ, PARACERVICAL","code_information":[{"code":"Px00098310195","type":"CDM"},{"code":"64435","type":"HCPCS"}],"standard_charges":[{"gross_charge":307.0,"discounted_cash":230.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR 11104 PUNCH BIOPSY SKIN SINGLE LESION","code_information":[{"code":"Px00098310202","type":"CDM"},{"code":"11104","type":"HCPCS"}],"standard_charges":[{"gross_charge":331.0,"discounted_cash":248.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR 11105 PUNCH BIOPSY SKIN EA SEP/ADDITIONAL LESION","code_information":[{"code":"Px00098310203","type":"CDM"},{"code":"11105","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.0,"discounted_cash":135.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR 11106 INCISIONAL BIOPSY SKIN SINGLE LESION CDM","code_information":[{"code":"Px00098310204","type":"CDM"},{"code":"11106","type":"HCPCS"}],"standard_charges":[{"gross_charge":397.0,"discounted_cash":297.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR 1063M REVIEW IME REPORT PER 15 MINUTES","code_information":[{"code":"Px00098310281","type":"CDM"},{"code":"1063M","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":112.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR D0019 IME / RVW EA 15 MIN","code_information":[{"code":"Px00098310290","type":"CDM"},{"code":"D0019","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":135.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR D0030 INSURER CONSULT EA 15 MIN","code_information":[{"code":"Px00098310292","type":"CDM"},{"code":"D0030","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":140.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR N0002 REPORT COMPLEX NARRATIVE (6-10Q)","code_information":[{"code":"Px00098310294","type":"CDM"},{"code":"N0002","type":"HCPCS"}],"standard_charges":[{"gross_charge":196.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 76705 ECHO EXAM OF ABDOMEN","code_information":[{"code":"Px00098310383","type":"CDM"},{"code":"76705","type":"HCPCS"}],"standard_charges":[{"gross_charge":631.0,"discounted_cash":473.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR 11107 INCISIONAL BIOPSY SKIN EA SEP/ADDITIONAL LESION","code_information":[{"code":"Px00098310454","type":"CDM"},{"code":"11107","type":"HCPCS"}],"standard_charges":[{"gross_charge":217.0,"discounted_cash":162.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"}]},{"description":"HC PR 20550 INJ TENDON SHEATH/LIGAMENT","code_information":[{"code":"Px00098311029","type":"CDM"},{"code":"20550","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":103.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 99421 ONLINE DIGITAL E/M SVC EST PT/UP TO 7 DAYS/5-10 MINS CDM","code_information":[{"code":"Px00098311066","type":"CDM"},{"code":"99421","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":34.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 99422 ONLINE DIGITAL E/M SVC EST PT/UP TO 7 DAYS/11-20 MINS CDM","code_information":[{"code":"Px00098311067","type":"CDM"},{"code":"99422","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":67.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 99423 ONLINE DIGITAL E/M SVC EST PT/UP TO 7 DAYS/21 OR MORE MINS CDM","code_information":[{"code":"Px00098311068","type":"CDM"},{"code":"99423","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":108.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 95800 SLP STDY UNATTENDED W/HRT RATE/O2 SAT/RESP/SLP TIME CDM","code_information":[{"code":"Px00098311302","type":"CDM"},{"code":"95800","type":"HCPCS"}],"standard_charges":[{"gross_charge":569.0,"discounted_cash":426.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 99441 WA L&I ATTORNEY/INSUR CALL 5-10 MINS CDM","code_information":[{"code":"Px00098322000","type":"CDM"},{"code":"99441","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":93.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 99442 WA L&I ATTORNEY/INSUR CALL 11-20 MINS CDM","code_information":[{"code":"Px00098322001","type":"CDM"},{"code":"99442","type":"HCPCS"}],"standard_charges":[{"gross_charge":233.0,"discounted_cash":174.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 93244 EXTERNAL ECG REC/ GT 48HRS/ UP TO 7 DAYS REVIEW & INTERPRET CDM","code_information":[{"code":"Px00098500001","type":"CDM"},{"code":"93244","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":64.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 93010 ECG 12 LEAD INTERP & REPT ONLY","code_information":[{"code":"Px00098510001","type":"CDM"},{"code":"93010","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":114.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 93016 CARDIO STRESS TEST PHYS SUPV ONLY","code_information":[{"code":"Px00098510002","type":"CDM"},{"code":"93016","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":57.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 93018 CARDIO STRESS TEST INTERP & REPT","code_information":[{"code":"Px00098510003","type":"CDM"},{"code":"93018","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":37.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 93303 ECHO TTE CONGENITAL COMPLETE","code_information":[{"code":"Px00098510006","type":"CDM"},{"code":"93303","type":"HCPCS"}],"standard_charges":[{"gross_charge":1747.0,"discounted_cash":1310.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 93304 ECHO TTE CONGENITAL LTD","code_information":[{"code":"Px00098510007","type":"CDM"},{"code":"93304","type":"HCPCS"}],"standard_charges":[{"gross_charge":832.0,"discounted_cash":624.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 93306 ECHO TTE 2D W/COLOR & DOP","code_information":[{"code":"Px00098510008","type":"CDM"},{"code":"93306","type":"HCPCS"}],"standard_charges":[{"gross_charge":710.0,"discounted_cash":532.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 93227 HOLTER MONITOR PHYS REVIEW & INTERP","code_information":[{"code":"Px00098510016","type":"CDM"},{"code":"93227","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":98.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 93272 CARDIAC EVENT PHYS REVIEW & INTERP","code_information":[{"code":"Px00098510017","type":"CDM"},{"code":"93272","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":66.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 93308 ECHO TTE 2D M-MODE LTD","code_information":[{"code":"Px00098510019","type":"CDM"},{"code":"93308","type":"HCPCS"}],"standard_charges":[{"gross_charge":700.0,"discounted_cash":525.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD EMERGENCY PHYSICIANS"},{"gross_charge":353.0,"discounted_cash":264.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 93312 ECHO TEE PROBE IMAGE & REPT","code_information":[{"code":"Px00098510020","type":"CDM"},{"code":"93312","type":"HCPCS"}],"standard_charges":[{"gross_charge":1747.0,"discounted_cash":1310.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 93320 ECHO DOPPLER PULSE CONTIN COMP","code_information":[{"code":"Px00098510021","type":"CDM"},{"code":"93320","type":"HCPCS"}],"standard_charges":[{"gross_charge":220.0,"discounted_cash":165.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 93321 ECHO DOPPLER PULSE CONTIN LTD","code_information":[{"code":"Px00098510022","type":"CDM"},{"code":"93321","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":68.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 93350 ECHO STRESS TEST W/INTERP & REPT","code_information":[{"code":"Px00098510023","type":"CDM"},{"code":"93350","type":"HCPCS"}],"standard_charges":[{"gross_charge":674.0,"discounted_cash":505.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 93325 ECHO DOPPLER COLOR VELOCITY MAP","code_information":[{"code":"Px00098510039","type":"CDM"},{"code":"93325","type":"HCPCS"}],"standard_charges":[{"gross_charge":281.0,"discounted_cash":210.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 95813 EEG OVER 1 HOUR","code_information":[{"code":"Px00098610008","type":"CDM"},{"code":"95813","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":225.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 95816 EEG AWAKE AND DROWSY","code_information":[{"code":"Px00098610009","type":"CDM"},{"code":"95816","type":"HCPCS"}],"standard_charges":[{"gross_charge":1361.0,"discounted_cash":1020.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 95819 EEG AWAKE AND ASLEEP","code_information":[{"code":"Px00098610010","type":"CDM"},{"code":"95819","type":"HCPCS"}],"standard_charges":[{"gross_charge":1597.0,"discounted_cash":1197.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 95717 EEG PHYS/QHP 2-12 HR WITHOUT VIDEO CDM","code_information":[{"code":"Px00098610088","type":"CDM"},{"code":"95717","type":"HCPCS"}],"standard_charges":[{"gross_charge":353.0,"discounted_cash":264.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 95718 EEG PHYS/QHP 2-12 HR WITH VEEG CDM","code_information":[{"code":"Px00098610090","type":"CDM"},{"code":"95718","type":"HCPCS"}],"standard_charges":[{"gross_charge":470.0,"discounted_cash":352.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 95719 EEG PHYS/QHP EA INCR GT 12HR LT 26HR AFTER 24HR WO VID CDM","code_information":[{"code":"Px00098610091","type":"CDM"},{"code":"95719","type":"HCPCS"}],"standard_charges":[{"gross_charge":548.0,"discounted_cash":411.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 95720 EEG PHYS/QHP EA INCR GT 12HR LT 26HR AFTER 24HR W/VEEG CDM","code_information":[{"code":"Px00098610092","type":"CDM"},{"code":"95720","type":"HCPCS"}],"standard_charges":[{"gross_charge":724.0,"discounted_cash":543.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 95721 EEG COMPLETE STD PHYS/QHP GT 36 HR LT 60 HR W/O VIDEO CDM","code_information":[{"code":"Px00098610093","type":"CDM"},{"code":"95721","type":"HCPCS"}],"standard_charges":[{"gross_charge":720.0,"discounted_cash":540.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 95722 EEG COMPLETE STD PHYS/QHP GT 36 HR LT 60 HR W/VEEG CDM","code_information":[{"code":"Px00098610094","type":"CDM"},{"code":"95722","type":"HCPCS"}],"standard_charges":[{"gross_charge":878.0,"discounted_cash":658.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 95723 EEG COMPLETE STD PHYS/QHP GT 60 HR LT 84 HR W/O VIDEO CDM","code_information":[{"code":"Px00098610095","type":"CDM"},{"code":"95723","type":"HCPCS"}],"standard_charges":[{"gross_charge":884.0,"discounted_cash":663.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 95724 EEG COMPLETE STD PHYS/QHP GT 60 HR LT 84 HR W/VEEG CDM","code_information":[{"code":"Px00098610096","type":"CDM"},{"code":"95724","type":"HCPCS"}],"standard_charges":[{"gross_charge":1116.0,"discounted_cash":837.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 95725 EEG COMPLETE STD PHYS/QHP GT 84 HR W/O VID CDM","code_information":[{"code":"Px00098610097","type":"CDM"},{"code":"95725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1014.0,"discounted_cash":760.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"HC PR 95726 EEG COMPLETE STD PHYS/QHP GT 84 HR W/VEEG CDM","code_information":[{"code":"Px00098610098","type":"CDM"},{"code":"95726","type":"HCPCS"}],"standard_charges":[{"gross_charge":1417.0,"discounted_cash":1062.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION (Unit Price)"}]},{"description":"DEPOMEDROL 80 MG/ML 1ML WITH BUPIVACAINE 0.25% MPF 10ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx0000-0016-7","type":"CDM"},{"code":"0000-0016-79","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"RUM LIQUID","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000000066","type":"CDM"},{"code":"00000000066","type":"NDC"}],"standard_charges":[{"gross_charge":0.5,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"VODKA LIQUID","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000000119","type":"CDM"},{"code":"00000000119","type":"NDC"}],"standard_charges":[{"gross_charge":0.5,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ON-Q PUMP (C-BLOC) BAG 5 ML/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000000334","type":"CDM"},{"code":"C9804","type":"HCPCS"},{"code":"00000000334","type":"NDC"}],"standard_charges":[{"gross_charge":633.9,"discounted_cash":475.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MORPHINE SULFATE IV SOLN PF 2 MG/ML","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000000338","type":"CDM"},{"code":"00000000338","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MORPHINE SULFATE IV SOLN PF 2 MG/ML","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000000338","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00000000338","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MEPERIDINE HCL INJ 25 MG/ML,MEPERIDINE HCL INJ 50 MG/ML,MEPERIDINE HCL INJ 100 MG/ML,MEPERIDINE HCL INJ 75 MG/ML,MEPERIDINE HCL INJ 25 MG/0.5ML (50 MG/ML),MEPERIDINE HCL INJ 100 MG/2ML (50 MG/ML)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000000339","type":"CDM"},{"code":"J2175","type":"HCPCS"},{"code":"00000000339","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LORAZEPAM INJ 2 MG/ML,LORAZEPAM INJ 4 MG/ML","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000000340","type":"CDM"},{"code":"J2060","type":"HCPCS"},{"code":"00000000340","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"METHACHOLINE 25 MG/ML INHALATION SOLUTION","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx00000000395","type":"CDM"},{"code":"J7674","type":"HCPCS"},{"code":"00000000395","type":"NDC"}],"standard_charges":[{"gross_charge":206.33,"discounted_cash":154.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ALUM & MAG HYDROXIDE-SIMETHICONE SUSP 400-400-40 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00000000417","type":"CDM"},{"code":"00000000417","type":"NDC"}],"standard_charges":[{"gross_charge":0.55,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LIDOCAINE HCL VISCOUS SOLN 2%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00000000425","type":"CDM"},{"code":"00000000425","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ON-Q PUMP (C-BLOC) BAG SELECT-A-FLOW","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000000535","type":"CDM"},{"code":"C9804","type":"HCPCS"},{"code":"00000000535","type":"NDC"}],"standard_charges":[{"gross_charge":648.64,"discounted_cash":486.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FORMALIN 1% IN NORMAL SALINE IRRIGATION 1000 ML","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00000000649","type":"CDM"},{"code":"00000000649","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ADENOSINE 1 MG/ML IN NS 180 ML (PULM HTN)- ONE STEP","drug_information":{"unit":180.0,"type":"ML"},"code_information":[{"code":"Rx00000000662","type":"CDM"},{"code":"00000000662","type":"NDC"}],"standard_charges":[{"gross_charge":1155.35,"discounted_cash":866.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ADENOSINE 1 MG/ML IN NS 270 ML (PULM HTN) - ONE STEP","drug_information":{"unit":270.0,"type":"ML"},"code_information":[{"code":"Rx00000000663","type":"CDM"},{"code":"00000000663","type":"NDC"}],"standard_charges":[{"gross_charge":1733.02,"discounted_cash":1299.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PHYTONADIONE 10 MG/ML PO SOLN (FROM INJ)","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00000000681","type":"CDM"},{"code":"00000000681","type":"NDC"}],"standard_charges":[{"gross_charge":24.31,"discounted_cash":18.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TRANEXAMIC ACID IV SOLN 1000 MG/10ML (100 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000000899","type":"CDM"},{"code":"J3290","type":"HCPCS"},{"code":"00000000899","type":"NDC"}],"standard_charges":[{"gross_charge":88.41,"discounted_cash":66.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TRANEXAMIC ACID IV SOLN 1000 MG/10ML (100 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000000901","type":"CDM"},{"code":"J3290","type":"HCPCS"},{"code":"00000000901","type":"NDC"}],"standard_charges":[{"gross_charge":88.41,"discounted_cash":66.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LIDOCAINE HCL SOLN 4%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000000911","type":"CDM"},{"code":"00000000911","type":"NDC"}],"standard_charges":[{"gross_charge":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MORPHINE LIQUID 0.4 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00000000981","type":"CDM"},{"code":"00000000981","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MULTIPLE VITAMINS W/ MINERALS LIQUID","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00000001175","type":"CDM"},{"code":"00000001175","type":"NDC"}],"standard_charges":[{"gross_charge":0.99,"discounted_cash":0.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FENTANYL-BUPIVACAINE 2 MCG-0.1 %,FENTANYL 0.2 MG/100ML-BUPIV 0.1%-NACL 0.9% EPIDURAL INJ,FENTANYL 0.5 MG/250ML-BUPIV 0.1%-NACL 0.9% PF EPIDURAL INJ","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00000001279","type":"CDM"},{"code":"00000001279","type":"NDC"}],"standard_charges":[{"gross_charge":109.95,"discounted_cash":82.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PHYTONADIONE 10 MG/ML PO SOLN (FROM INJ)","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00000001291","type":"CDM"},{"code":"00000001291","type":"NDC"}],"standard_charges":[{"gross_charge":24.31,"discounted_cash":18.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"EPINEPHRINE INJ 1 MG/ML,EPINEPHRINE PF INJ 1 MG/ML,EPINEPHRINE INJ 1 MG/ML (1:1000),EPINEPHRINE INJ 30 MG/30ML (1 MG/ML) (1:1000),EPINEPHRINE SOLN PREFILLED SYRINGE 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx00000001401","type":"CDM"},{"code":"00000001401","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SIMETHICONE SUSP 40 MG/0.6ML","drug_information":{"unit":0.6,"type":"ML"},"code_information":[{"code":"Rx00000001421","type":"CDM"},{"code":"00000001421","type":"NDC"}],"standard_charges":[{"gross_charge":0.53,"discounted_cash":0.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SILVER NITRATE-POTASSIUM NITRATE APPLICATOR 75-25%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000001499","type":"CDM"},{"code":"00000001499","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DIPHENHYD-LIDOCAINE-AL HYDROXIDE-MG HYDROXIDE-SIMETH","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000001521","type":"CDM"},{"code":"00000001521","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ALTEPLASE CATH DECLOT IN SW INJ 0.5MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00000001532","type":"CDM"},{"code":"J2997","type":"HCPCS"},{"code":"00000001532","type":"NDC"}],"standard_charges":[{"gross_charge":304.7,"discounted_cash":228.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"OXYTOCIN-SODIUM CHLORIDE 0.9% IV SOLN 30 UNIT/500ML","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00000001566","type":"CDM"},{"code":"00000001566","type":"NDC"}],"standard_charges":[{"gross_charge":107.53,"discounted_cash":80.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LORAZEPAM CONC 2 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00000001568","type":"CDM"},{"code":"00000001568","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CEFAZOLIN 1 GM (ANCEF) WITH GENTAMICIN (GARAMYCIN) 80MG","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"Rx00000001677","type":"CDM"},{"code":"J0690","type":"HCPCS"},{"code":"00000001677","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"EPINEPHRINE 1:1000 1ML WITH LIDOCAINE 1% 30 ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00000001681","type":"CDM"},{"code":"00000001681","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PHENYLEPHRINE INJECTION 10MG IN 50ML NS (200MCG/ML CONC) - ONE STEP","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000001831","type":"CDM"},{"code":"00000001831","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"KETAMINE HCL SOLN PREF SYR 100 MG/2ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000002192","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00000002192","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"OXYTOCIN-SODIUM CHLORIDE 0.9% IV SOLN 30 UNIT/500ML","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00000002218","type":"CDM"},{"code":"J7999","type":"HCPCS"},{"code":"00000002218","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"METHADONE HCL CONC 10 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000002229","type":"CDM"},{"code":"00000002229","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MORPHINE SULFATE IV SOLN 5 MG/ML,MORPHINE SULFATE-NACL SOLN PREF SYR 150 MG/30ML-0.9%","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00000002426","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00000002426","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FENTANYL 4 MCG/ML + BUPIVACAINE 0.1% IN NS EPIDURAL (NO PCA)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000002622","type":"CDM"},{"code":"00000002622","type":"NDC"}],"standard_charges":[{"gross_charge":125.34,"discounted_cash":94.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FENTANYL CITRATE-NACL 0.9% IV SOLN 2.5 MG/250ML,FENTANYL CITRATE-NACL PF 0.9% IV SOLN 1 MG/100 ML (10 MCG/ML),FENTANYL CITRATE-NACL 0.9% INJ SOLN 1 MG/100ML,FENTANYL CITRATE-NACL 0.9% INJ SOLN 2.5 MG/250ML,FENTANYL CITRATE IV SOLN 1000 MCG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000002775","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"00000002775","type":"NDC"}],"standard_charges":[{"gross_charge":474.75,"discounted_cash":356.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"AMIODARONE HCL IN DEXTROSE 5% IV SOLN 900 MG/500ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000002877","type":"CDM"},{"code":"J0282","type":"HCPCS"},{"code":"00000002877","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ANTICOAGULANT CITRATE DEXTROSE SOLUTION A","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00000002878","type":"CDM"},{"code":"00000002878","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MISOPROSTOL 25 MCG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000003026","type":"CDM"},{"code":"00000003026","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SPIRONOLACTONE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000003035","type":"CDM"},{"code":"00000003035","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BUPIVACAINE 0.5% DBL LUMN ON-Q PUMP 500 ML","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00000003320","type":"CDM"},{"code":"00000003320","type":"NDC"}],"standard_charges":[{"gross_charge":219.9,"discounted_cash":164.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 1 MG/ML,HYDROMORPHONE HCL INJ 2 MG/ML,HYDROMORPHONE HCL INJ 4 MG/ML,HYDROMORPHONE HCL-NACL SOLN PREF SYR 0.5 MG/ML-0.9%,HYDROMORPHONE HCL-NACL SOLN PREF SYR 1 MG/ML-0.9%,HYDROMORPHONE HCL-NACL SOLN PREF SYR 2 MG/ML-0.9%,HYDROMORPHONE HCL PRESERVATIVE FREE (PF) INJ 1 MG/ML,HYDROMORPHONE HCL PRESERVATIVE FREE (PF) INJ 2 MG/ML,HYDROMORPHONE HCL PRESERVATIVE FREE (PF) INJ 4 MG/ML,HYDROMORPHONE HCL-NACL SOLN PREF SYR 0.2 MG/0.2ML-0.9%,HYDROMORPHONE HCL-NACL SOLN PREF SYR 0.5 MG/0.5ML-0.9%,HYDROMORPHONE HCL INJ 0.5 MG/ML,HYDROMORPHONE HCL INJ 0.2 MG/ML","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000003352","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00000003352","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SODIUM CHLORIDE 0.9% IV SOLN (CHILLED NS)","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00000003583","type":"CDM"},{"code":"J7030","type":"HCPCS"},{"code":"00000003583","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ROPIVACAINE HCL 0.2% ON-Q SINGLE LUMEN PUMP","drug_information":{"unit":400.0,"type":"ML"},"code_information":[{"code":"Rx00000003635","type":"CDM"},{"code":"00000003635","type":"NDC"}],"standard_charges":[{"gross_charge":815.3,"discounted_cash":611.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"METHADONE HCL CONC 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000003663","type":"CDM"},{"code":"00000003663","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BOTULINUM CHEMODENERVATION 50 UNIT/ML 2 ML SYRINGE","drug_information":{"unit":100.0,"type":"UN"},"code_information":[{"code":"Rx00000003775","type":"CDM"},{"code":"J0585","type":"HCPCS"},{"code":"00000003775","type":"NDC"}],"standard_charges":[{"gross_charge":2292.94,"discounted_cash":1719.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BOTULINUM CHEMODENERVATION 100 UNIT/ML 1ML SYRINGE","drug_information":{"unit":100.0,"type":"UN"},"code_information":[{"code":"Rx00000003776","type":"CDM"},{"code":"J0585","type":"HCPCS"},{"code":"00000003776","type":"NDC"}],"standard_charges":[{"gross_charge":2292.94,"discounted_cash":1719.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BOTULINUM CHEMODENERVATION 20 UNIT/ML 5 ML SYRINGE","drug_information":{"unit":100.0,"type":"UN"},"code_information":[{"code":"Rx00000003777","type":"CDM"},{"code":"J0585","type":"HCPCS"},{"code":"00000003777","type":"NDC"}],"standard_charges":[{"gross_charge":2292.94,"discounted_cash":1719.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BOTULINUM CHEMODENERVATION 40 UNIT/ML 2.5 ML SYRINGE","drug_information":{"unit":100.0,"type":"UN"},"code_information":[{"code":"Rx00000003778","type":"CDM"},{"code":"J0585","type":"HCPCS"},{"code":"00000003778","type":"NDC"}],"standard_charges":[{"gross_charge":2292.94,"discounted_cash":1719.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BOTULINUM CHEMODENERVATION 33 UNIT/ML 3 ML SYRINGE","drug_information":{"unit":100.0,"type":"UN"},"code_information":[{"code":"Rx00000003779","type":"CDM"},{"code":"J0585","type":"HCPCS"},{"code":"00000003779","type":"NDC"}],"standard_charges":[{"gross_charge":2292.94,"discounted_cash":1719.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FENTANYL 50 MCG/ML PCA/INFUSION,FENTANYL CITRATE IV SOLN 2500 MCG/50ML,FENTANYL CITRATE IV SOLN 5000 MCG/100ML,FENTANYL CITRATE INJ 1500 MCG/30ML,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 1500 MCG/30ML,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 2750 MCG/55ML,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 2500 MCG/50ML,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 1000 MCG/20ML,FENTANYL CITRATE IV SOLN 1500 MCG/30ML,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 1250 MCG/25ML,FENTANYL CITRATE-NACL SOLN PREF SYR 2500 MCG/50ML-0.9%,FENTANYL CITRATE-NACL 0.9% IV SOLN 2.5 MG/50ML,FENTANYL CITRATE-NACL 0.9% IV SOLN 5 MG/100ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00000003790","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"00000003790","type":"NDC"}],"standard_charges":[{"gross_charge":157.59,"discounted_cash":118.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00000004000","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"00000004000","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00000004001","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"00000004001","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CEFTAZIDIME FOR INJ","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00000004002","type":"CDM"},{"code":"J0713","type":"HCPCS"},{"code":"00000004002","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CEFTAZIDIME FOR INJ","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00000004003","type":"CDM"},{"code":"J0713","type":"HCPCS"},{"code":"00000004003","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CEFAZOLIN SODIUM FOR INJ","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00000004008","type":"CDM"},{"code":"J0690","type":"HCPCS"},{"code":"00000004008","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CEFAZOLIN SODIUM FOR INJ","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00000004009","type":"CDM"},{"code":"J0690","type":"HCPCS"},{"code":"00000004009","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CEFAZOLIN SODIUM FOR INJ","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000004010","type":"CDM"},{"code":"J0690","type":"HCPCS"},{"code":"00000004010","type":"NDC"}],"standard_charges":[{"gross_charge":962.16,"discounted_cash":721.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CEFTAZIDIME FOR INJ","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000004011","type":"CDM"},{"code":"J0713","type":"HCPCS"},{"code":"00000004011","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000004012","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"00000004012","type":"NDC"}],"standard_charges":[{"gross_charge":219.9,"discounted_cash":164.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MEROPENEM IV FOR SOLN","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00000004014","type":"CDM"},{"code":"J2185","type":"HCPCS"},{"code":"00000004014","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MEROPENEM IV FOR SOLN","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000004015","type":"CDM"},{"code":"J2185","type":"HCPCS"},{"code":"00000004015","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00000004016","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00000004016","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000004017","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00000004017","type":"NDC"}],"standard_charges":[{"gross_charge":108.48,"discounted_cash":81.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NAFCILLIN SODIUM FOR INJ","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00000004018","type":"CDM"},{"code":"00000004018","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NAFCILLIN SODIUM FOR INJ","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000004019","type":"CDM"},{"code":"00000004019","type":"NDC"}],"standard_charges":[{"gross_charge":218.43,"discounted_cash":163.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM NA FOR INJ","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00000004020","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"00000004020","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM NA FOR INJ","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000004021","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"00000004021","type":"NDC"}],"standard_charges":[{"gross_charge":108.48,"discounted_cash":81.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"EMTRICITABINE-TENOFOVIR DF 200-300 MG (ED PREPACK-OR) PO TABS","drug_information":{"unit":30.0,"type":"EA"},"code_information":[{"code":"Rx00000004022","type":"CDM"},{"code":"00000004022","type":"NDC"}],"standard_charges":[{"gross_charge":101.32,"discounted_cash":75.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM 0.8-0.16 MG/ML IV SOLN (COMPOUND)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000004119","type":"CDM"},{"code":"00000004119","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM 0.008-0.0016 MG/ML IV SOLN (COMPOUND)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000004120","type":"CDM"},{"code":"00000004120","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00000004132","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00000004132","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NAFCILLIN SODIUM FOR INJ","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00000004133","type":"CDM"},{"code":"00000004133","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PENICILLIN G POTASSIUM FOR INJ","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00000004135","type":"CDM"},{"code":"J2540","type":"HCPCS"},{"code":"00000004135","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PENICILLIN G POTASSIUM FOR INJ","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00000004136","type":"CDM"},{"code":"J2540","type":"HCPCS"},{"code":"00000004136","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PENICILLIN G POTASSIUM FOR INJ","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000004137","type":"CDM"},{"code":"J2540","type":"HCPCS"},{"code":"00000004137","type":"NDC"}],"standard_charges":[{"gross_charge":113.19,"discounted_cash":84.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM NA FOR INJ","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00000004138","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"00000004138","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MEROPENEM IV FOR SOLN","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00000004140","type":"CDM"},{"code":"J2185","type":"HCPCS"},{"code":"00000004140","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM SUSP","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00000004168","type":"CDM"},{"code":"00000004168","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MORPHINE SULFATE ORAL SOLN 100 MG/5ML (20 MG/ML)","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00000004250","type":"CDM"},{"code":"00000004250","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ADENOSINE 10 MCG/ML IN NS 10 ML - ONE STEP","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00000004266","type":"CDM"},{"code":"J0153","type":"HCPCS"},{"code":"00000004266","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"VANCOMYCIN HCL ADD-A-VIAL SIMPLE 1 GM (BASE EQUIVALENT)","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00000004639","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"00000004639","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ACETIC ACID SOLN 3%","drug_information":{"unit":120.0,"type":"ML"},"code_information":[{"code":"Rx00000004746","type":"CDM"},{"code":"00000004746","type":"NDC"}],"standard_charges":[{"gross_charge":1.82,"discounted_cash":1.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LIDOCAINE 1% 30 ML + EPINEPHRINE (1:1000) 1 ML IN LR 1000 ML ONE STEP","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00000004880","type":"CDM"},{"code":"00000004880","type":"NDC"}],"standard_charges":[{"gross_charge":879.87,"discounted_cash":659.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NITROGLYCERIN 200 MCG/ML SYRINGE ONE STEP","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00000005067","type":"CDM"},{"code":"00000005067","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"INSULIN LISPRO INJ SOLN 100 UNIT/ML","drug_information":{"unit":0.01,"type":"ML"},"code_information":[{"code":"Rx00000005068","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00000005068","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"INSULIN REGULAR (HUMAN) INJ 100 UNIT/ML","drug_information":{"unit":0.01,"type":"ML"},"code_information":[{"code":"Rx00000005070","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00000005070","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"INDIGO CARMINE (INGDIGOINDISULFONATE) 40 MG + NS 100 ML - ONE STEP","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000005177","type":"CDM"},{"code":"00000005177","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DEXTROSE INJ 50%","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx00000005308","type":"CDM"},{"code":"00000005308","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"INSULIN REGULAR 1 UNIT/ML IN NS INJ INTERMITTENT","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000005445","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00000005445","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HYDROXYCHLOROQUINE SULFATE 25 MG/ML PO SUSP","drug_information":{"unit":8.0,"type":"ML"},"code_information":[{"code":"Rx00000005605","type":"CDM"},{"code":"00000005605","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"AZITHROMYCIN ADD-A-VIAL 500 MG","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00000006391","type":"CDM"},{"code":"J0456","type":"HCPCS"},{"code":"00000006391","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CIPROFLOXACIN FOR ORAL SUSP 500 MG/5ML (10%) (10 GM/100ML)","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx00000006856","type":"CDM"},{"code":"00000006856","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CIPROFLOXACIN FOR ORAL SUSP 500 MG/5ML (10%) (10 GM/100ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000006857","type":"CDM"},{"code":"00000006857","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CIPROFLOXACIN FOR ORAL SUSP 500 MG/5ML (10%) (10 GM/100ML)","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx00000006858","type":"CDM"},{"code":"00000006858","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"AMOXICILLIN (TRIHYDRATE) FOR SUSP 250 MG/5ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000006859","type":"CDM"},{"code":"00000006859","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"AMOXICILLIN (TRIHYDRATE) FOR SUSP 250 MG/5ML","drug_information":{"unit":1.2,"type":"ML"},"code_information":[{"code":"Rx00000006860","type":"CDM"},{"code":"00000006860","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PENICILLIN V POTASSIUM FOR SOLN 250 MG/5ML","drug_information":{"unit":64.0,"type":"ML"},"code_information":[{"code":"Rx00000006861","type":"CDM"},{"code":"00000006861","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PENICILLIN V POTASSIUM FOR SOLN 250 MG/5ML","drug_information":{"unit":32.0,"type":"ML"},"code_information":[{"code":"Rx00000006862","type":"CDM"},{"code":"00000006862","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PENICILLIN V POTASSIUM FOR SOLN 250 MG/5ML","drug_information":{"unit":31.25,"type":"ML"},"code_information":[{"code":"Rx00000006863","type":"CDM"},{"code":"00000006863","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"RALTEGRAVIR POTASSIUM 400 MG (ED PREPACK-FS) PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000006904","type":"CDM"},{"code":"00000006904","type":"NDC"}],"standard_charges":[{"gross_charge":8587.32,"discounted_cash":6440.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | NDC EA = 60 TABLET"}]},{"description":"BARICITINIB TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00002418230","type":"CDM"},{"code":"00002418230","type":"NDC"}],"standard_charges":[{"gross_charge":374.67,"discounted_cash":281.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BARICITINIB TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00002473230","type":"CDM"},{"code":"00002473230","type":"NDC"}],"standard_charges":[{"gross_charge":374.67,"discounted_cash":281.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"INSULIN LISPRO INJ SOLN 100 UNIT/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00002751001","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00002751001","type":"NDC"}],"standard_charges":[{"gross_charge":534.61,"discounted_cash":400.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"OLANZAPINE FOR IM INJ 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00002759701","type":"CDM"},{"code":"J2359","type":"HCPCS"},{"code":"00002759701","type":"NDC"}],"standard_charges":[{"gross_charge":337.76,"discounted_cash":253.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PEMETREXED DISODIUM FOR IV SOLN 500 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00002762301","type":"CDM"},{"code":"J9305","type":"HCPCS"},{"code":"00002762301","type":"NDC"}],"standard_charges":[{"gross_charge":26505.26,"discounted_cash":19878.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PEMETREXED DISODIUM FOR IV SOLN 100 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00002764001","type":"CDM"},{"code":"J9305","type":"HCPCS"},{"code":"00002764001","type":"NDC"}],"standard_charges":[{"gross_charge":5301.08,"discounted_cash":3975.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"INSULIN NPH (HUMAN) (ISOPHANE) INJ 100 UNIT/ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00002831517","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00002831517","type":"NDC"}],"standard_charges":[{"gross_charge":515.04,"discounted_cash":386.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"APIXABAN TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00003089331","type":"CDM"},{"code":"00003089331","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"APIXABAN TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00003089431","type":"CDM"},{"code":"00003089431","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ABATACEPT FOR IV SOLN 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00003218713","type":"CDM"},{"code":"J0129","type":"HCPCS"},{"code":"00003218713","type":"NDC"}],"standard_charges":[{"gross_charge":6207.1,"discounted_cash":4655.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"IPILIMUMAB SOLN FOR IV INFUSION 50 MG/10ML (5 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00003232711","type":"CDM"},{"code":"J9228","type":"HCPCS"},{"code":"00003232711","type":"NDC"}],"standard_charges":[{"gross_charge":64417.71,"discounted_cash":48313.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"IPILIMUMAB SOLN FOR IV INFUSION 200 MG/40ML (5 MG/ML)","drug_information":{"unit":40.0,"type":"ML"},"code_information":[{"code":"Rx00003232822","type":"CDM"},{"code":"J9228","type":"HCPCS"},{"code":"00003232822","type":"NDC"}],"standard_charges":[{"gross_charge":257670.27,"discounted_cash":193252.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NIVOLUMAB IV SOLN 40 MG/4ML","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx00003377211","type":"CDM"},{"code":"J9299","type":"HCPCS"},{"code":"00003377211","type":"NDC"}],"standard_charges":[{"gross_charge":9418.2,"discounted_cash":7063.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NIVOLUMAB IV SOLN 100 MG/10ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00003377412","type":"CDM"},{"code":"J9299","type":"HCPCS"},{"code":"00003377412","type":"NDC"}],"standard_charges":[{"gross_charge":23545.3,"discounted_cash":17658.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"VALGANCICLOVIR HCL TAB 450 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00004003822","type":"CDM"},{"code":"00004003822","type":"NDC"}],"standard_charges":[{"gross_charge":364.77,"discounted_cash":273.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MYCOPHENOLATE MOFETIL FOR ORAL SUSP 200 MG/ML","drug_information":{"unit":1.25,"type":"ML"},"code_information":[{"code":"Rx00004026129","type":"CDM"},{"code":"J7517","type":"HCPCS"},{"code":"00004026129","type":"NDC"}],"standard_charges":[{"gross_charge":34.69,"discounted_cash":26.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MYCOPHENOLATE MOFETIL HCL FOR IV SOLN 500 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00004029809","type":"CDM"},{"code":"J7519","type":"HCPCS"},{"code":"00004029809","type":"NDC"}],"standard_charges":[{"gross_charge":464.45,"discounted_cash":348.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"GANCICLOVIR SODIUM FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00004694004","type":"CDM"},{"code":"J1570","type":"HCPCS"},{"code":"00004694004","type":"NDC"}],"standard_charges":[{"gross_charge":701.18,"discounted_cash":525.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MENINGOCOCCAL GROUP B VAC (RECOMB) IM SUSP PREFILLED SYR","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00005010005","type":"CDM"},{"code":"00005010005","type":"NDC"}],"standard_charges":[{"gross_charge":1023.81,"discounted_cash":767.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PNEUMOCOCCAL 20-VALENT CONJUGATE VACCINE SUS PREF SYR 0.5 ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00005200002","type":"CDM"},{"code":"90677","type":"HCPCS"},{"code":"00005200002","type":"NDC"}],"standard_charges":[{"gross_charge":1347.78,"discounted_cash":1010.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MULTIPLE VITAMINS W/ MINERALS LIQUID","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00005434462","type":"CDM"},{"code":"00005434462","type":"NDC"}],"standard_charges":[{"gross_charge":1.11,"discounted_cash":0.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SITAGLIPTIN PHOSPHATE TAB 25 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00006022128","type":"CDM"},{"code":"00006022128","type":"NDC"}],"standard_charges":[{"gross_charge":45.35,"discounted_cash":34.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SITAGLIPTIN PHOSPHATE TAB 25 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00006022154","type":"CDM"},{"code":"00006022154","type":"NDC"}],"standard_charges":[{"gross_charge":45.35,"discounted_cash":34.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"RALTEGRAVIR POTASSIUM TAB 400 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00006022761","type":"CDM"},{"code":"00006022761","type":"NDC"}],"standard_charges":[{"gross_charge":143.17,"discounted_cash":107.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SITAGLIPTIN PHOSPHATE TAB 100 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00006027731","type":"CDM"},{"code":"00006027731","type":"NDC"}],"standard_charges":[{"gross_charge":45.35,"discounted_cash":34.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PEMBROLIZUMAB IV SOLN 100 MG/4ML (25 MG/ML)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx00006302602","type":"CDM"},{"code":"J9271","type":"HCPCS"},{"code":"00006302602","type":"NDC"}],"standard_charges":[{"gross_charge":42797.04,"discounted_cash":32097.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FOSAPREPITANT DIMEGLUMINE FOR IV INFUSION 150 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00006306100","type":"CDM"},{"code":"J1453","type":"HCPCS"},{"code":"00006306100","type":"NDC"}],"standard_charges":[{"gross_charge":1941.91,"discounted_cash":1456.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"IMIPENEM-CILASTATIN INTRAVENOUS FOR SOLN 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00006351458","type":"CDM"},{"code":"J0743","type":"HCPCS"},{"code":"00006351458","type":"NDC"}],"standard_charges":[{"gross_charge":118.92,"discounted_cash":89.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"INFLIXIMAB-ABDA FOR IV INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00006430502","type":"CDM"},{"code":"Q5104","type":"HCPCS"},{"code":"00006430502","type":"NDC"}],"standard_charges":[{"gross_charge":2786.97,"discounted_cash":2090.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MEASLES-MUMPS-RUBELLA VIRUS VACCINES FOR INJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00006468100","type":"CDM"},{"code":"90707","type":"HCPCS"},{"code":"00006468100","type":"NDC"}],"standard_charges":[{"gross_charge":689.84,"discounted_cash":517.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"VARICELLA VIRUS VAC LIVE FOR INJ 1350 PFU/0.5ML","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00006482700","type":"CDM"},{"code":"90716","type":"HCPCS"},{"code":"00006482700","type":"NDC"}],"standard_charges":[{"gross_charge":857.0,"discounted_cash":642.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SUGAMMADEX SODIUM IV 200 MG/2ML (BASE EQUIVALENT)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00006542302","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00006542302","type":"NDC"}],"standard_charges":[{"gross_charge":563.86,"discounted_cash":422.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SUGAMMADEX SODIUM IV 200 MG/2ML (BASE EQUIVALENT)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00006542312","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00006542312","type":"NDC"}],"standard_charges":[{"gross_charge":790.12,"discounted_cash":592.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ANTIVENIN LATRODECTUS MACTANS INJ KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00006542402","type":"CDM"},{"code":"J3590","type":"HCPCS"},{"code":"00006542402","type":"NDC"}],"standard_charges":[{"gross_charge":203.11,"discounted_cash":152.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM FOR DELAYED RELEASE SUSP PACKET 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00008084402","type":"CDM"},{"code":"00008084402","type":"NDC"}],"standard_charges":[{"gross_charge":59.41,"discounted_cash":44.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM FOR IV SOLN 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00008092360","type":"CDM"},{"code":"J2470","type":"HCPCS"},{"code":"00008092360","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TEMSIROLIMUS SOLN FOR IV INFUSION 25 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00008117901","type":"CDM"},{"code":"J9330","type":"HCPCS"},{"code":"00008117901","type":"NDC"}],"standard_charges":[{"gross_charge":13113.74,"discounted_cash":9835.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TEMSIROLIMUS 10 MG/ML (FINAL CONCENTRATION) IV SOLN","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx000081179RX","type":"CDM"},{"code":"J9330","type":"HCPCS"},{"code":"000081179RX","type":"NDC"}],"standard_charges":[{"gross_charge":13113.74,"discounted_cash":9835.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HYDROCORTISONE SODIUM SUCCINATE PF FOR INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00009001103","type":"CDM"},{"code":"J1720","type":"HCPCS"},{"code":"00009001103","type":"NDC"}],"standard_charges":[{"gross_charge":160.08,"discounted_cash":120.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HYDROCORTISONE SODIUM SUCCINATE PF FOR INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00009001104","type":"CDM"},{"code":"J1720","type":"HCPCS"},{"code":"00009001104","type":"NDC"}],"standard_charges":[{"gross_charge":158.71,"discounted_cash":119.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"METHYLPREDNISOLONE SOD SUCC FOR INJ PF 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00009003928","type":"CDM"},{"code":"J2919","type":"HCPCS"},{"code":"00009003928","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"METHYLPREDNISOLONE SOD SUCC FOR INJ PF 125 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00009004722","type":"CDM"},{"code":"J2919","type":"HCPCS"},{"code":"00009004722","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BACITRACIN INTRAMUSCULAR FOR SOLN 50000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00009023301","type":"CDM"},{"code":"00009023301","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BACITRACIN INTRAMUSCULAR FOR SOLN 50000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00009023303","type":"CDM"},{"code":"00009023303","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"GELATIN ADSORBABLE OPHTH FILM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00009029703","type":"CDM"},{"code":"00009029703","type":"NDC"}],"standard_charges":[{"gross_charge":1215.26,"discounted_cash":911.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ARGININE HCL INJ 10%","drug_information":{"unit":300.0,"type":"ML"},"code_information":[{"code":"Rx00009043624","type":"CDM"},{"code":"00009043624","type":"NDC"}],"standard_charges":[{"gross_charge":193.51,"discounted_cash":145.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"METHYLPREDNISOLONE SOD SUCC FOR INJ 1000 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00009069801","type":"CDM"},{"code":"J2919","type":"HCPCS"},{"code":"00009069801","type":"NDC"}],"standard_charges":[{"gross_charge":295.25,"discounted_cash":221.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"METHYLPREDNISOLONE SOD SUCC FOR INJ 500 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00009075801","type":"CDM"},{"code":"J2919","type":"HCPCS"},{"code":"00009075801","type":"NDC"}],"standard_charges":[{"gross_charge":162.87,"discounted_cash":122.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CARBOPROST TROMETHAMINE IM SOLN 250 MCG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00009085608","type":"CDM"},{"code":"J0675","type":"HCPCS"},{"code":"00009085608","type":"NDC"}],"standard_charges":[{"gross_charge":446.85,"discounted_cash":335.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE INJ 900 MG/6ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00009090211","type":"CDM"},{"code":"J0736","type":"HCPCS"},{"code":"00009090211","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"METHYLPREDNISOLONE ACETATE INJ SUSP 40 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00009307303","type":"CDM"},{"code":"J1010","type":"HCPCS"},{"code":"00009307303","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ALPROSTADIL INJ 500 MCG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00009316906","type":"CDM"},{"code":"J0270","type":"HCPCS"},{"code":"00009316906","type":"NDC"}],"standard_charges":[{"gross_charge":964.94,"discounted_cash":723.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"METHYLPREDNISOLONE ACETATE INJ SUSP 80 MG/ML","drug_information":{"unit":0.75,"type":"ML"},"code_information":[{"code":"Rx00009347503","type":"CDM"},{"code":"J1010","type":"HCPCS"},{"code":"00009347503","type":"NDC"}],"standard_charges":[{"gross_charge":99.41,"discounted_cash":74.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"METHYLPREDNISOLONE ACETATE INJ SUSP 80 MG/ML","drug_information":{"unit":0.75,"type":"ML"},"code_information":[{"code":"Rx00009347522","type":"CDM"},{"code":"J1010","type":"HCPCS"},{"code":"00009347522","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"IBUTILIDE FUMARATE INJ 1 MG/10ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00009379401","type":"CDM"},{"code":"J1742","type":"HCPCS"},{"code":"00009379401","type":"NDC"}],"standard_charges":[{"gross_charge":511.08,"discounted_cash":383.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LINEZOLID IV SOLN 200 MG/100ML (2 MG/ML),LINEZOLID IV SOLN 600 MG/300ML (2 MG/ML),LINEZOLID IN SODIUM CHLORIDE IV SOLN 600 MG/300ML-0.9%","drug_information":{"unit":300.0,"type":"ML"},"code_information":[{"code":"Rx00009514001","type":"CDM"},{"code":"J2020","type":"HCPCS"},{"code":"00009514001","type":"NDC"}],"standard_charges":[{"gross_charge":601.06,"discounted_cash":450.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LINEZOLID IV SOLN 600 MG/300ML (2 MG/ML)","drug_information":{"unit":300.0,"type":"ML"},"code_information":[{"code":"Rx00009514004","type":"CDM"},{"code":"J2020","type":"HCPCS"},{"code":"00009514004","type":"NDC"}],"standard_charges":[{"gross_charge":336.18,"discounted_cash":252.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"IRINOTECAN HCL INJ 300 MG/15ML (20 MG/ML)","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00009752905","type":"CDM"},{"code":"J9206","type":"HCPCS"},{"code":"00009752905","type":"NDC"}],"standard_charges":[{"gross_charge":776.01,"discounted_cash":582.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"IDARUBICIN HCL IV INJ 10 MG/10ML (1 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00013258691","type":"CDM"},{"code":"J9211","type":"HCPCS"},{"code":"00013258691","type":"NDC"}],"standard_charges":[{"gross_charge":701.26,"discounted_cash":525.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"IXABEPILONE FOR IV INFUSION 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00015191012","type":"CDM"},{"code":"J9207","type":"HCPCS"},{"code":"00015191012","type":"NDC"}],"standard_charges":[{"gross_charge":8360.13,"discounted_cash":6270.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"WHITE PETROLATUM-MINERAL OIL OPHTH OINTMENT","drug_information":{"unit":3.5,"type":"GM"},"code_information":[{"code":"Rx00023024004","type":"CDM"},{"code":"00023024004","type":"NDC"}],"standard_charges":[{"gross_charge":8.37,"discounted_cash":6.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SULFACETAMIDE SODIUM-PREDNISOLONE OPHTH OINT 10-0.2%","drug_information":{"unit":3.5,"type":"GM"},"code_information":[{"code":"Rx00023031304","type":"CDM"},{"code":"00023031304","type":"NDC"}],"standard_charges":[{"gross_charge":634.7,"discounted_cash":476.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CARBOXYMETHYLCELLULOSE SODIUM OPHTH SOLN 0.5%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00023079815","type":"CDM"},{"code":"00023079815","type":"NDC"}],"standard_charges":[{"gross_charge":8.19,"discounted_cash":6.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ONABOTULINUMTOXINA FOR INJ 100 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00023114501","type":"CDM"},{"code":"J0585","type":"HCPCS"},{"code":"00023114501","type":"NDC"}],"standard_charges":[{"gross_charge":2821.41,"discounted_cash":2116.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PANCRELIPASE (LIP-PROT-AMYL) DR CAP 5000-17000-24000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00023611501","type":"CDM"},{"code":"00023611501","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BUTALBITAL-ASPIRIN-CAFFEINE CAP 50-325-40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00023614601","type":"CDM"},{"code":"00023614601","type":"NDC"}],"standard_charges":[{"gross_charge":40.45,"discounted_cash":30.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PRIMAQUINE PHOSPHATE TAB 26.3 MG (15 MG BASE)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00024159601","type":"CDM"},{"code":"00024159601","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SOD FERRIC GLUC CMPLX IN SUCROSE IV SOLN 12.5 MG/ML (FE EQ)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00024279210","type":"CDM"},{"code":"J2916","type":"HCPCS"},{"code":"00024279210","type":"NDC"}],"standard_charges":[{"gross_charge":213.7,"discounted_cash":160.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DRONEDARONE HCL TAB 400 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00024414260","type":"CDM"},{"code":"00024414260","type":"NDC"}],"standard_charges":[{"gross_charge":54.55,"discounted_cash":40.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"RASBURICASE FOR IV SOLN 1.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00024515010","type":"CDM"},{"code":"J2783","type":"HCPCS"},{"code":"00024515010","type":"NDC"}],"standard_charges":[{"gross_charge":7875.43,"discounted_cash":5906.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CABAZITAXEL INJ 10 MG/ML","drug_information":{"unit":6.0,"type":"ML"},"code_information":[{"code":"Rx000245824RX","type":"CDM"},{"code":"J9043","type":"HCPCS"},{"code":"000245824RX","type":"NDC"}],"standard_charges":[{"gross_charge":334623.86,"discounted_cash":250967.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ZIV-AFLIBERCEPT IV SOLN 100 MG/4ML (FOR INFUSION)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx00024584001","type":"CDM"},{"code":"J9400","type":"HCPCS"},{"code":"00024584001","type":"NDC"}],"standard_charges":[{"gross_charge":5691.4,"discounted_cash":4268.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ZIV-AFLIBERCEPT IV SOLN 200 MG/8ML (FOR INFUSION)","drug_information":{"unit":8.0,"type":"ML"},"code_information":[{"code":"Rx00024584101","type":"CDM"},{"code":"J9400","type":"HCPCS"},{"code":"00024584101","type":"NDC"}],"standard_charges":[{"gross_charge":11382.8,"discounted_cash":8537.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"INSULIN LISPRO INJ SOLN 100 UNIT/ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00024592605","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00024592605","type":"NDC"}],"standard_charges":[{"gross_charge":126.22,"discounted_cash":94.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PANCRELIPASE (LIP-PROT-AMYL) DR CAP 12000-38000-60000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00032121201","type":"CDM"},{"code":"00032121201","type":"NDC"}],"standard_charges":[{"gross_charge":17.12,"discounted_cash":12.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PANCRELIPASE (LIP-PROT-AMYL) DR CAP 24000-76000-120000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00032122401","type":"CDM"},{"code":"00032122401","type":"NDC"}],"standard_charges":[{"gross_charge":33.96,"discounted_cash":25.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HYDROCORTISONE ACETATE W/ PRAMOXINE PERIANAL FOAM 1-1%","drug_information":{"unit":10.0,"type":"GM"},"code_information":[{"code":"Rx00037682210","type":"CDM"},{"code":"00037682210","type":"NDC"}],"standard_charges":[{"gross_charge":753.43,"discounted_cash":565.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HYOSCYAMINE SULFATE INJ 0.5 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00037900105","type":"CDM"},{"code":"J1980","type":"HCPCS"},{"code":"00037900105","type":"NDC"}],"standard_charges":[{"gross_charge":197.66,"discounted_cash":148.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ESTROGENS, CONJUGATED FOR INJ 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00046074905","type":"CDM"},{"code":"J1410","type":"HCPCS"},{"code":"00046074905","type":"NDC"}],"standard_charges":[{"gross_charge":2187.39,"discounted_cash":1640.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ESTROGENS, CONJUGATED TAB 0.3 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00046110081","type":"CDM"},{"code":"00046110081","type":"NDC"}],"standard_charges":[{"gross_charge":29.16,"discounted_cash":21.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ESTROGENS, CONJUGATED TAB 0.625 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00046110281","type":"CDM"},{"code":"00046110281","type":"NDC"}],"standard_charges":[{"gross_charge":29.16,"discounted_cash":21.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PENICILLIN G POTASSIUM FOR INJ 5000000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00049052022","type":"CDM"},{"code":"J2540","type":"HCPCS"},{"code":"00049052022","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PENICILLIN G POTASSIUM FOR INJ 20000000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00049053028","type":"CDM"},{"code":"J2540","type":"HCPCS"},{"code":"00049053028","type":"NDC"}],"standard_charges":[{"gross_charge":341.65,"discounted_cash":256.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"VORICONAZOLE FOR INJ 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00049319028","type":"CDM"},{"code":"J3465","type":"HCPCS"},{"code":"00049319028","type":"NDC"}],"standard_charges":[{"gross_charge":403.15,"discounted_cash":302.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BCG LIVE INTRAVESICAL FOR SUSP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00052060202","type":"CDM"},{"code":"J9030","type":"HCPCS"},{"code":"00052060202","type":"NDC"}],"standard_charges":[{"gross_charge":1279.35,"discounted_cash":959.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ALPHA1-PROTEINASE INHIBITOR (HUMAN) FOR IV SOLN 4000 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00053720202","type":"CDM"},{"code":"J0256","type":"HCPCS"},{"code":"00053720202","type":"NDC"}],"standard_charges":[{"gross_charge":8034.73,"discounted_cash":6026.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ALPHA1-PROTEINASE INHIBITOR (HUMAN) FOR IV SOLN 5000 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00053720302","type":"CDM"},{"code":"J0256","type":"HCPCS"},{"code":"00053720302","type":"NDC"}],"standard_charges":[{"gross_charge":9967.13,"discounted_cash":7475.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ALPHA1-PROTEINASE INHIBITOR (HUMAN) FOR IV SOLN 1000 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00053721101","type":"CDM"},{"code":"J0256","type":"HCPCS"},{"code":"00053721101","type":"NDC"}],"standard_charges":[{"gross_charge":2705.82,"discounted_cash":2029.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ANTIHEMOPHILIC FACTOR RECOMB (RFVIII) FOR INJ KIT 250 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00053813102","type":"CDM"},{"code":"J7192","type":"HCPCS"},{"code":"00053813102","type":"NDC"}],"standard_charges":[{"gross_charge":1618.92,"discounted_cash":1214.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ANTIHEMOPHILIC FACTOR RECOMB (RFVIII) FOR INJ KIT 1000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00053813302","type":"CDM"},{"code":"J7192","type":"HCPCS"},{"code":"00053813302","type":"NDC"}],"standard_charges":[{"gross_charge":4467.94,"discounted_cash":3350.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ANTIHEMOPHILIC FACTOR RECOMB (RFVIII) FOR INJ KIT 2000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00053813402","type":"CDM"},{"code":"J7192","type":"HCPCS"},{"code":"00053813402","type":"NDC"}],"standard_charges":[{"gross_charge":8681.25,"discounted_cash":6510.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FLECAINIDE ACETATE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054001020","type":"CDM"},{"code":"00054001020","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PREDNISONE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054001720","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"00054001720","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PREDNISONE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054001820","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"00054001820","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"IPRATROPIUM BROMIDE NASAL SOLN 0.06% (42 MCG/SPRAY)","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00054004641","type":"CDM"},{"code":"00054004641","type":"NDC"}],"standard_charges":[{"gross_charge":150.56,"discounted_cash":112.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DIGOXIN ORAL SOLN 0.05 MG/ML","drug_information":{"unit":1.25,"type":"ML"},"code_information":[{"code":"Rx00054005746","type":"CDM"},{"code":"00054005746","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BUPRENORPHINE HCL SL TAB 2 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054017613","type":"CDM"},{"code":"00054017613","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BUPRENORPHINE HCL SL TAB 8 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054017713","type":"CDM"},{"code":"J0571","type":"HCPCS"},{"code":"00054017713","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MORPHINE SULFATE TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054023525","type":"CDM"},{"code":"00054023525","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HYDROMORPHONE HCL TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054026424","type":"CDM"},{"code":"00054026424","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HYDROMORPHONE HCL TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054026425","type":"CDM"},{"code":"00054026425","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MORPHINE SULFATE ORAL SOLN 100 MG/5ML (20 MG/ML)","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00054051744","type":"CDM"},{"code":"00054051744","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MORPHINE SULFATE ORAL SOLN 100 MG/5ML (20 MG/ML)","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00054051750","type":"CDM"},{"code":"00054051750","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LITHIUM CARBONATE CAP 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054252625","type":"CDM"},{"code":"00054252625","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ACETYLCYSTEINE INHAL SOLN 10%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00054302702","type":"CDM"},{"code":"J7608","type":"HCPCS"},{"code":"00054302702","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CALCITRIOL ORAL SOLN 1 MCG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00054312041","type":"CDM"},{"code":"00054312041","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DEXAMETHASONE CONC 1 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00054317644","type":"CDM"},{"code":"J8540","type":"HCPCS"},{"code":"00054317644","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FUROSEMIDE ORAL SOLN 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00054329446","type":"CDM"},{"code":"00054329446","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LIDOCAINE HCL VISCOUS SOLN 2%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00054350049","type":"CDM"},{"code":"00054350049","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LIDOCAINE HCL SOLN 4%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00054350547","type":"CDM"},{"code":"00054350547","type":"NDC"}],"standard_charges":[{"gross_charge":167.29,"discounted_cash":125.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LITHIUM ORAL SOLUTION 8 MEQ/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00054352763","type":"CDM"},{"code":"00054352763","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MEGESTROL ACETATE SUSP 40 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00054354258","type":"CDM"},{"code":"00054354258","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LEUCOVORIN CALCIUM TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054449625","type":"CDM"},{"code":"00054449625","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CLOTRIMAZOLE TROCHE 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054814622","type":"CDM"},{"code":"00054814622","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DEXAMETHASONE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054817425","type":"CDM"},{"code":"J8540","type":"HCPCS"},{"code":"00054817425","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DEXAMETHASONE TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054817525","type":"CDM"},{"code":"J8540","type":"HCPCS"},{"code":"00054817525","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DEXAMETHASONE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054817625","type":"CDM"},{"code":"J8540","type":"HCPCS"},{"code":"00054817625","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PREDNISONE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054872425","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"00054872425","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PREDNISONE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054873925","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"00054873925","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"WARFARIN SODIUM TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00056017075","type":"CDM"},{"code":"00056017075","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"WARFARIN SODIUM TAB 3 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00056018875","type":"CDM"},{"code":"00056018875","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TRAVOPROST OPHTH SOLN 0.004% (BENZALKONIUM FREE) (BAK FREE)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00065026005","type":"CDM"},{"code":"00065026005","type":"NDC"}],"standard_charges":[{"gross_charge":1612.41,"discounted_cash":1209.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CYCLOPENTOLATE HCL OPHTH SOLN 1%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00065039605","type":"CDM"},{"code":"00065039605","type":"NDC"}],"standard_charges":[{"gross_charge":250.72,"discounted_cash":188.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TOBRAMYCIN OPHTH OINT 0.3%","drug_information":{"unit":3.5,"type":"GM"},"code_information":[{"code":"Rx00065064435","type":"CDM"},{"code":"00065064435","type":"NDC"}],"standard_charges":[{"gross_charge":890.69,"discounted_cash":668.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TOBRAMYCIN-DEXAMETHASONE OPHTH OINT 0.3-0.1%","drug_information":{"unit":3.5,"type":"GM"},"code_information":[{"code":"Rx00065064835","type":"CDM"},{"code":"00065064835","type":"NDC"}],"standard_charges":[{"gross_charge":942.85,"discounted_cash":707.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TETRACAINE HCL OPHTH SOLN 0.5%","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx00065074114","type":"CDM"},{"code":"00065074114","type":"NDC"}],"standard_charges":[{"gross_charge":54.56,"discounted_cash":40.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"OPHTHALMIC IRRIGATION SOLUTION - INTRAOCULAR","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00065079515","type":"CDM"},{"code":"00065079515","type":"NDC"}],"standard_charges":[{"gross_charge":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"RIFAMPIN FOR INJ 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00068059701","type":"CDM"},{"code":"J2804","type":"HCPCS"},{"code":"00068059701","type":"NDC"}],"standard_charges":[{"gross_charge":1036.34,"discounted_cash":777.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"VINORELBINE TARTRATE INJ 10 MG/ML (BASE EQUIV)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00069009901","type":"CDM"},{"code":"J9390","type":"HCPCS"},{"code":"00069009901","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PAMIDRONATE DISODIUM IV SOLN 3 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00069018601","type":"CDM"},{"code":"J2430","type":"HCPCS"},{"code":"00069018601","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FILGRASTIM-AAFI SOLN PREFILLED SYRINGE 300 MCG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00069029101","type":"CDM"},{"code":"Q5110","type":"HCPCS"},{"code":"00069029101","type":"NDC"}],"standard_charges":[{"gross_charge":496.2,"discounted_cash":372.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FILGRASTIM-AAFI SOLN PREFILLED SYRINGE 300 MCG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00069029110","type":"CDM"},{"code":"Q5110","type":"HCPCS"},{"code":"00069029110","type":"NDC"}],"standard_charges":[{"gross_charge":496.22,"discounted_cash":372.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SUNITINIB MALATE CAP 25 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00069077038","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"00069077038","type":"NDC"}],"standard_charges":[{"gross_charge":921.98,"discounted_cash":691.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"INFLIXIMAB-DYYB FOR IV INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00069080901","type":"CDM"},{"code":"Q5103","type":"HCPCS"},{"code":"00069080901","type":"NDC"}],"standard_charges":[{"gross_charge":2611.82,"discounted_cash":1958.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"EPOETIN ALFA-EPBX INJ 2000 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00069130501","type":"CDM"},{"code":"Q5106","type":"HCPCS"},{"code":"00069130501","type":"NDC"}],"standard_charges":[{"gross_charge":126.27,"discounted_cash":94.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"EPOETIN ALFA-EPBX INJ 2000 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00069130510","type":"CDM"},{"code":"Q5106","type":"HCPCS"},{"code":"00069130510","type":"NDC"}],"standard_charges":[{"gross_charge":126.31,"discounted_cash":94.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"EPOETIN ALFA-EPBX INJ 3000 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00069130601","type":"CDM"},{"code":"Q5106","type":"HCPCS"},{"code":"00069130601","type":"NDC"}],"standard_charges":[{"gross_charge":191.54,"discounted_cash":143.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"EPOETIN ALFA-EPBX INJ 3000 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00069130610","type":"CDM"},{"code":"Q5106","type":"HCPCS"},{"code":"00069130610","type":"NDC"}],"standard_charges":[{"gross_charge":189.48,"discounted_cash":142.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"EPOETIN ALFA-EPBX INJ 4000 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00069130701","type":"CDM"},{"code":"Q5106","type":"HCPCS"},{"code":"00069130701","type":"NDC"}],"standard_charges":[{"gross_charge":252.55,"discounted_cash":189.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"EPOETIN ALFA-EPBX INJ 4000 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00069130710","type":"CDM"},{"code":"Q5106","type":"HCPCS"},{"code":"00069130710","type":"NDC"}],"standard_charges":[{"gross_charge":252.63,"discounted_cash":189.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"EPOETIN ALFA-EPBX INJ 10000 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00069130801","type":"CDM"},{"code":"Q5106","type":"HCPCS"},{"code":"00069130801","type":"NDC"}],"standard_charges":[{"gross_charge":545.25,"discounted_cash":408.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"EPOETIN ALFA-EPBX INJ 10000 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00069130810","type":"CDM"},{"code":"Q5106","type":"HCPCS"},{"code":"00069130810","type":"NDC"}],"standard_charges":[{"gross_charge":545.43,"discounted_cash":409.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"EPOETIN ALFA-EPBX INJ 40000 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00069130901","type":"CDM"},{"code":"Q5106","type":"HCPCS"},{"code":"00069130901","type":"NDC"}],"standard_charges":[{"gross_charge":2181.02,"discounted_cash":1635.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DOXORUBICIN HCL INJ 2 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00069303020","type":"CDM"},{"code":"J9000","type":"HCPCS"},{"code":"00069303020","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DOXORUBICIN HCL INJ 2 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00069303120","type":"CDM"},{"code":"J9000","type":"HCPCS"},{"code":"00069303120","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DOXORUBICIN HCL INJ 2 MG/ML","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx00069303220","type":"CDM"},{"code":"J9000","type":"HCPCS"},{"code":"00069303220","type":"NDC"}],"standard_charges":[{"gross_charge":159.91,"discounted_cash":119.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FOSPHENYTOIN SODIUM INJ 500 MG/10ML (PHENYTOIN EQUIV)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00069600121","type":"CDM"},{"code":"Q2009","type":"HCPCS"},{"code":"00069600121","type":"NDC"}],"standard_charges":[{"gross_charge":163.03,"discounted_cash":122.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PREGABALIN CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00071101268","type":"CDM"},{"code":"00071101268","type":"NDC"}],"standard_charges":[{"gross_charge":74.82,"discounted_cash":56.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PREGABALIN CAP 75 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00071101441","type":"CDM"},{"code":"00071101441","type":"NDC"}],"standard_charges":[{"gross_charge":82.32,"discounted_cash":61.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PHENYTOIN SODIUM EXTENDED CAP 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00071374066","type":"CDM"},{"code":"00071374066","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ADALIMUMAB AUTO-INJECTOR KIT 80 MG/0.8ML","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00074012403","type":"CDM"},{"code":"J0139","type":"HCPCS"},{"code":"00074012403","type":"NDC"}],"standard_charges":[{"gross_charge":27722.21,"discounted_cash":20791.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ADALIMUMAB AUTO-INJECTOR KIT 40 MG/0.4ML","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00074055402","type":"CDM"},{"code":"J0139","type":"HCPCS"},{"code":"00074055402","type":"NDC"}],"standard_charges":[{"gross_charge":13861.05,"discounted_cash":10395.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CYCLOSPORINE MODIFIED CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00074310832","type":"CDM"},{"code":"J7515","type":"HCPCS"},{"code":"00074310832","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LEUPROLIDE ACETATE (3 MONTH) FOR INJ KIT 22.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00074334603","type":"CDM"},{"code":"J9217","type":"HCPCS"},{"code":"00074334603","type":"NDC"}],"standard_charges":[{"gross_charge":3735.82,"discounted_cash":2801.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LEUPROLIDE ACETATE (6 MONTH) FOR INJ KIT 45 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00074347303","type":"CDM"},{"code":"J9217","type":"HCPCS"},{"code":"00074347303","type":"NDC"}],"standard_charges":[{"gross_charge":6965.1,"discounted_cash":5223.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LEUPROLIDE ACETATE FOR INJ KIT 7.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00074364203","type":"CDM"},{"code":"J9217","type":"HCPCS"},{"code":"00074364203","type":"NDC"}],"standard_charges":[{"gross_charge":1245.3,"discounted_cash":933.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LEUPROLIDE ACETATE (4 MONTH) FOR INJ KIT 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00074368303","type":"CDM"},{"code":"J9217","type":"HCPCS"},{"code":"00074368303","type":"NDC"}],"standard_charges":[{"gross_charge":4643.35,"discounted_cash":3482.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ADALIMUMAB AUTO-INJECTOR KIT 40 MG/0.8ML","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00074433902","type":"CDM"},{"code":"J0139","type":"HCPCS"},{"code":"00074433902","type":"NDC"}],"standard_charges":[{"gross_charge":13861.05,"discounted_cash":10395.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ADALIMUMAB 40 MG/0.8ML SUBQ (HUMIRA DRUG PROGRAM PTS ONLY)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00074433971","type":"CDM"},{"code":"J0139","type":"HCPCS"},{"code":"00074433971","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CYCLOSPORINE MODIFIED ORAL SOLN 100 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00074726950","type":"CDM"},{"code":"J7502","type":"HCPCS"},{"code":"00074726950","type":"NDC"}],"standard_charges":[{"gross_charge":17.45,"discounted_cash":13.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CYCLOSPORINE IV SOLN 50 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00078010901","type":"CDM"},{"code":"J7516","type":"HCPCS"},{"code":"00078010901","type":"NDC"}],"standard_charges":[{"gross_charge":478.35,"discounted_cash":358.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CYCLOSPORINE ORAL SOLN 100 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00078011022","type":"CDM"},{"code":"J7502","type":"HCPCS"},{"code":"00078011022","type":"NDC"}],"standard_charges":[{"gross_charge":68.89,"discounted_cash":51.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"IMATINIB MESYLATE TAB 100 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078040134","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"00078040134","type":"NDC"}],"standard_charges":[{"gross_charge":386.12,"discounted_cash":289.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CARBAMAZEPINE TAB ER 12HR 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078051005","type":"CDM"},{"code":"00078051005","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"IMATINIB MESYLATE TAB 400 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078064930","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"00078064930","type":"NDC"}],"standard_charges":[{"gross_charge":1391.19,"discounted_cash":1043.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SACUBITRIL-VALSARTAN TAB 24-26 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078065920","type":"CDM"},{"code":"00078065920","type":"NDC"}],"standard_charges":[{"gross_charge":48.46,"discounted_cash":36.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"OCTREOTIDE ACETATE FOR IM INJ KIT 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078079761","type":"CDM"},{"code":"J2353","type":"HCPCS"},{"code":"00078079761","type":"NDC"}],"standard_charges":[{"gross_charge":17092.07,"discounted_cash":12819.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"OCTREOTIDE ACETATE FOR IM INJ KIT 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078081881","type":"CDM"},{"code":"J2353","type":"HCPCS"},{"code":"00078081881","type":"NDC"}],"standard_charges":[{"gross_charge":18301.43,"discounted_cash":13726.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"EPTIFIBATIDE IV SOLN 20 MG/10ML (2 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00085117701","type":"CDM"},{"code":"J1327","type":"HCPCS"},{"code":"00085117701","type":"NDC"}],"standard_charges":[{"gross_charge":1016.97,"discounted_cash":762.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"POSACONAZOLE SUSP 40 MG/ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00085132801","type":"CDM"},{"code":"00085132801","type":"NDC"}],"standard_charges":[{"gross_charge":141.39,"discounted_cash":106.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"POSACONAZOLE TAB DELAYED RELEASE 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00085432402","type":"CDM"},{"code":"00085432402","type":"NDC"}],"standard_charges":[{"gross_charge":282.55,"discounted_cash":211.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"POSACONAZOLE IV SOLN 300 MG/16.7ML (18 MG/ML)","drug_information":{"unit":16.7,"type":"ML"},"code_information":[{"code":"Rx00085433101","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00085433101","type":"NDC"}],"standard_charges":[{"gross_charge":3078.72,"discounted_cash":2309.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DILTIAZEM HCL TAB 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093031801","type":"CDM"},{"code":"00093031801","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NEOMYCIN SULFATE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093117701","type":"CDM"},{"code":"00093117701","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"WARFARIN SODIUM TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093171401","type":"CDM"},{"code":"00093171401","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"METOCLOPRAMIDE HCL TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093220301","type":"CDM"},{"code":"00093220301","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SUCRALFATE TAB 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093221001","type":"CDM"},{"code":"00093221001","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE TAB 875-125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093227534","type":"CDM"},{"code":"00093227534","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ACYCLOVIR CREAM 5%","drug_information":{"unit":5.0,"type":"GM"},"code_information":[{"code":"Rx00093363020","type":"CDM"},{"code":"00093363020","type":"NDC"}],"standard_charges":[{"gross_charge":1649.42,"discounted_cash":1237.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PENICILLIN V POTASSIUM FOR SOLN 250 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00093412773","type":"CDM"},{"code":"00093412773","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LEVALBUTEROL HCL SOLN NEBU 1.25 MG/3ML (BASE EQUIV)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00093414856","type":"CDM"},{"code":"J7614","type":"HCPCS"},{"code":"00093414856","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"AMOXICILLIN (TRIHYDRATE) FOR SUSP 125 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00093415073","type":"CDM"},{"code":"00093415073","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"AMOXICILLIN (TRIHYDRATE) FOR SUSP 125 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00093415080","type":"CDM"},{"code":"00093415080","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"OXYCODONE HCL TAB ER 12HR DETER 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093573401","type":"CDM"},{"code":"00093573401","type":"NDC"}],"standard_charges":[{"gross_charge":100.46,"discounted_cash":75.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CYCLOSPORINE MODIFIED CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093574219","type":"CDM"},{"code":"J7502","type":"HCPCS"},{"code":"00093574219","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CYCLOSPORINE MODIFIED CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093574265","type":"CDM"},{"code":"J7502","type":"HCPCS"},{"code":"00093574265","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ADAPALENE GEL 0.1%","drug_information":{"unit":45.0,"type":"GM"},"code_information":[{"code":"Rx00093630195","type":"CDM"},{"code":"00093630195","type":"NDC"}],"standard_charges":[{"gross_charge":145.85,"discounted_cash":109.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BUDESONIDE INHALATION SUSP 0.25 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00093681573","type":"CDM"},{"code":"J7626","type":"HCPCS"},{"code":"00093681573","type":"NDC"}],"standard_charges":[{"gross_charge":31.05,"discounted_cash":23.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TOLTERODINE TARTRATE CAP ER 24HR 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093716356","type":"CDM"},{"code":"00093716356","type":"NDC"}],"standard_charges":[{"gross_charge":26.5,"discounted_cash":19.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CLOZAPINE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093777201","type":"CDM"},{"code":"00093777201","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE FOR SUSP 600-42.9 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00093867578","type":"CDM"},{"code":"00093867578","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MEXILETINE HCL CAP 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093873901","type":"CDM"},{"code":"00093873901","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MEXILETINE HCL CAP 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093874001","type":"CDM"},{"code":"00093874001","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"VENLAFAXINE HCL TAB 50 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093914901","type":"CDM"},{"code":"00093914901","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB 25-100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093970201","type":"CDM"},{"code":"00093970201","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"METRONIDAZOLE GEL 0.75%","drug_information":{"unit":45.0,"type":"GM"},"code_information":[{"code":"Rx00115147446","type":"CDM"},{"code":"00115147446","type":"NDC"}],"standard_charges":[{"gross_charge":407.18,"discounted_cash":305.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PROPRANOLOL HCL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00115166001","type":"CDM"},{"code":"00115166001","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CHLORHEXIDINE GLUCONATE SOLN 0.12%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00116200115","type":"CDM"},{"code":"00116200115","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MAGNESIUM HYDROXIDE SUSP 400 MG/5ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00121043130","type":"CDM"},{"code":"00121043130","type":"NDC"}],"standard_charges":[{"gross_charge":1.7,"discounted_cash":1.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FERROUS SULFATE SOLN 300 MG/5ML (60 MG/5ML ELEMENTAL FE)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121053005","type":"CDM"},{"code":"00121053005","type":"NDC"}],"standard_charges":[{"gross_charge":3.15,"discounted_cash":2.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DOCUSATE SODIUM LIQUID 150 MG/15ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121054410","type":"CDM"},{"code":"00121054410","type":"NDC"}],"standard_charges":[{"gross_charge":0.72,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"METOCLOPRAMIDE HCL SOLN 5 MG/5ML (10 MG/10ML) (BASE EQUIV)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121057616","type":"CDM"},{"code":"00121057616","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HALOPERIDOL LACTATE ORAL CONC 2 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00121058104","type":"CDM"},{"code":"00121058104","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HALOPERIDOL LACTATE ORAL CONC 2 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00121058115","type":"CDM"},{"code":"00121058115","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SODIUM CITRATE & CITRIC ACID SOLN 500-334 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00121059515","type":"CDM"},{"code":"00121059515","type":"NDC"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":0.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FLUOXETINE HCL SOLUTION 20 MG/5ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00121072104","type":"CDM"},{"code":"00121072104","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SUCRALFATE SUSP 1 GM/10ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00121074710","type":"CDM"},{"code":"00121074710","type":"NDC"}],"standard_charges":[{"gross_charge":30.17,"discounted_cash":22.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PREDNISOLONE SOD PHOSPHATE ORAL SOLN 15 MG/5ML (BASE EQUIV)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121075908","type":"CDM"},{"code":"J7510","type":"HCPCS"},{"code":"00121075908","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"VANCOMYCIN HCL CAP 125 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00121086720","type":"CDM"},{"code":"00121086720","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"VANCOMYCIN HCL CAP 250 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00121089020","type":"CDM"},{"code":"00121089020","type":"NDC"}],"standard_charges":[{"gross_charge":16.49,"discounted_cash":12.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"IBUPROFEN SUSP 100 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00121091405","type":"CDM"},{"code":"00121091405","type":"NDC"}],"standard_charges":[{"gross_charge":1.55,"discounted_cash":1.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PROMETHAZINE HCL ORAL SOLN 6.25 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121092716","type":"CDM"},{"code":"Q0169","type":"HCPCS"},{"code":"00121092716","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DIPHENHYDRAMINE HCL ELIXIR 12.5 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121097810","type":"CDM"},{"code":"00121097810","type":"NDC"}],"standard_charges":[{"gross_charge":1.01,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LACTULOSE SOLUTION 10 GM/15ML","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00121115430","type":"CDM"},{"code":"00121115430","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LACTULOSE SOLUTION 10 GM/15ML","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00121115440","type":"CDM"},{"code":"00121115440","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SODIUM CITRATE & CITRIC ACID SOLN 500-334 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00121119000","type":"CDM"},{"code":"00121119000","type":"NDC"}],"standard_charges":[{"gross_charge":1.95,"discounted_cash":1.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DEXTROMETHORPHAN-GUAIFENESIN SYRUP 10-100 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121127600","type":"CDM"},{"code":"00121127600","type":"NDC"}],"standard_charges":[{"gross_charge":1.32,"discounted_cash":0.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DEXTROMETHORPHAN-GUAIFENESIN SYRUP 10-100 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121127610","type":"CDM"},{"code":"00121127610","type":"NDC"}],"standard_charges":[{"gross_charge":1.38,"discounted_cash":1.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ACETAMINOPHEN SOLN 160 MG/5ML","drug_information":{"unit":10.15625,"type":"ML"},"code_information":[{"code":"Rx00121131411","type":"CDM"},{"code":"00121131411","type":"NDC"}],"standard_charges":[{"gross_charge":2.18,"discounted_cash":1.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"GUAIFENESIN-CODEINE SOLN 100-10 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121155010","type":"CDM"},{"code":"00121155010","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"METOCLOPRAMIDE HCL SOLN 5 MG/5ML (10 MG/10ML) (BASE EQUIV)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121157610","type":"CDM"},{"code":"00121157610","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"GUAIFENESIN LIQUID 100 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121174405","type":"CDM"},{"code":"00121174405","type":"NDC"}],"standard_charges":[{"gross_charge":0.92,"discounted_cash":0.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ALUM & MAG HYDROXIDE-SIMETHICONE SUSP 200-200-20 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00121176130","type":"CDM"},{"code":"00121176130","type":"NDC"}],"standard_charges":[{"gross_charge":1.54,"discounted_cash":1.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ALUM & MAG HYDROXIDE-SIMETHICONE SUSP 400-400-40 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00121176230","type":"CDM"},{"code":"00121176230","type":"NDC"}],"standard_charges":[{"gross_charge":1.78,"discounted_cash":1.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"GUAIFENESIN-CODEINE SOLN 100-10 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121177505","type":"CDM"},{"code":"00121177505","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MEGESTROL ACETATE SUSP 40 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121477640","type":"CDM"},{"code":"00121477640","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LIDOCAINE HCL VISCOUS SOLN 2%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121495015","type":"CDM"},{"code":"00121495015","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LIDOCAINE HCL VISCOUS SOLN 2%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121495040","type":"CDM"},{"code":"00121495040","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LACOSAMIDE IV INJ 200 MG/20ML (10 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00131181067","type":"CDM"},{"code":"C9254","type":"HCPCS"},{"code":"00131181067","type":"NDC"}],"standard_charges":[{"gross_charge":166.46,"discounted_cash":124.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LACOSAMIDE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00131247760","type":"CDM"},{"code":"00131247760","type":"NDC"}],"standard_charges":[{"gross_charge":98.22,"discounted_cash":73.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LACOSAMIDE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00131248060","type":"CDM"},{"code":"00131248060","type":"NDC"}],"standard_charges":[{"gross_charge":162.68,"discounted_cash":122.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CEFAZOLIN SODIUM FOR IV SOLN 3 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143914025","type":"CDM"},{"code":"J0688","type":"HCPCS"},{"code":"00143914025","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MITOMYCIN FOR INJ 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143927901","type":"CDM"},{"code":"J9280","type":"HCPCS"},{"code":"00143927901","type":"NDC"}],"standard_charges":[{"gross_charge":379.05,"discounted_cash":284.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM FOR IV SOLN 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143928410","type":"CDM"},{"code":"J2471","type":"HCPCS"},{"code":"00143928410","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NOREPINEPHRINE BITARTRATE IV SOLN 1 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx00143931810","type":"CDM"},{"code":"00143931810","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ACETAMINOPHEN IV SOLN 10 MG/ML","drug_information":{"unit":65.0,"type":"ML"},"code_information":[{"code":"Rx00143938601","type":"CDM"},{"code":"J0137","type":"HCPCS"},{"code":"00143938601","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ACETAMINOPHEN IV SOLN 10 MG/ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00143938601","type":"CDM"},{"code":"J0137","type":"HCPCS"},{"code":"00143938601","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ETOMIDATE IV SOLN 2 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00143950710","type":"CDM"},{"code":"00143950710","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"KETAMINE HCL INJ 50 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00143950801","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00143950801","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"KETAMINE HCL INJ 50 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00143950810","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00143950810","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DROPERIDOL INJ 2.5 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00143951501","type":"CDM"},{"code":"J1790","type":"HCPCS"},{"code":"00143951501","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"METHOTREXATE SODIUM INJ PF 50 MG/2ML (25 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00143951901","type":"CDM"},{"code":"J9260","type":"HCPCS"},{"code":"00143951901","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"METHOTREXATE SODIUM INJ PF 50 MG/2ML (25 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00143951910","type":"CDM"},{"code":"J9260","type":"HCPCS"},{"code":"00143951910","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DEXMEDETOMIDINE HCL IN NACL 0.9% IV SOLN 400 MCG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00143952510","type":"CDM"},{"code":"00143952510","type":"NDC"}],"standard_charges":[{"gross_charge":130.17,"discounted_cash":97.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FLUPHENAZINE DECANOATE INJ 25 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00143952901","type":"CDM"},{"code":"J2680","type":"HCPCS"},{"code":"00143952901","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DOXORUBICIN HCL INJ 2 MG/ML","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx00143954701","type":"CDM"},{"code":"J9000","type":"HCPCS"},{"code":"00143954701","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LEUCOVORIN CALCIUM FOR INJ 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143955301","type":"CDM"},{"code":"J0640","type":"HCPCS"},{"code":"00143955301","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ARGATROBAN IV SOLN 50 MG/50ML (1 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00143955901","type":"CDM"},{"code":"J0883","type":"HCPCS"},{"code":"00143955901","type":"NDC"}],"standard_charges":[{"gross_charge":706.39,"discounted_cash":529.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NICARDIPINE HCL IV SOLN 40 MG/200ML IN SODIUM CHLORIDE 0.9%","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx00143963301","type":"CDM"},{"code":"J2404","type":"HCPCS"},{"code":"00143963301","type":"NDC"}],"standard_charges":[{"gross_charge":567.05,"discounted_cash":425.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NICARDIPINE HCL IV SOLN 40 MG/200ML IN SODIUM CHLORIDE 0.9%","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx00143963310","type":"CDM"},{"code":"J2404","type":"HCPCS"},{"code":"00143963310","type":"NDC"}],"standard_charges":[{"gross_charge":588.61,"discounted_cash":441.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"VALPROATE SODIUM INJ 100 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00143963701","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00143963701","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"VALPROATE SODIUM INJ 100 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00143963710","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00143963710","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FLUCONAZOLE IN NACL 0.9% INJ 400 MG/200ML","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx00143966806","type":"CDM"},{"code":"J1450","type":"HCPCS"},{"code":"00143966806","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ARGATROBAN INJ 250 MG/2.5ML (CONCENTRATE FOR IV INFUSION)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00143967401","type":"CDM"},{"code":"J0883","type":"HCPCS"},{"code":"00143967401","type":"NDC"}],"standard_charges":[{"gross_charge":754.53,"discounted_cash":565.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"GLYCOPYRROLATE INJ 0.2 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00143968225","type":"CDM"},{"code":"J1596","type":"HCPCS"},{"code":"00143968225","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NICARDIPINE HCL IV SOLN 2.5 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00143968910","type":"CDM"},{"code":"J2404","type":"HCPCS"},{"code":"00143968910","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"IRINOTECAN HCL INJ 100 MG/5ML (20 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00143970101","type":"CDM"},{"code":"J9206","type":"HCPCS"},{"code":"00143970101","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MILRINONE LACTATE IN DEXTROSE 5% IV SOLN 20 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00143971901","type":"CDM"},{"code":"J2260","type":"HCPCS"},{"code":"00143971901","type":"NDC"}],"standard_charges":[{"gross_charge":105.27,"discounted_cash":78.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MILRINONE LACTATE IN DEXTROSE 5% IV SOLN 20 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00143971910","type":"CDM"},{"code":"J2260","type":"HCPCS"},{"code":"00143971910","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LEVOFLOXACIN IN D5W IV SOLN 750 MG/150ML","drug_information":{"unit":150.0,"type":"ML"},"code_information":[{"code":"Rx00143972001","type":"CDM"},{"code":"J1956","type":"HCPCS"},{"code":"00143972001","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LEVOFLOXACIN IN D5W IV SOLN 750 MG/150ML","drug_information":{"unit":150.0,"type":"ML"},"code_information":[{"code":"Rx00143972024","type":"CDM"},{"code":"J1956","type":"HCPCS"},{"code":"00143972024","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LEVOFLOXACIN IN D5W IV SOLN 500 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00143972101","type":"CDM"},{"code":"J1956","type":"HCPCS"},{"code":"00143972101","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LEVOFLOXACIN IN D5W IV SOLN 500 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00143972124","type":"CDM"},{"code":"J1956","type":"HCPCS"},{"code":"00143972124","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LEVOFLOXACIN IN D5W IV SOLN 250 MG/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00143972224","type":"CDM"},{"code":"J1956","type":"HCPCS"},{"code":"00143972224","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CLONIDINE HCL INJ (FOR EPIDURAL INFUSION) 500 MCG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00143972301","type":"CDM"},{"code":"J0735","type":"HCPCS"},{"code":"00143972301","type":"NDC"}],"standard_charges":[{"gross_charge":104.17,"discounted_cash":78.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CLONIDINE HCL INJ (FOR EPIDURAL INFUSION) 100 MCG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00143972401","type":"CDM"},{"code":"J0735","type":"HCPCS"},{"code":"00143972401","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TERBUTALINE SULFATE INJ 1 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00143974610","type":"CDM"},{"code":"J3105","type":"HCPCS"},{"code":"00143974610","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FLUMAZENIL IV SOLN 0.5 MG/5ML (0.1 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00143978410","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00143978410","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ENALAPRILAT IV SOLN 1.25 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00143978710","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00143978710","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"METOPROLOL TARTRATE IV SOLN 5 MG/5ML,METOPROLOL TARTRATE IV SOLN CART INJ 5 MG/5ML (1 MG/ML),METOPROLOL TARTRATE IV SOLN PREFILLED SYR 5 MG/5ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00143987325","type":"CDM"},{"code":"00143987325","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CEFAZOLIN SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143992490","type":"CDM"},{"code":"J0690","type":"HCPCS"},{"code":"00143992490","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CIPROFLOXACIN HCL TAB 500 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143992801","type":"CDM"},{"code":"00143992801","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BACITRACIN-POLYMYXIN B OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00168002109","type":"CDM"},{"code":"00168002109","type":"NDC"}],"standard_charges":[{"gross_charge":0.67,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HYDROCORTISONE CREAM 2.5%","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx00168008031","type":"CDM"},{"code":"00168008031","type":"NDC"}],"standard_charges":[{"gross_charge":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE GEL 1% (TWICE-DAILY)","drug_information":{"unit":60.0,"type":"GM"},"code_information":[{"code":"Rx00168020260","type":"CDM"},{"code":"00168020260","type":"NDC"}],"standard_charges":[{"gross_charge":585.27,"discounted_cash":438.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CLOTRIMAZOLE W/ BETAMETHASONE CREAM 1-0.05%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx00168025815","type":"CDM"},{"code":"00168025815","type":"NDC"}],"standard_charges":[{"gross_charge":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LIDOCAINE-PRILOCAINE CREAM 2.5-2.5%","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx00168035730","type":"CDM"},{"code":"00168035730","type":"NDC"}],"standard_charges":[{"gross_charge":39.39,"discounted_cash":29.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LIDOCAINE-PRILOCAINE CREAM 2.5-2.5%","drug_information":{"unit":5.0,"type":"GM"},"code_information":[{"code":"Rx00168035755","type":"CDM"},{"code":"00168035755","type":"NDC"}],"standard_charges":[{"gross_charge":37.93,"discounted_cash":28.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"INSULIN REGULAR (HUMAN) INJ 100 UNIT/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00169183311","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00169183311","type":"NDC"}],"standard_charges":[{"gross_charge":431.83,"discounted_cash":323.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"INSULIN NPH (HUMAN) (ISOPHANE) INJ 100 UNIT/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00169183411","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00169183411","type":"NDC"}],"standard_charges":[{"gross_charge":431.83,"discounted_cash":323.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"INSULIN ASPART INJ SOLN 100 UNIT/ML,INSULIN ASPART SOLN CARTRIDGE 100 UNIT/ML,INSULIN ASPART SOLN PEN-INJECTOR 100 UNIT/ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00169330312","type":"CDM"},{"code":"J1817","type":"HCPCS"},{"code":"00169330312","type":"NDC"}],"standard_charges":[{"gross_charge":229.62,"discounted_cash":172.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LIRAGLUTIDE SOLN PEN-INJECTOR 18 MG/3ML (6 MG/ML)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00169406013","type":"CDM"},{"code":"J3590","type":"HCPCS"},{"code":"00169406013","type":"NDC"}],"standard_charges":[{"gross_charge":1577.27,"discounted_cash":1182.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HISTIDINE DILUENT IV SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00169701298","type":"CDM"},{"code":"00169701298","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HISTIDINE DILUENT IV SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00169701598","type":"CDM"},{"code":"00169701598","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"COAGULATION FACTOR VIIA (RECOMB) FOR INJ 2 MG (2000 MCG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00169702001","type":"CDM"},{"code":"J7189","type":"HCPCS"},{"code":"00169702001","type":"NDC"}],"standard_charges":[{"gross_charge":19217.04,"discounted_cash":14412.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"COAGULATION FACTOR VIIA (RECOMB) FOR INJ 1 MG (1000 MCG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00169720101","type":"CDM"},{"code":"J7189","type":"HCPCS"},{"code":"00169720101","type":"NDC"}],"standard_charges":[{"gross_charge":10523.86,"discounted_cash":7892.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"COAGULATION FACTOR VIIA (RECOMB) FOR INJ 5 MG (5000 MCG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00169720501","type":"CDM"},{"code":"J7189","type":"HCPCS"},{"code":"00169720501","type":"NDC"}],"standard_charges":[{"gross_charge":52619.23,"discounted_cash":39464.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DIAZEPAM TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00172392560","type":"CDM"},{"code":"00172392560","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"EPOPROSTENOL SODIUM FOR INJ 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00173051700","type":"CDM"},{"code":"J1325","type":"HCPCS"},{"code":"00173051700","type":"NDC"}],"standard_charges":[{"gross_charge":136.99,"discounted_cash":102.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"EPOPROSTENOL SODIUM FOR INJ 1.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00173051900","type":"CDM"},{"code":"J1325","type":"HCPCS"},{"code":"00173051900","type":"NDC"}],"standard_charges":[{"gross_charge":330.87,"discounted_cash":248.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SALMETEROL XINAFOATE AER POW BA 50 MCG/ACT (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00173052000","type":"CDM"},{"code":"00173052000","type":"NDC"}],"standard_charges":[{"gross_charge":35.77,"discounted_cash":26.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ZANAMIVIR AEROSOL POWDER BREATH ACTIVATED 5 MG/ACT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00173068101","type":"CDM"},{"code":"00173068101","type":"NDC"}],"standard_charges":[{"gross_charge":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"OFATUMUMAB CONC FOR IV INFUSION 1000 MG/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00173082101","type":"CDM"},{"code":"J9302","type":"HCPCS"},{"code":"00173082101","type":"NDC"}],"standard_charges":[{"gross_charge":32808.13,"discounted_cash":24606.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"OFATUMUMAB CONC FOR IV INFUSION 100 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00173082133","type":"CDM"},{"code":"J9302","type":"HCPCS"},{"code":"00173082133","type":"NDC"}],"standard_charges":[{"gross_charge":3519.41,"discounted_cash":2639.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FLUTICASONE FUROATE-VILANTEROL AERO POWD BA 100-25 MCG/ACT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00173085914","type":"CDM"},{"code":"00173085914","type":"NDC"}],"standard_charges":[{"gross_charge":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"UMECLIDINIUM-VILANTEROL AERO POWD BA 62.5-25 MCG/ACT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00173086906","type":"CDM"},{"code":"00173086906","type":"NDC"}],"standard_charges":[{"gross_charge":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MEPOLIZUMAB FOR INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00173088101","type":"CDM"},{"code":"J2182","type":"HCPCS"},{"code":"00173088101","type":"NDC"}],"standard_charges":[{"gross_charge":14091.02,"discounted_cash":10568.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MEPOLIZUMAB SUBCUTANEOUS SOLUTION AUTO-INJECTOR 100 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00173089201","type":"CDM"},{"code":"J2182","type":"HCPCS"},{"code":"00173089201","type":"NDC"}],"standard_charges":[{"gross_charge":16676.41,"discounted_cash":12507.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MEPOLIZUMAB SUBCUTANEOUS SOLUTION PREF SYRINGE 100 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00173089242","type":"CDM"},{"code":"J2182","type":"HCPCS"},{"code":"00173089242","type":"NDC"}],"standard_charges":[{"gross_charge":16676.41,"discounted_cash":12507.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BUDESONIDE-FORMOTEROL FUMARATE DIHYD AEROSOL 160-4.5 MCG/ACT","drug_information":{"unit":6.0,"type":"GM"},"code_information":[{"code":"Rx00186037028","type":"CDM"},{"code":"00186037028","type":"NDC"}],"standard_charges":[{"gross_charge":251.56,"discounted_cash":188.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BUDESONIDE-FORMOTEROL FUMARATE DIHYD AEROSOL 80-4.5 MCG/ACT","drug_information":{"unit":6.9,"type":"GM"},"code_information":[{"code":"Rx00186037228","type":"CDM"},{"code":"00186037228","type":"NDC"}],"standard_charges":[{"gross_charge":251.57,"discounted_cash":188.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TICAGRELOR TAB 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00186077660","type":"CDM"},{"code":"00186077660","type":"NDC"}],"standard_charges":[{"gross_charge":31.78,"discounted_cash":23.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TICAGRELOR TAB 90 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00186077739","type":"CDM"},{"code":"00186077739","type":"NDC"}],"standard_charges":[{"gross_charge":31.77,"discounted_cash":23.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NITROPRUSSIDE SODIUM IV SOLN 25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00187430202","type":"CDM"},{"code":"00187430202","type":"NDC"}],"standard_charges":[{"gross_charge":1760.18,"discounted_cash":1320.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TEMAZEPAM CAP 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00228207610","type":"CDM"},{"code":"00228207610","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PROPYLTHIOURACIL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00228234810","type":"CDM"},{"code":"00228234810","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"POTASSIUM IODIDE ORAL SOLN 1 GM/ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00245000331","type":"CDM"},{"code":"00245000331","type":"NDC"}],"standard_charges":[{"gross_charge":46.54,"discounted_cash":34.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"AMINO ACID INFUSION 10%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00264193310","type":"CDM"},{"code":"00264193310","type":"NDC"}],"standard_charges":[{"gross_charge":357.37,"discounted_cash":268.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"POTASSIUM CHLORIDE INJ 2 MEQ/ML","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00264194020","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"00264194020","type":"NDC"}],"standard_charges":[{"gross_charge":139.27,"discounted_cash":104.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"METRONIDAZOLE IV SOLN 500 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00264553532","type":"CDM"},{"code":"J1836","type":"HCPCS"},{"code":"00264553532","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"WATER FOR IRRIGATION, STERILE IRRIGATION SOLN","drug_information":{"unit":3000.0,"type":"ML"},"code_information":[{"code":"Rx00264738660","type":"CDM"},{"code":"00264738660","type":"NDC"}],"standard_charges":[{"gross_charge":274862.98,"discounted_cash":206147.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00264780020","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00264780020","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LIDOCAINE IV INFUSION IN D5W INJ 8 MG/ML","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00264959820","type":"CDM"},{"code":"J2002","type":"HCPCS"},{"code":"00264959820","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SINCALIDE FOR INJ 5 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00270055615","type":"CDM"},{"code":"J2805","type":"HCPCS"},{"code":"00270055615","type":"NDC"}],"standard_charges":[{"gross_charge":772.34,"discounted_cash":579.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NITROGLYCERIN OINT 2%","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"Rx00281032608","type":"CDM"},{"code":"00281032608","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BENZOCAINE MOUTH/THROAT AEROSOL 20%","drug_information":{"unit":57.0,"type":"GM"},"code_information":[{"code":"Rx00283067902","type":"CDM"},{"code":"00283067902","type":"NDC"}],"standard_charges":[{"gross_charge":28.48,"discounted_cash":21.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SODIUM ZIRCONIUM CYCLOSILICATE FOR SUSP PACKET 5 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00310110501","type":"CDM"},{"code":"00310110501","type":"NDC"}],"standard_charges":[{"gross_charge":61.02,"discounted_cash":45.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MICONAZOLE NITRATE POWDER 2%","drug_information":{"unit":43.0,"type":"GM"},"code_information":[{"code":"Rx00316022515","type":"CDM"},{"code":"00316022515","type":"NDC"}],"standard_charges":[{"gross_charge":3.76,"discounted_cash":2.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"WATER FOR IRRIGATION, STERILE IRRIGATION SOLN","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338000402","type":"CDM"},{"code":"00338000402","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"WATER FOR INJECTION","drug_information":{"unit":2000.0,"type":"ML"},"code_information":[{"code":"Rx00338001306","type":"CDM"},{"code":"00338001306","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DEXTROSE INJ 5%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00338001703","type":"CDM"},{"code":"J7060","type":"HCPCS"},{"code":"00338001703","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DEXTROSE INJ 5%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338001704","type":"CDM"},{"code":"J7070","type":"HCPCS"},{"code":"00338001704","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DEXTROSE INJ 5%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338001711","type":"CDM"},{"code":"J7060","type":"HCPCS"},{"code":"00338001711","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DEXTROSE INJ 5%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338001741","type":"CDM"},{"code":"J7060","type":"HCPCS"},{"code":"00338001741","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DEXTROSE INJ 5%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00338001741","type":"CDM"},{"code":"J7060","type":"HCPCS"},{"code":"00338001741","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DEXTROSE INJ 5%","drug_information":{"unit":300.0,"type":"ML"},"code_information":[{"code":"Rx00338001748","type":"CDM"},{"code":"J7060","type":"HCPCS"},{"code":"00338001748","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DEXTROSE INJ 5%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00338001748","type":"CDM"},{"code":"J7060","type":"HCPCS"},{"code":"00338001748","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DEXTROSE INJ 10%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338002302","type":"CDM"},{"code":"00338002302","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DEXTROSE INJ 10%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338002304","type":"CDM"},{"code":"00338002304","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DEXTROSE INJ 10%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338002304","type":"CDM"},{"code":"00338002304","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.45%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338004303","type":"CDM"},{"code":"00338004303","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.45%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338004304","type":"CDM"},{"code":"00338004304","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.45%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338004304","type":"CDM"},{"code":"00338004304","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00338004903","type":"CDM"},{"code":"J7040","type":"HCPCS"},{"code":"00338004903","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338004904","type":"CDM"},{"code":"J7030","type":"HCPCS"},{"code":"00338004904","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00338004911","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00338004911","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00338004948","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00338004948","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 3%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00338005403","type":"CDM"},{"code":"00338005403","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 3%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00338005403","type":"CDM"},{"code":"J7131","type":"HCPCS"},{"code":"00338005403","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DEXTROSE 5% W/ SODIUM CHLORIDE 0.45%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338008504","type":"CDM"},{"code":"00338008504","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DEXTROSE 5% W/ SODIUM CHLORIDE 0.9%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338008904","type":"CDM"},{"code":"J7042","type":"HCPCS"},{"code":"00338008904","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DEXTROSE 5% W/ SODIUM CHLORIDE 0.9%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00338008904","type":"CDM"},{"code":"J7042","type":"HCPCS"},{"code":"00338008904","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NOREPINEPHRINE-DEXTROSE IV SOLUTION 4 MG/250ML-5%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338011220","type":"CDM"},{"code":"00338011220","type":"NDC"}],"standard_charges":[{"gross_charge":166.96,"discounted_cash":125.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DEXTROSE 5% IN LACTATED RINGERS","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338012504","type":"CDM"},{"code":"J7121","type":"HCPCS"},{"code":"00338012504","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ELECTROLYTE-R SOLUTION,ELECTROLYTE-148 SOLUTION,ELECTROLYTE-A SOLUTION,ELECTROLYTE-R (PH 7.4) SOLUTION","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338017904","type":"CDM"},{"code":"00338017904","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ELECTROLYTE-R SOLUTION,ELECTROLYTE-148 SOLUTION,ELECTROLYTE-A SOLUTION,ELECTROLYTE-R (PH 7.4) SOLUTION","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338017904","type":"CDM"},{"code":"00338017904","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"AMINO ACID INFUSION 8% IN D14W","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338018006","type":"CDM"},{"code":"00338018006","type":"NDC"}],"standard_charges":[{"gross_charge":357.37,"discounted_cash":268.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"AMINO ACID INFUSION 8% IN D14W","drug_information":{"unit":2000.0,"type":"ML"},"code_information":[{"code":"Rx00338018401","type":"CDM"},{"code":"00338018401","type":"NDC"}],"standard_charges":[{"gross_charge":590.45,"discounted_cash":442.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"THROMBIN (RECOMBINANT) FOR SOLN 5000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00338032201","type":"CDM"},{"code":"00338032201","type":"NDC"}],"standard_charges":[{"gross_charge":297.67,"discounted_cash":223.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LIDOCAINE IV INFUSION IN D5W INJ 8 MG/ML","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338041102","type":"CDM"},{"code":"J2002","type":"HCPCS"},{"code":"00338041102","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"AMINO ACID INFUSION 15%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00338050203","type":"CDM"},{"code":"00338050203","type":"NDC"}],"standard_charges":[{"gross_charge":477.79,"discounted_cash":358.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DEXTROSE INJ 5%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00338055118","type":"CDM"},{"code":"J7060","type":"HCPCS"},{"code":"00338055118","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DEXTROSE INJ 5%","drug_information":{"unit":300.0,"type":"ML"},"code_information":[{"code":"Rx00338055118","type":"CDM"},{"code":"J7060","type":"HCPCS"},{"code":"00338055118","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338055311","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00338055311","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00338055311","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00338055311","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00338055318","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00338055318","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":300.0,"type":"ML"},"code_information":[{"code":"Rx00338055318","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00338055318","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"AMINO ACID INFUSION 10%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00338064403","type":"CDM"},{"code":"00338064403","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"AMINO ACID INFUSION 10%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338064404","type":"CDM"},{"code":"00338064404","type":"NDC"}],"standard_charges":[{"gross_charge":163.15,"discounted_cash":122.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"AMINO ACID INFUSION 10%","drug_information":{"unit":2000.0,"type":"ML"},"code_information":[{"code":"Rx00338064406","type":"CDM"},{"code":"00338064406","type":"NDC"}],"standard_charges":[{"gross_charge":310.76,"discounted_cash":233.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"KCL 10 MEQ/L (0.075%) IN DEXTROSE 5% & NACL 0.45% INJ","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338066904","type":"CDM"},{"code":"00338066904","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"KCL 20 MEQ/L (0.15%) IN DEXTROSE 5% & NACL 0.45% INJ","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338067104","type":"CDM"},{"code":"00338067104","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"KCL 40 MEQ/L (0.3%) IN DEXTROSE 5% & NACL 0.45% INJ","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338067504","type":"CDM"},{"code":"00338067504","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"KCL 20 MEQ/L (0.15%) IN NACL 0.9% INJ,KCL 20 MEQ/L (0.149%) IN NACL 0.9% INJ","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338069104","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"00338069104","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"KCL 40 MEQ/L (0.3%) IN NACL 0.9% INJ,KCL 40 MEQ/L (0.298%) IN NACL 0.9% INJ","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338069504","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"00338069504","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"POTASSIUM CHLORIDE INJ 20 MEQ/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00338070341","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"00338070341","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"KCL 20 MEQ/L (0.15%) IN NACL 0.45% INJ,KCL 20 MEQ/L (0.149%) IN NACL 0.45% INJ","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338070434","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"00338070434","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"POTASSIUM CHLORIDE INJ 10 MEQ/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00338070948","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"00338070948","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DEXTROSE INJ 70%","drug_information":{"unit":2000.0,"type":"ML"},"code_information":[{"code":"Rx00338071906","type":"CDM"},{"code":"00338071906","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"KCL 40 MEQ/L (0.3%) IN DEXTROSE 5% & NACL 0.9% INJ","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338080704","type":"CDM"},{"code":"00338080704","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/L (0.15%) IN D5W LACTATED RINGERS","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338081104","type":"CDM"},{"code":"00338081104","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DOPAMINE IN DEXTROSE 5% INJ 1.6 MG/ML","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338100702","type":"CDM"},{"code":"J1265","type":"HCPCS"},{"code":"00338100702","type":"NDC"}],"standard_charges":[{"gross_charge":104.7,"discounted_cash":78.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DOPAMINE IN DEXTROSE 5% INJ 1.6 MG/ML","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00338100703","type":"CDM"},{"code":"J1265","type":"HCPCS"},{"code":"00338100703","type":"NDC"}],"standard_charges":[{"gross_charge":152.81,"discounted_cash":114.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NITROGLYCERIN IV SOLN 200 MCG/ML IN D5W","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338104902","type":"CDM"},{"code":"J2305","type":"HCPCS"},{"code":"00338104902","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"METRONIDAZOLE IV SOLN 500 MG/100ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00338105548","type":"CDM"},{"code":"J1836","type":"HCPCS"},{"code":"00338105548","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DOBUTAMINE IN DEXTROSE 5% INJ 4 MG/ML","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338107702","type":"CDM"},{"code":"J1250","type":"HCPCS"},{"code":"00338107702","type":"NDC"}],"standard_charges":[{"gross_charge":186.77,"discounted_cash":140.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"AMINO ACID INFUSION 4.25% IN D5W","drug_information":{"unit":2000.0,"type":"ML"},"code_information":[{"code":"Rx00338108904","type":"CDM"},{"code":"00338108904","type":"NDC"}],"standard_charges":[{"gross_charge":435.06,"discounted_cash":326.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"AMINO ACID INFUSION 5% IN D15W","drug_information":{"unit":2000.0,"type":"ML"},"code_information":[{"code":"Rx00338109904","type":"CDM"},{"code":"00338109904","type":"NDC"}],"standard_charges":[{"gross_charge":512.76,"discounted_cash":384.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"AMINO ACID INFUSION 5% IN D20W","drug_information":{"unit":2000.0,"type":"ML"},"code_information":[{"code":"Rx00338110104","type":"CDM"},{"code":"00338110104","type":"NDC"}],"standard_charges":[{"gross_charge":512.76,"discounted_cash":384.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"AMINO ACID INFUSION 4.25% IN D5W","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338113303","type":"CDM"},{"code":"00338113303","type":"NDC"}],"standard_charges":[{"gross_charge":248.61,"discounted_cash":186.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"AMINO ACID INFUSION 5% IN D15W","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338113703","type":"CDM"},{"code":"00338113703","type":"NDC"}],"standard_charges":[{"gross_charge":271.91,"discounted_cash":203.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"AMINO ACID INFUSION 5% IN D20W","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338113803","type":"CDM"},{"code":"00338113803","type":"NDC"}],"standard_charges":[{"gross_charge":271.91,"discounted_cash":203.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MESNA INJ 100 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00338130501","type":"CDM"},{"code":"J9209","type":"HCPCS"},{"code":"00338130501","type":"NDC"}],"standard_charges":[{"gross_charge":175.79,"discounted_cash":131.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"VANCOMYCIN HCL-DEXTROSE IV SOLN 500 MG/100ML-5%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00338355148","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"00338355148","type":"NDC"}],"standard_charges":[{"gross_charge":116.59,"discounted_cash":87.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"VANCOMYCIN HCL-DEXTROSE IV SOLN 750 MG/150ML-5%","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx00338358048","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"00338358048","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE IN D5W IV SOLN 600 MG/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00338361224","type":"CDM"},{"code":"J0737","type":"HCPCS"},{"code":"00338361224","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE IN D5W IV SOLN 600 MG/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00338361250","type":"CDM"},{"code":"J0737","type":"HCPCS"},{"code":"00338361250","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE IN D5W IV SOLN 900 MG/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00338381424","type":"CDM"},{"code":"J0736","type":"HCPCS"},{"code":"00338381424","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE IN D5W IV SOLN 900 MG/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00338381450","type":"CDM"},{"code":"J0736","type":"HCPCS"},{"code":"00338381450","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FLUCONAZOLE IN NACL 0.9% INJ 200 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00338604648","type":"CDM"},{"code":"J1450","type":"HCPCS"},{"code":"00338604648","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DEXTROSE INJ 5%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338634602","type":"CDM"},{"code":"J7060","type":"HCPCS"},{"code":"00338634602","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DEXTROSE INJ 5%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00338634603","type":"CDM"},{"code":"J7060","type":"HCPCS"},{"code":"00338634603","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338915130","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00338915130","type":"NDC"}],"standard_charges":[{"gross_charge":135.47,"discounted_cash":101.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00338915130","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00338915130","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FAT EMULSION PLANT BASED (SOY/OLIVE) IV EMULSION 20%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338954002","type":"CDM"},{"code":"00338954002","type":"NDC"}],"standard_charges":[{"gross_charge":149.98,"discounted_cash":112.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00338954304","type":"CDM"},{"code":"J7040","type":"HCPCS"},{"code":"00338954304","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00338955050","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00338955050","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DEXMEDETOMIDINE HCL IN NACL 0.9% IV SOLN 400 MCG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00338955712","type":"CDM"},{"code":"00338955712","type":"NDC"}],"standard_charges":[{"gross_charge":185.63,"discounted_cash":139.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"VASOPRESSIN-SODIUM CHLORIDE IV SOLN 20 UNIT/100ML-0.9%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00338964012","type":"CDM"},{"code":"J2601","type":"HCPCS"},{"code":"00338964012","type":"NDC"}],"standard_charges":[{"gross_charge":400.71,"discounted_cash":300.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FUROSEMIDE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378020801","type":"CDM"},{"code":"00378020801","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DIPHENOXYLATE W/ ATROPINE TAB 2.5-0.025 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378041501","type":"CDM"},{"code":"00378041501","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"THIORIDAZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378061401","type":"CDM"},{"code":"00378061401","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CLONIDINE TD PATCH WEEKLY 0.1 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378087199","type":"CDM"},{"code":"00378087199","type":"NDC"}],"standard_charges":[{"gross_charge":109.26,"discounted_cash":81.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CLONIDINE TD PATCH WEEKLY 0.3 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378087399","type":"CDM"},{"code":"00378087399","type":"NDC"}],"standard_charges":[{"gross_charge":255.21,"discounted_cash":191.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LITHIUM CARBONATE TAB ER 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378130001","type":"CDM"},{"code":"00378130001","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"REPAGLINIDE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378312201","type":"CDM"},{"code":"00378312201","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ESTRADIOL TD PATCH WEEKLY 0.05 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378335099","type":"CDM"},{"code":"00378335099","type":"NDC"}],"standard_charges":[{"gross_charge":77.64,"discounted_cash":58.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FELODIPINE TAB ER 24HR 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378501101","type":"CDM"},{"code":"00378501101","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"VALSARTAN TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378580793","type":"CDM"},{"code":"00378580793","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CITALOPRAM HYDROBROMIDE TAB 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378623301","type":"CDM"},{"code":"00378623301","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SODIUM CHLORIDE SOLN NEBU 3%","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00378699789","type":"CDM"},{"code":"J7131","type":"HCPCS"},{"code":"00378699789","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LOXAPINE SUCCINATE CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378701001","type":"CDM"},{"code":"00378701001","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LOXAPINE SUCCINATE CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378702501","type":"CDM"},{"code":"00378702501","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ALBUTEROL SULFATE SOLN NEBU 1.25 MG/3ML (BASE EQUIV)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00378705852","type":"CDM"},{"code":"J7613","type":"HCPCS"},{"code":"00378705852","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NITROGLYCERIN TD PATCH 24HR 0.1 MG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378910293","type":"CDM"},{"code":"00378910293","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NITROGLYCERIN TD PATCH 24HR 0.4 MG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378911293","type":"CDM"},{"code":"00378911293","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 12 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378911998","type":"CDM"},{"code":"00378911998","type":"NDC"}],"standard_charges":[{"gross_charge":128.17,"discounted_cash":96.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LEVALBUTEROL HCL SOLN NEBU 1.25 MG/3ML (BASE EQUIV)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00378969252","type":"CDM"},{"code":"J7614","type":"HCPCS"},{"code":"00378969252","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"IODINE TINCTURE","drug_information":{"unit":473.0,"type":"ML"},"code_information":[{"code":"Rx00395121316","type":"CDM"},{"code":"00395121316","type":"NDC"}],"standard_charges":[{"gross_charge":33.61,"discounted_cash":25.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CHERRY SYRUP","drug_information":{"unit":473.0,"type":"ML"},"code_information":[{"code":"Rx00395266216","type":"CDM"},{"code":"00395266216","type":"NDC"}],"standard_charges":[{"gross_charge":14.69,"discounted_cash":11.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 10-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406012562","type":"CDM"},{"code":"00406012562","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ACETAMINOPHEN W/ CODEINE TAB 300-30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406048423","type":"CDM"},{"code":"00406048423","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"OXYCODONE W/ ACETAMINOPHEN TAB 5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406051262","type":"CDM"},{"code":"00406051262","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MORPHINE SULFATE POWDER","drug_information":{"unit":5.0,"type":"GM"},"code_information":[{"code":"Rx00406152153","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00406152153","type":"NDC"}],"standard_charges":[{"gross_charge":278.39,"discounted_cash":208.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"METHADONE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406575562","type":"CDM"},{"code":"00406575562","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MORPHINE SULFATE TAB ER 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406831562","type":"CDM"},{"code":"00406831562","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"IOHEXOL INJ 240 MG/ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00407141233","type":"CDM"},{"code":"Q9966","type":"HCPCS"},{"code":"00407141233","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":67.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"IODIXANOL INJ 320 MG/ML (IODINE EQUIVALENT)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00407222301","type":"CDM"},{"code":"Q9967","type":"HCPCS"},{"code":"00407222301","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":67.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"IODIXANOL INJ 320 MG/ML (IODINE EQUIVALENT)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00407222302","type":"CDM"},{"code":"Q9967","type":"HCPCS"},{"code":"00407222302","type":"NDC"}],"standard_charges":[{"gross_charge":197.7,"discounted_cash":148.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"METRONIDAZOLE IV SOLN 500 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00409015224","type":"CDM"},{"code":"J1836","type":"HCPCS"},{"code":"00409015224","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"GEMCITABINE HCL INJ 1 GM/26.3ML (38 MG/ML) (BASE EQUIV)","drug_information":{"unit":26.3,"type":"ML"},"code_information":[{"code":"Rx00409018101","type":"CDM"},{"code":"J9201","type":"HCPCS"},{"code":"00409018101","type":"NDC"}],"standard_charges":[{"gross_charge":204.54,"discounted_cash":153.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"GEMCITABINE HCL INJ 2 GM/52.6ML (38 MG/ML) (BASE EQUIV)","drug_information":{"unit":52.6,"type":"ML"},"code_information":[{"code":"Rx00409018201","type":"CDM"},{"code":"J9201","type":"HCPCS"},{"code":"00409018201","type":"NDC"}],"standard_charges":[{"gross_charge":368.34,"discounted_cash":276.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PARICALCITOL IV SOLN 5 MCG/ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx00409100811","type":"CDM"},{"code":"J2501","type":"HCPCS"},{"code":"00409100811","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MORPHINE SULFATE IV SOLN 50 MG/ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00409113405","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00409113405","type":"NDC"}],"standard_charges":[{"gross_charge":199.74,"discounted_cash":149.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.25%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409115901","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00409115901","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409116202","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00409116202","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BUPIVACAINE HCL INJ 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409116318","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00409116318","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.75%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409116502","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00409116502","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DILTIAZEM HCL IV SOLN 50 MG/10ML (5 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409117102","type":"CDM"},{"code":"00409117102","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DILTIAZEM HCL IV SOLN 50 MG/10ML (5 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409117112","type":"CDM"},{"code":"00409117112","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LIDOCAINE INJ 1.5% W/ EPINEPHRINE-1:200000 (PF)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00409120901","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"00409120901","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx00409128305","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00409128305","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 1 MG/ML,HYDROMORPHONE HCL-NACL SOLN PREF SYR 1 MG/ML-0.9%,HYDROMORPHONE HCL PRESERVATIVE FREE (PF) INJ 1 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409128310","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00409128310","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx00409128331","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00409128331","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 2 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx00409131230","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00409131230","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MEROPENEM IV FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409139051","type":"CDM"},{"code":"J2185","type":"HCPCS"},{"code":"00409139051","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BUMETANIDE INJ 0.25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409141204","type":"CDM"},{"code":"J1939","type":"HCPCS"},{"code":"00409141204","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NALBUPHINE HCL INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409146301","type":"CDM"},{"code":"J2300","type":"HCPCS"},{"code":"00409146301","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BUTORPHANOL TARTRATE INJ 1 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409162301","type":"CDM"},{"code":"J0595","type":"HCPCS"},{"code":"00409162301","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BUPIVACAINE INJ 0.25% W/ EPINEPHRINE 1:200000","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409175250","type":"CDM"},{"code":"00409175250","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DEXTROSE INJ 25%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409177510","type":"CDM"},{"code":"00409177510","type":"NDC"}],"standard_charges":[{"gross_charge":162.75,"discounted_cash":122.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LEVETIRACETAM INJ 500 MG/5ML (100 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409188622","type":"CDM"},{"code":"J1953","type":"HCPCS"},{"code":"00409188622","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MORPHINE SULFATE IV SOLN PF 2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409189001","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00409189001","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MORPHINE SULFATE INJ PF 2 MG/ML,MORPHINE SULFATE IV SOLN PF 2 MG/ML,MORPHINE SULFATE INJ 2 MG/ML,MORPHINE SULFATE-NACL SOL PREF SYR 2 MG/ML-0.9%,MORPHINE SULFATE IV SOLN 2 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00409189010","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00409189010","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MORPHINE SULFATE IV SOLN PF 2 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00409189011","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00409189011","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MORPHINE SULFATE IV SOLN PF 4 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409189101","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00409189101","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MORPHINE SULFATE IV SOLN PF 4 MG/ML","drug_information":{"unit":0.75,"type":"ML"},"code_information":[{"code":"Rx00409189103","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00409189103","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MORPHINE SULFATE INJ 4 MG/ML,MORPHINE SULFATE INJ PF 4 MG/ML,MORPHINE SULFATE IV SOLN PF 4 MG/ML,MORPHINE SULFATE IV SOLN 4 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00409189110","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00409189110","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MORPHINE SULFATE IV SOLN PF 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409189311","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00409189311","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BACTERIOSTATIC SODIUM CHLORIDE INJ SOLN 0.9%","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00409196605","type":"CDM"},{"code":"00409196605","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BACTERIOSTATIC SODIUM CHLORIDE INJ SOLN 0.9%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409196606","type":"CDM"},{"code":"00409196606","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LORAZEPAM INJ 2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409198530","type":"CDM"},{"code":"J2060","type":"HCPCS"},{"code":"00409198530","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MAGNESIUM SULFATE INJ 50%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409216877","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"00409216877","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LABETALOL HCL IV SOLN 5 MG/ML,LABETALOL HCL IV SOLN PREFILLED SYRINGE 20 MG/4ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 50 MG/10ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 25 MG/5ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 10 MG/2ML (5 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409226720","type":"CDM"},{"code":"J1920","type":"HCPCS"},{"code":"00409226720","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MIDAZOLAM HCL INJ 2 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 10 MG/10ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 5 MG/5ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 2 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/5ML (BASE EQUIVALENT),MIDAZOLAM INJ SOLN PREFILLED SYRINGE 2 MG/2ML,MIDAZOLAM IV SOLN PREFILLED SYRINGE 2 MG/2ML,MIDAZOLAM INJ SOLN PREFILLED SYRINGE 3 MG/3ML,MIDAZOLAM INJ SOLN PREFILLED SYRINGE 5 MG/5ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409230516","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00409230516","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MIDAZOLAM HCL INJ 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 25 MG/5ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 5 MG/ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 50 MG/10ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx00409230821","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00409230821","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DOBUTAMINE HCL INJ 12.5 MG/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00409234402","type":"CDM"},{"code":"J1250","type":"HCPCS"},{"code":"00409234402","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DOBUTAMINE IN DEXTROSE 5% INJ 1 MG/ML","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00409234632","type":"CDM"},{"code":"J1250","type":"HCPCS"},{"code":"00409234632","type":"NDC"}],"standard_charges":[{"gross_charge":229.21,"discounted_cash":171.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx00409255201","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00409255201","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MIDAZOLAM HCL INJ 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 25 MG/5ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 5 MG/ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 50 MG/10ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx00409259603","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00409259603","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MILRINONE LACTATE IN DEXTROSE 5% IV SOLN 40 MG/200ML","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx00409277602","type":"CDM"},{"code":"J2260","type":"HCPCS"},{"code":"00409277602","type":"NDC"}],"standard_charges":[{"gross_charge":330.52,"discounted_cash":247.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR IV SOLN 3 (2-1) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409298703","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"00409298703","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR IV SOLN 3 (2-1) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409298723","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"00409298723","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LIDOCAINE INJ 0.5% W/ EPINEPHRINE-1:200000","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409317701","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"00409317701","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LIDOCAINE INJ 1% W/ EPINEPHRINE-1:100000","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409317802","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"00409317802","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LIDOCAINE INJ 1% W/ EPINEPHRINE-1:100000","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409317803","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"00409317803","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LIDOCAINE INJ 2% W/ EPINEPHRINE-1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409318301","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"00409318301","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"POTASSIUM ACETATE INJ 2 MEQ/ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00409329451","type":"CDM"},{"code":"00409329451","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SODIUM ACETATE INJ 2 MEQ/ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00409329906","type":"CDM"},{"code":"00409329906","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ACETYLCYSTEINE INHAL SOLN 20%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409330803","type":"CDM"},{"code":"J7608","type":"HCPCS"},{"code":"00409330803","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"METOCLOPRAMIDE HCL INJ 5 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409341401","type":"CDM"},{"code":"J2765","type":"HCPCS"},{"code":"00409341401","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"IMIPENEM-CILASTATIN INTRAVENOUS FOR SOLN 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409350810","type":"CDM"},{"code":"J0743","type":"HCPCS"},{"code":"00409350810","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BUPIVACAINE 0.75% IN DEXTROSE INJ 8.25%","drug_information":{"unit":0.666666666666667,"type":"ML"},"code_information":[{"code":"Rx00409361301","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00409361301","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MORPHINE SULFATE INJ PF 0.5 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409381412","type":"CDM"},{"code":"J2274","type":"HCPCS"},{"code":"00409381412","type":"NDC"}],"standard_charges":[{"gross_charge":135.09,"discounted_cash":101.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MORPHINE SULFATE INJ PF 1 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409381512","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00409381512","type":"NDC"}],"standard_charges":[{"gross_charge":133.99,"discounted_cash":100.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"WATER FOR INJECT, BACTERIOSTATIC BENZYL ALCOHOL","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00409397703","type":"CDM"},{"code":"00409397703","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MANNITOL IV SOLN 25%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00409403101","type":"CDM"},{"code":"J2151","type":"HCPCS"},{"code":"00409403101","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ZINC CHLORIDE INJ 1 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409409001","type":"CDM"},{"code":"00409409001","type":"NDC"}],"standard_charges":[{"gross_charge":156.42,"discounted_cash":117.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CUPRIC CHLORIDE INJ 0.4 MG/ML (ELEMENTAL)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409409201","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00409409201","type":"NDC"}],"standard_charges":[{"gross_charge":208.9,"discounted_cash":156.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CUPRIC CHLORIDE INJ 0.4 MG/ML (ELEMENTAL)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409409211","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00409409211","type":"NDC"}],"standard_charges":[{"gross_charge":130.4,"discounted_cash":97.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CHROMIC CHLORIDE INJ 40 MCG/10ML (4 MCG/ML) (ELEMENTAL CR)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409409301","type":"CDM"},{"code":"00409409301","type":"NDC"}],"standard_charges":[{"gross_charge":133.25,"discounted_cash":99.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"AMINO ACID INFUSION 10%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00409416405","type":"CDM"},{"code":"00409416405","type":"NDC"}],"standard_charges":[{"gross_charge":174.51,"discounted_cash":130.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 1 MG/ML,HYDROMORPHONE HCL-NACL SOLN PREF SYR 1 MG/ML-0.9%,HYDROMORPHONE HCL PRESERVATIVE FREE (PF) INJ 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx00409426401","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00409426401","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL INJ 0.5%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409427501","type":"CDM"},{"code":"00409427501","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409427601","type":"CDM"},{"code":"00409427601","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409427602","type":"CDM"},{"code":"00409427602","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL INJ 2%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409427701","type":"CDM"},{"code":"00409427701","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409427902","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"00409427902","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 2%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409428202","type":"CDM"},{"code":"00409428202","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"AMINOCAPROIC ACID INJ 250 MG/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00409434673","type":"CDM"},{"code":"J0281","type":"HCPCS"},{"code":"00409434673","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LIDOCAINE HCL LARYNGOTRACHEAL SOLN 4%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409469801","type":"CDM"},{"code":"00409469801","type":"NDC"}],"standard_charges":[{"gross_charge":21.4,"discounted_cash":16.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CIPROFLOXACIN 400 MG/200ML IN D5W","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx00409477702","type":"CDM"},{"code":"J0744","type":"HCPCS"},{"code":"00409477702","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CIPROFLOXACIN 200 MG/100ML IN D5W","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00409477723","type":"CDM"},{"code":"J0744","type":"HCPCS"},{"code":"00409477723","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"WATER FOR INJECTION","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409488710","type":"CDM"},{"code":"00409488710","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"WATER FOR INJECTION","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00409488720","type":"CDM"},{"code":"00409488720","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"WATER FOR INJECTION","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00409488750","type":"CDM"},{"code":"00409488750","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"WATER FOR INJECTION","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00409488799","type":"CDM"},{"code":"00409488799","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SODIUM CHLORIDE PRESERVATIVE FREE (PF) INJ 0.9%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409488810","type":"CDM"},{"code":"00409488810","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SODIUM CHLORIDE PRESERVATIVE FREE (PF) INJ 0.9%","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00409488820","type":"CDM"},{"code":"00409488820","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SODIUM CHLORIDE PRESERVATIVE FREE (PF) INJ 0.9%","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00409488850","type":"CDM"},{"code":"00409488850","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SODIUM BICARBONATE IV SOLN 8.4%","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx00409490034","type":"CDM"},{"code":"00409490034","type":"NDC"}],"standard_charges":[{"gross_charge":230.89,"discounted_cash":173.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SODIUM BICARBONATE IV SOLN 4.2%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409555502","type":"CDM"},{"code":"00409555502","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SODIUM BICARBONATE IV SOLN 4.2%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409555512","type":"CDM"},{"code":"00409555512","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DOPAMINE HCL INJ 40 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409582001","type":"CDM"},{"code":"J1265","type":"HCPCS"},{"code":"00409582001","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"AMINOPHYLLINE INJ 25 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409592101","type":"CDM"},{"code":"J0280","type":"HCPCS"},{"code":"00409592101","type":"NDC"}],"standard_charges":[{"gross_charge":131.86,"discounted_cash":98.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409610202","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"00409610202","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx00409610204","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"00409610204","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409610210","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"00409610210","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409610220","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"00409610220","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SODIUM CHLORIDE IRRIGATION SOLN 0.9%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00409613803","type":"CDM"},{"code":"00409613803","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ACETIC ACID IRRIGATION SOLN 0.25%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00409614322","type":"CDM"},{"code":"00409614322","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ERYTHROMYCIN LACTOBIONATE FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409648201","type":"CDM"},{"code":"J1364","type":"HCPCS"},{"code":"00409648201","type":"NDC"}],"standard_charges":[{"gross_charge":405.07,"discounted_cash":303.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 10 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409651001","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"00409651001","type":"NDC"}],"standard_charges":[{"gross_charge":190.94,"discounted_cash":143.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DEXTROSE INJ 50%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00409664816","type":"CDM"},{"code":"00409664816","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SODIUM CHLORIDE INJ 2.5 MEQ/ML (14.6%)","drug_information":{"unit":40.0,"type":"ML"},"code_information":[{"code":"Rx00409666075","type":"CDM"},{"code":"00409666075","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MAGNESIUM SULFATE IN DEXTROSE 5% IV SOLN 1 GM/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00409672723","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"00409672723","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MAGNESIUM SULFATE IV SOLN 20 GM/500ML (40 MG/ML)","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00409672903","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"00409672903","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MAGNESIUM SULFATE IV SOLN 40 GM/1000ML (40 MG/ML)","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00409672909","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"00409672909","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LORAZEPAM INJ 2 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00409677811","type":"CDM"},{"code":"J2060","type":"HCPCS"},{"code":"00409677811","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"POTASSIUM CHLORIDE INJ 40 MEQ/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00409707726","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"00409707726","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00409710167","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00409710167","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00409710169","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00409710169","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SODIUM CHLORIDE IRRIGATION SOLN 0.9%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00409713809","type":"CDM"},{"code":"00409713809","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"WATER FOR IRRIGATION, STERILE IRRIGATION SOLN","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00409713909","type":"CDM"},{"code":"00409713909","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"POTASSIUM PHOSPHATES INJ 45 MM/15ML (PHOS) 66 MEQ/15ML (K)","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00409729501","type":"CDM"},{"code":"00409729501","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SODIUM ACETATE INJ 2 MEQ/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00409729925","type":"CDM"},{"code":"00409729925","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR IV SOLN 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409733349","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00409733349","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 10 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409733410","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00409733410","type":"NDC"}],"standard_charges":[{"gross_charge":111.19,"discounted_cash":83.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DEXTRAN 40 INJ 10% IN SALINE","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00409741903","type":"CDM"},{"code":"J7100","type":"HCPCS"},{"code":"00409741903","type":"NDC"}],"standard_charges":[{"gross_charge":551.6,"discounted_cash":413.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HEPARIN SOD (PORCINE) IN NACL IV SOLN 25000 UNIT/250ML-0.45%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00409765005","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"00409765005","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MANNITOL IV SOLN 20%","drug_information":{"unit":62.5,"type":"ML"},"code_information":[{"code":"Rx00409771513","type":"CDM"},{"code":"J2151","type":"HCPCS"},{"code":"00409771513","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LACTATED RINGER'S FOR IRRIGATION","drug_information":{"unit":3000.0,"type":"ML"},"code_information":[{"code":"Rx00409782808","type":"CDM"},{"code":"00409782808","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DEXTROSE INJ 5%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00409792230","type":"CDM"},{"code":"J7060","type":"HCPCS"},{"code":"00409792230","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DEXTROSE 5% W/ SODIUM CHLORIDE 0.2%,DEXTROSE 5% W/ SODIUM CHLORIDE 0.225%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00409792409","type":"CDM"},{"code":"00409792409","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LACTATED RINGER'S SOLUTION","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00409795303","type":"CDM"},{"code":"J7120","type":"HCPCS"},{"code":"00409795303","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LACTATED RINGER'S SOLUTION","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00409795309","type":"CDM"},{"code":"J7120","type":"HCPCS"},{"code":"00409795309","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ELECTROLYTE-R SOLUTION,ELECTROLYTE-148 SOLUTION,ELECTROLYTE-R (PH 7.4) SOLUTION,ELECTROLYTE-A SOLUTION","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00409796709","type":"CDM"},{"code":"00409796709","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ELECTROLYTE-R IN D5W SOLN","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00409796809","type":"CDM"},{"code":"00409796809","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00409798302","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00409798302","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00409798303","type":"CDM"},{"code":"J7040","type":"HCPCS"},{"code":"00409798303","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00409798309","type":"CDM"},{"code":"J7030","type":"HCPCS"},{"code":"00409798309","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00409798325","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00409798325","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00409798330","type":"CDM"},{"code":"J7040","type":"HCPCS"},{"code":"00409798330","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00409798436","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00409798436","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00409798436","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00409798436","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":300.0,"type":"ML"},"code_information":[{"code":"Rx00409798437","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00409798437","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.45%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00409798503","type":"CDM"},{"code":"00409798503","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.45%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00409798525","type":"CDM"},{"code":"00409798525","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"POTASSIUM ACETATE INJ 2 MEQ/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00409818301","type":"CDM"},{"code":"00409818301","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 100 MCG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409909309","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"00409909309","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FENTANYL CITRATE PF SOLN CARTRIDGE 100 MCG/2MLFENTANYL CITRATE PF SOLN CARTRIDGE 100 MCG/2ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 100 MCG/2ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 1000 MCG/20ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 250 MCG/5ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 2500 MCG/50ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 500 MCG/10ML,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 100 MCG/2ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 50 MCG/ML,FENTANYL CITRATE PF SOLN PREFILLED SYRINGE 50 MCG/ML,FENTANYL CITRATE PF SOLN PREFILLED SYRINGE 25 MCG/0.5ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409909422","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"00409909422","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 250 MCG/5ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409909425","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"00409909425","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 2500 MCG/50ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00409909441","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"00409909441","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DOPAMINE HCL INJ 40 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409910420","type":"CDM"},{"code":"J1265","type":"HCPCS"},{"code":"00409910420","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PHYTONADIONE INJ 1 MG/0.5ML (2 MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00409915701","type":"CDM"},{"code":"J3430","type":"HCPCS"},{"code":"00409915701","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PHYTONADIONE INJ 10 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx00409915850","type":"CDM"},{"code":"J3430","type":"HCPCS"},{"code":"00409915850","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CEFTAROLINE FOSAMIL FOR IV SOLN 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00456040010","type":"CDM"},{"code":"J0712","type":"HCPCS"},{"code":"00456040010","type":"NDC"}],"standard_charges":[{"gross_charge":1180.48,"discounted_cash":885.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"THYROID TAB 60 MG (1 GRAIN)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00456045901","type":"CDM"},{"code":"00456045901","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CEFTAROLINE FOSAMIL FOR IV SOLN 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00456060010","type":"CDM"},{"code":"J0712","type":"HCPCS"},{"code":"00456060010","type":"NDC"}],"standard_charges":[{"gross_charge":1180.48,"discounted_cash":885.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LINACLOTIDE CAP 145 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00456120130","type":"CDM"},{"code":"00456120130","type":"NDC"}],"standard_charges":[{"gross_charge":78.02,"discounted_cash":58.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CEFTAZIDIME-AVIBACTAM SODIUM FOR IV SOLN 2.5 GM (2-0.5 GM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00456270001","type":"CDM"},{"code":"J0714","type":"HCPCS"},{"code":"00456270001","type":"NDC"}],"standard_charges":[{"gross_charge":2289.48,"discounted_cash":1717.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CEFTAZIDIME-AVIBACTAM SODIUM FOR IV SOLN 2.5 GM (2-0.5 GM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00456270010","type":"CDM"},{"code":"J0714","type":"HCPCS"},{"code":"00456270010","type":"NDC"}],"standard_charges":[{"gross_charge":2290.23,"discounted_cash":1717.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ISAVUCONAZONIUM SULFATE CAP 186 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00469052014","type":"CDM"},{"code":"00469052014","type":"NDC"}],"standard_charges":[{"gross_charge":419.37,"discounted_cash":314.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TACROLIMUS CAP 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00469060773","type":"CDM"},{"code":"J7507","type":"HCPCS"},{"code":"00469060773","type":"NDC"}],"standard_charges":[{"gross_charge":15.25,"discounted_cash":11.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TACROLIMUS INJ 5 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00469301601","type":"CDM"},{"code":"J7525","type":"HCPCS"},{"code":"00469301601","type":"NDC"}],"standard_charges":[{"gross_charge":1480.17,"discounted_cash":1110.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"AMPHOTERICIN B LIPOSOME IV FOR SUSP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00469305130","type":"CDM"},{"code":"J0289","type":"HCPCS"},{"code":"00469305130","type":"NDC"}],"standard_charges":[{"gross_charge":617.74,"discounted_cash":463.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"REGADENOSON IV INJ 0.4 MG/5ML (0.08 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00469650189","type":"CDM"},{"code":"J2785","type":"HCPCS"},{"code":"00469650189","type":"NDC"}],"standard_charges":[{"gross_charge":1496.03,"discounted_cash":1122.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ACYCLOVIR SUSP 200 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00472008216","type":"CDM"},{"code":"00472008216","type":"NDC"}],"standard_charges":[{"gross_charge":15.74,"discounted_cash":11.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PERMETHRIN CREAM 5%","drug_information":{"unit":60.0,"type":"GM"},"code_information":[{"code":"Rx00472024260","type":"CDM"},{"code":"00472024260","type":"NDC"}],"standard_charges":[{"gross_charge":407.99,"discounted_cash":305.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ALBUTEROL SULFATE SYRUP 2 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00472082516","type":"CDM"},{"code":"00472082516","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MICONAZOLE NITRATE VAGINAL SUPPOS 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00472173803","type":"CDM"},{"code":"00472173803","type":"NDC"}],"standard_charges":[{"gross_charge":65.62,"discounted_cash":49.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"IPRATROPIUM-ALBUTEROL NEBU SOLN 0.5-2.5(3) MG/3ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00487020101","type":"CDM"},{"code":"J7620","type":"HCPCS"},{"code":"00487020101","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"RACEPINEPHRINE HCL SOLN NEBU 2.25% (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00487590199","type":"CDM"},{"code":"00487590199","type":"NDC"}],"standard_charges":[{"gross_charge":1.88,"discounted_cash":1.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SODIUM CHLORIDE SOLN NEBU 3%","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00487900360","type":"CDM"},{"code":"J7131","type":"HCPCS"},{"code":"00487900360","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SODIUM CHLORIDE SOLN NEBU 0.9%","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00487930103","type":"CDM"},{"code":"00487930103","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SODIUM CHLORIDE SOLN NEBU 0.9%","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00487930133","type":"CDM"},{"code":"00487930133","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ALBUTEROL SULFATE SOLN NEBU 0.083% (2.5 MG/3ML)","drug_information":{"unit":1.5,"type":"ML"},"code_information":[{"code":"Rx00487950101","type":"CDM"},{"code":"J7613","type":"HCPCS"},{"code":"00487950101","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BUDESONIDE INHALATION SUSP 0.5 MG/2ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00487970101","type":"CDM"},{"code":"J7626","type":"HCPCS"},{"code":"00487970101","type":"NDC"}],"standard_charges":[{"gross_charge":19.32,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"IPRATROPIUM BROMIDE INHAL SOLN 0.02%","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00487980101","type":"CDM"},{"code":"J7644","type":"HCPCS"},{"code":"00487980101","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"IRON DEXTRAN INJ 50 MG/ML (ELEMENTAL IRON)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00517023410","type":"CDM"},{"code":"J1750","type":"HCPCS"},{"code":"00517023410","type":"NDC"}],"standard_charges":[{"gross_charge":123.4,"discounted_cash":92.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"METHYLENE BLUE IV SOLN 50 MG/10ML (5 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00517037405","type":"CDM"},{"code":"Q9968","type":"HCPCS"},{"code":"00517037405","type":"NDC"}],"standard_charges":[{"gross_charge":510.76,"discounted_cash":383.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"INDIGOTINDISULFONATE SODIUM INJ 8 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00517037505","type":"CDM"},{"code":"J9220","type":"HCPCS"},{"code":"00517037505","type":"NDC"}],"standard_charges":[{"gross_charge":911.86,"discounted_cash":683.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ATROPINE SULFATE INJ 0.4 MG/ML,ATROPINE SULFATE IV SOLN 0.4 MG/ML,ATROPINE SULFATE INJ PF 0.4 MG/ML,ATROPINE SULFATE IV SOLN PREFILLED SYRINGE 0.4 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00517040125","type":"CDM"},{"code":"J0461","type":"HCPCS"},{"code":"00517040125","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FERRIC CARBOXYMALTOSE IV SOLN 750 MG/15ML (FE EQUIVALENT)","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00517065001","type":"CDM"},{"code":"J1439","type":"HCPCS"},{"code":"00517065001","type":"NDC"}],"standard_charges":[{"gross_charge":4456.49,"discounted_cash":3342.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FOMEPIZOLE INJ 1 GM/ML (FOR IV INFUSION)","drug_information":{"unit":1.5,"type":"ML"},"code_information":[{"code":"Rx00517071001","type":"CDM"},{"code":"J1451","type":"HCPCS"},{"code":"00517071001","type":"NDC"}],"standard_charges":[{"gross_charge":2962.94,"discounted_cash":2222.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BETAMETHASONE SOD PHOSPHATE & ACETATE INJ SUSP 6 (3-3) MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00517072001","type":"CDM"},{"code":"J0702","type":"HCPCS"},{"code":"00517072001","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"METHYLERGONOVINE MALEATE INJ 0.2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00517074020","type":"CDM"},{"code":"J2210","type":"HCPCS"},{"code":"00517074020","type":"NDC"}],"standard_charges":[{"gross_charge":150.14,"discounted_cash":112.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ATROPINE SULFATE INJ 1 MG/ML,ATROPINE SULFATE IV SOLN 1 MG/ML,ATROPINE SULFATE INJ PF 1 MG/ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx00517101025","type":"CDM"},{"code":"J0461","type":"HCPCS"},{"code":"00517101025","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"IRON SUCROSE INJ 20 MG/ML (FE EQUIV)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00517231005","type":"CDM"},{"code":"J1756","type":"HCPCS"},{"code":"00517231005","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"IRON SUCROSE INJ 20 MG/ML (FE EQUIV)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00517234010","type":"CDM"},{"code":"J1756","type":"HCPCS"},{"code":"00517234010","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CAFFEINE & SODIUM BENZOATE INJ 125-125 MG/ML (500 MG/2ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00517250210","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00517250210","type":"NDC"}],"standard_charges":[{"gross_charge":227.03,"discounted_cash":170.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PAPAVERINE HCL INJ 30 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00517401001","type":"CDM"},{"code":"J2440","type":"HCPCS"},{"code":"00517401001","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NITROGLYCERIN IV SOLN 5 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00517481025","type":"CDM"},{"code":"J2305","type":"HCPCS"},{"code":"00517481025","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HYDROXYZINE HCL IM SOLN 50 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00517560125","type":"CDM"},{"code":"J3410","type":"HCPCS"},{"code":"00517560125","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SELENIOUS ACID INJ 60 MCG/ML (SELENIUM EQUIV)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00517656001","type":"CDM"},{"code":"00517656001","type":"NDC"}],"standard_charges":[{"gross_charge":1220.86,"discounted_cash":915.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CALCIUM CHLORIDE INJ 10%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00517671010","type":"CDM"},{"code":"00517671010","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ACETYLCYSTEINE INHAL SOLN 20%","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx00517760425","type":"CDM"},{"code":"J7608","type":"HCPCS"},{"code":"00517760425","type":"NDC"}],"standard_charges":[{"gross_charge":22.68,"discounted_cash":17.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ZINC SULFATE INJ 5 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00517810525","type":"CDM"},{"code":"00517810525","type":"NDC"}],"standard_charges":[{"gross_charge":273.0,"discounted_cash":204.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TRACE MIN (CU-MN-SE-ZN) INJ 300-55-60-3000 MCG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00517930501","type":"CDM"},{"code":"00517930501","type":"NDC"}],"standard_charges":[{"gross_charge":115.49,"discounted_cash":86.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TRACE MIN (CU-MN-SE-ZN) INJ 300-55-60-3000 MCG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00517930525","type":"CDM"},{"code":"00517930525","type":"NDC"}],"standard_charges":[{"gross_charge":169.9,"discounted_cash":127.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BUTALBITAL-ACETAMINOPHEN-CAFFEINE TAB 50-325-40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00527169501","type":"CDM"},{"code":"00527169501","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CODEINE SULFATE TAB 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00527169801","type":"CDM"},{"code":"00527169801","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FLUPHENAZINE HCL TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00527178801","type":"CDM"},{"code":"00527178801","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"METHADONE HCL CONC 10 MG/ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00527192736","type":"CDM"},{"code":"00527192736","type":"NDC"}],"standard_charges":[{"gross_charge":150.03,"discounted_cash":112.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LEVOFLOXACIN ORAL SOLN 25 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00527194866","type":"CDM"},{"code":"00527194866","type":"NDC"}],"standard_charges":[{"gross_charge":78.7,"discounted_cash":59.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"VENLAFAXINE HCL TAB ER 24HR 150 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00527260432","type":"CDM"},{"code":"00527260432","type":"NDC"}],"standard_charges":[{"gross_charge":14.89,"discounted_cash":11.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LIDOCAINE HCL SOLN 4%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00527600480","type":"CDM"},{"code":"00527600480","type":"NDC"}],"standard_charges":[{"gross_charge":97.36,"discounted_cash":73.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CALCIUM CARBONATE (ANTACID) CHEW TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536100715","type":"CDM"},{"code":"00536100715","type":"NDC"}],"standard_charges":[{"gross_charge":0.51,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"POLYETHYLENE GLYCOL 3350 ORAL POWDER 17 GM/SCOOP","drug_information":{"unit":238.0,"type":"GM"},"code_information":[{"code":"Rx00536105224","type":"CDM"},{"code":"00536105224","type":"NDC"}],"standard_charges":[{"gross_charge":5.26,"discounted_cash":3.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ASPIRIN TAB 325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536105405","type":"CDM"},{"code":"00536105405","type":"NDC"}],"standard_charges":[{"gross_charge":0.5,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BENZOYL PEROXIDE GEL 5%","drug_information":{"unit":42.5,"type":"GM"},"code_information":[{"code":"Rx00536105556","type":"CDM"},{"code":"00536105556","type":"NDC"}],"standard_charges":[{"gross_charge":3.77,"discounted_cash":2.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PETROLATUM OINTMENT","drug_information":{"unit":454.0,"type":"GM"},"code_information":[{"code":"Rx00536114398","type":"CDM"},{"code":"00536114398","type":"NDC"}],"standard_charges":[{"gross_charge":10.94,"discounted_cash":8.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PHENYLEPHRINE-COCOA BUTTER SUPPOS 0.25-88.44%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536118612","type":"CDM"},{"code":"00536118612","type":"NDC"}],"standard_charges":[{"gross_charge":0.74,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DIBUCAINE OINT 1%","drug_information":{"unit":28.0,"type":"GM"},"code_information":[{"code":"Rx00536121195","type":"CDM"},{"code":"00536121195","type":"NDC"}],"standard_charges":[{"gross_charge":3.83,"discounted_cash":2.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TETRAHYDROZOLINE HCL OPHTH SOLN 0.05%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00536121794","type":"CDM"},{"code":"00536121794","type":"NDC"}],"standard_charges":[{"gross_charge":1.92,"discounted_cash":1.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"OPHTHALMIC IRRIGATION SOLUTION","drug_information":{"unit":118.0,"type":"ML"},"code_information":[{"code":"Rx00536122497","type":"CDM"},{"code":"00536122497","type":"NDC"}],"standard_charges":[{"gross_charge":3.33,"discounted_cash":2.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ASPIRIN TAB DELAYED RELEASE 81 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536123441","type":"CDM"},{"code":"00536123441","type":"NDC"}],"standard_charges":[{"gross_charge":0.51,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LIDOCAINE CREAM 4%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx00536126720","type":"CDM"},{"code":"00536126720","type":"NDC"}],"standard_charges":[{"gross_charge":8.27,"discounted_cash":6.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BISMUTH SUBSALICYLATE SUSP 262 MG/15ML","drug_information":{"unit":237.0,"type":"ML"},"code_information":[{"code":"Rx00536128636","type":"CDM"},{"code":"00536128636","type":"NDC"}],"standard_charges":[{"gross_charge":3.34,"discounted_cash":2.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ALUM & MAG HYDROXIDE-SIMETHICONE SUSP 200-200-20 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00536131783","type":"CDM"},{"code":"00536131783","type":"NDC"}],"standard_charges":[{"gross_charge":0.59,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ACETAMINOPHEN TAB 325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536132710","type":"CDM"},{"code":"00536132710","type":"NDC"}],"standard_charges":[{"gross_charge":0.51,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NICOTINE POLACRILEX GUM 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536137206","type":"CDM"},{"code":"00536137206","type":"NDC"}],"standard_charges":[{"gross_charge":0.86,"discounted_cash":0.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HYDROCORTISONE CREAM 1%","drug_information":{"unit":28.0,"type":"GM"},"code_information":[{"code":"Rx00536140795","type":"CDM"},{"code":"00536140795","type":"NDC"}],"standard_charges":[{"gross_charge":1.78,"discounted_cash":1.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SELENIUM SULFIDE LOTION 1%","drug_information":{"unit":207.0,"type":"ML"},"code_information":[{"code":"Rx00536199553","type":"CDM"},{"code":"00536199553","type":"NDC"}],"standard_charges":[{"gross_charge":3.19,"discounted_cash":2.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SIMETHICONE SUSP 40 MG/0.6ML","drug_information":{"unit":0.6,"type":"ML"},"code_information":[{"code":"Rx00536222075","type":"CDM"},{"code":"00536222075","type":"NDC"}],"standard_charges":[{"gross_charge":0.53,"discounted_cash":0.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CAPSAICIN CREAM 0.025%","drug_information":{"unit":60.0,"type":"GM"},"code_information":[{"code":"Rx00536252525","type":"CDM"},{"code":"00536252525","type":"NDC"}],"standard_charges":[{"gross_charge":3.8,"discounted_cash":2.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NICOTINE POLACRILEX GUM 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536302934","type":"CDM"},{"code":"00536302934","type":"NDC"}],"standard_charges":[{"gross_charge":0.83,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ASCORBIC ACID TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536329201","type":"CDM"},{"code":"00536329201","type":"NDC"}],"standard_charges":[{"gross_charge":0.52,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NIACIN TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536407601","type":"CDM"},{"code":"00536407601","type":"NDC"}],"standard_charges":[{"gross_charge":0.51,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CALCIUM POLYCARBOPHIL TAB 625 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536430611","type":"CDM"},{"code":"00536430611","type":"NDC"}],"standard_charges":[{"gross_charge":0.55,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MULTIPLE VITAMINS W/ MINERALS TAB","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536466110","type":"CDM"},{"code":"00536466110","type":"NDC"}],"standard_charges":[{"gross_charge":0.53,"discounted_cash":0.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TOLNAFTATE POWDER 1%","drug_information":{"unit":45.0,"type":"GM"},"code_information":[{"code":"Rx00536515026","type":"CDM"},{"code":"00536515026","type":"NDC"}],"standard_charges":[{"gross_charge":2.48,"discounted_cash":1.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ZINC OXIDE OINT 20%","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx00536570028","type":"CDM"},{"code":"00536570028","type":"NDC"}],"standard_charges":[{"gross_charge":2.33,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NICOTINE TD PATCH 24HR 7 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536589488","type":"CDM"},{"code":"00536589488","type":"NDC"}],"standard_charges":[{"gross_charge":1.94,"discounted_cash":1.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NICOTINE TD PATCH 24HR 14 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536589588","type":"CDM"},{"code":"00536589588","type":"NDC"}],"standard_charges":[{"gross_charge":2.06,"discounted_cash":1.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NICOTINE TD PATCH 24HR 21 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536589688","type":"CDM"},{"code":"00536589688","type":"NDC"}],"standard_charges":[{"gross_charge":1.76,"discounted_cash":1.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MEDROXYPROGESTERONE ACETATE IM SUSP 150 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00548540000","type":"CDM"},{"code":"J1050","type":"HCPCS"},{"code":"00548540000","type":"NDC"}],"standard_charges":[{"gross_charge":180.39,"discounted_cash":135.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MEDROXYPROGESTERONE ACETATE IM SUSP 150 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00548540025","type":"CDM"},{"code":"J1050","type":"HCPCS"},{"code":"00548540025","type":"NDC"}],"standard_charges":[{"gross_charge":170.42,"discounted_cash":127.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ 300 MG/3ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00548560800","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00548560800","type":"NDC"}],"standard_charges":[{"gross_charge":218.14,"discounted_cash":163.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"COSYNTROPIN FOR INJ 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00548590000","type":"CDM"},{"code":"J0834","type":"HCPCS"},{"code":"00548590000","type":"NDC"}],"standard_charges":[{"gross_charge":134.41,"discounted_cash":100.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"VASOPRESSIN IV SOLN 20 UNIT/ML (FOR IV INFUSION)","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00548970100","type":"CDM"},{"code":"J2598","type":"HCPCS"},{"code":"00548970100","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CHLORDIAZEPOXIDE HCL CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00555003302","type":"CDM"},{"code":"00555003302","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ISONIAZID TAB 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00555007102","type":"CDM"},{"code":"00555007102","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CLONAZEPAM ORALLY DISINTEGRATING TAB 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00555009596","type":"CDM"},{"code":"00555009596","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CHLORDIAZEPOXIDE HCL CAP 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00555015802","type":"CDM"},{"code":"00555015802","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NORETHINDRONE ACETATE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00555021110","type":"CDM"},{"code":"00555021110","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MEGESTROL ACETATE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00555060602","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"00555060602","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ESTRADIOL TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00555088602","type":"CDM"},{"code":"00555088602","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ESTRADIOL TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00555089902","type":"CDM"},{"code":"00555089902","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"AMPHETAMINE-DEXTROAMPHETAMINE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00555097102","type":"CDM"},{"code":"00555097102","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"RHO D IMMUNE GLOBULIN IM SOLN PREF SYR 250 UNIT (50 MCG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00562780605","type":"CDM"},{"code":"J2788","type":"HCPCS"},{"code":"00562780605","type":"NDC"}],"standard_charges":[{"gross_charge":248.03,"discounted_cash":186.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"GLUCOSE GEL 40%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx00574006915","type":"CDM"},{"code":"00574006915","type":"NDC"}],"standard_charges":[{"gross_charge":1.92,"discounted_cash":1.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BROMOCRIPTINE MESYLATE TAB 2.5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00574010603","type":"CDM"},{"code":"00574010603","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CHARCOAL ACTIVATED-SORBITOL SUSP","drug_information":{"unit":120.0,"type":"ML"},"code_information":[{"code":"Rx00574012004","type":"CDM"},{"code":"00574012004","type":"NDC"}],"standard_charges":[{"gross_charge":12.26,"discounted_cash":9.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CHARCOAL ACTIVATED-SORBITOL SUSP","drug_information":{"unit":120.0,"type":"ML"},"code_information":[{"code":"Rx00574012074","type":"CDM"},{"code":"00574012074","type":"NDC"}],"standard_charges":[{"gross_charge":12.26,"discounted_cash":9.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CHARCOAL ACTIVATED LIQ","drug_information":{"unit":120.0,"type":"ML"},"code_information":[{"code":"Rx00574012174","type":"CDM"},{"code":"00574012174","type":"NDC"}],"standard_charges":[{"gross_charge":12.26,"discounted_cash":9.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"AMILORIDE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00574029201","type":"CDM"},{"code":"00574029201","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ORAL VEHICLES - SYRUP","drug_information":{"unit":473.0,"type":"ML"},"code_information":[{"code":"Rx00574030216","type":"CDM"},{"code":"00574030216","type":"NDC"}],"standard_charges":[{"gross_charge":16.1,"discounted_cash":12.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CHARCOAL ACTIVATED-SORBITOL SUSP","drug_information":{"unit":120.0,"type":"ML"},"code_information":[{"code":"Rx00574052074","type":"CDM"},{"code":"00574052074","type":"NDC"}],"standard_charges":[{"gross_charge":15.02,"discounted_cash":11.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"METHAZOLAMIDE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00574079001","type":"CDM"},{"code":"00574079001","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ACETYLCYSTEINE INJ 200 MG/ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00574080530","type":"CDM"},{"code":"J0132","type":"HCPCS"},{"code":"00574080530","type":"NDC"}],"standard_charges":[{"gross_charge":257.94,"discounted_cash":193.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DIHYDROERGOTAMINE MESYLATE INJ 1 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00574085005","type":"CDM"},{"code":"J1110","type":"HCPCS"},{"code":"00574085005","type":"NDC"}],"standard_charges":[{"gross_charge":762.27,"discounted_cash":571.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NEOMYCIN-POLYMYXIN-DEXAMETHASONE OPHTH OINT 0.1%","drug_information":{"unit":3.5,"type":"GM"},"code_information":[{"code":"Rx00574416035","type":"CDM"},{"code":"00574416035","type":"NDC"}],"standard_charges":[{"gross_charge":52.88,"discounted_cash":39.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ASPIRIN SUPPOS 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00574703412","type":"CDM"},{"code":"00574703412","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BISACODYL SUPPOS 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00574705012","type":"CDM"},{"code":"00574705012","type":"NDC"}],"standard_charges":[{"gross_charge":0.72,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BISACODYL SUPPOS 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00574705050","type":"CDM"},{"code":"00574705050","type":"NDC"}],"standard_charges":[{"gross_charge":0.68,"discounted_cash":0.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HYDROMORPHONE HCL SUPPOS 3 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00574722406","type":"CDM"},{"code":"00574722406","type":"NDC"}],"standard_charges":[{"gross_charge":72.58,"discounted_cash":54.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DIAZOXIDE SUSP 50 MG/ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00575620030","type":"CDM"},{"code":"00575620030","type":"NDC"}],"standard_charges":[{"gross_charge":1906.27,"discounted_cash":1429.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ESTRADIOL TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591052801","type":"CDM"},{"code":"00591052801","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PROPAFENONE HCL TAB 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591058201","type":"CDM"},{"code":"00591058201","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DICYCLOMINE HCL CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591079401","type":"CDM"},{"code":"00591079401","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DICYCLOMINE HCL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591079501","type":"CDM"},{"code":"00591079501","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CLONIDINE TD PATCH WEEKLY 0.2 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591350904","type":"CDM"},{"code":"00591350904","type":"NDC"}],"standard_charges":[{"gross_charge":186.59,"discounted_cash":139.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BUTALBITAL-ASPIRIN-CAFF W/ CODEINE CAP 50-325-40-30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591354601","type":"CDM"},{"code":"00591354601","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TRIHEXYPHENIDYL HCL TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591533501","type":"CDM"},{"code":"00591533501","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PROBENECID TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591534701","type":"CDM"},{"code":"00591534701","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ASPIRIN-DIPYRIDAMOLE CAP ER 12HR 25-200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00597000160","type":"CDM"},{"code":"00597000160","type":"NDC"}],"standard_charges":[{"gross_charge":39.06,"discounted_cash":29.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"IPRATROPIUM-ALBUTEROL INHAL AEROSOL SOLN 20-100 MCG/ACT","drug_information":{"unit":4.0,"type":"GM"},"code_information":[{"code":"Rx00597002402","type":"CDM"},{"code":"00597002402","type":"NDC"}],"standard_charges":[{"gross_charge":1725.07,"discounted_cash":1293.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"IPRATROPIUM BROMIDE HFA INHAL AEROSOL 17 MCG/ACT","drug_information":{"unit":12.9,"type":"GM"},"code_information":[{"code":"Rx00597008717","type":"CDM"},{"code":"00597008717","type":"NDC"}],"standard_charges":[{"gross_charge":1265.25,"discounted_cash":948.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TIOTROPIUM BROMIDE INHAL AEROSOL 2.5 MCG/ACT","drug_information":{"unit":4.0,"type":"GM"},"code_information":[{"code":"Rx00597010051","type":"CDM"},{"code":"00597010051","type":"NDC"}],"standard_charges":[{"gross_charge":103.07,"discounted_cash":77.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"EMPAGLIFLOZIN TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00597015230","type":"CDM"},{"code":"00597015230","type":"NDC"}],"standard_charges":[{"gross_charge":41.23,"discounted_cash":30.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"IDARUCIZUMAB IV SOLN 2.5 GM/50ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00597019705","type":"CDM"},{"code":"J3590","type":"HCPCS"},{"code":"00597019705","type":"NDC"}],"standard_charges":[{"gross_charge":22173.41,"discounted_cash":16630.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DABIGATRAN ETEXILATE MESYLATE CAP 75 MG (ETEXILATE BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00597035556","type":"CDM"},{"code":"00597035556","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DABIGATRAN ETEXILATE MESYLATE CAP 150 MG (ETEXILATE BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00597036082","type":"CDM"},{"code":"00597036082","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PERPHENAZINE TAB 8 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00603506221","type":"CDM"},{"code":"00603506221","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NYSTATIN CREAM 100000 UNIT/GM","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx00603781878","type":"CDM"},{"code":"00603781878","type":"NDC"}],"standard_charges":[{"gross_charge":87.69,"discounted_cash":65.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 2 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx00641012125","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00641012125","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE INJ 10 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00641036721","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"00641036721","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DIPHENHYDRAMINE HCL INJ 50 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641037621","type":"CDM"},{"code":"J1200","type":"HCPCS"},{"code":"00641037621","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DIPHENHYDRAMINE HCL INJ 50 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641037625","type":"CDM"},{"code":"J1200","type":"HCPCS"},{"code":"00641037625","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PHENOBARBITAL SODIUM INJ 65 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641047621","type":"CDM"},{"code":"J2560","type":"HCPCS"},{"code":"00641047621","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PHENOBARBITAL SODIUM INJ 130 MG/ML","drug_information":{"unit":0.384615384615385,"type":"ML"},"code_information":[{"code":"Rx00641047721","type":"CDM"},{"code":"J2560","type":"HCPCS"},{"code":"00641047721","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PHENYTOIN SODIUM INJ 50 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641049325","type":"CDM"},{"code":"J1165","type":"HCPCS"},{"code":"00641049325","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PROMETHAZINE HCL INJ 25 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641092821","type":"CDM"},{"code":"J2550","type":"HCPCS"},{"code":"00641092821","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CHLORPROMAZINE HCL INJ 25 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641139735","type":"CDM"},{"code":"J3230","type":"HCPCS"},{"code":"00641139735","type":"NDC"}],"standard_charges":[{"gross_charge":184.45,"discounted_cash":138.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DIGOXIN INJ 0.25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641141035","type":"CDM"},{"code":"J1160","type":"HCPCS"},{"code":"00641141035","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ATROPINE SULFATE INJ 8 MG/20ML (0.4 MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00641600610","type":"CDM"},{"code":"J0461","type":"HCPCS"},{"code":"00641600610","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BUMETANIDE INJ 0.25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641600710","type":"CDM"},{"code":"J1939","type":"HCPCS"},{"code":"00641600710","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DILTIAZEM HCL IV SOLN 125 MG/25ML (5 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641601510","type":"CDM"},{"code":"00641601510","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DOXAPRAM HCL INJ 20 MG/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00641601806","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00641601806","type":"NDC"}],"standard_charges":[{"gross_charge":342.31,"discounted_cash":256.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MORPHINE SULF FOR MICROINFUSION PF INJ 200 MG/20ML (10MG/ML)","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00641603901","type":"CDM"},{"code":"J2274","type":"HCPCS"},{"code":"00641603901","type":"NDC"}],"standard_charges":[{"gross_charge":1195.1,"discounted_cash":896.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LORAZEPAM INJ 2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641604610","type":"CDM"},{"code":"J2060","type":"HCPCS"},{"code":"00641604610","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MEPERIDINE HCL INJ 25 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641605201","type":"CDM"},{"code":"J2175","type":"HCPCS"},{"code":"00641605201","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MEPERIDINE HCL INJ 25 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641605225","type":"CDM"},{"code":"J2175","type":"HCPCS"},{"code":"00641605225","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MIDAZOLAM HCL INJ 2 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 10 MG/10ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 5 MG/5ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 2 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/5ML (BASE EQUIVALENT),MIDAZOLAM INJ SOLN PREFILLED SYRINGE 2 MG/2ML,MIDAZOLAM IV SOLN PREFILLED SYRINGE 2 MG/2ML,MIDAZOLAM INJ SOLN PREFILLED SYRINGE 3 MG/3ML,MIDAZOLAM INJ SOLN PREFILLED SYRINGE 5 MG/5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00641605610","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00641605610","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MIDAZOLAM HCL INJ 2 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 10 MG/10ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 5 MG/5ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 2 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/5ML (BASE EQUIVALENT),MIDAZOLAM INJ SOLN PREFILLED SYRINGE 2 MG/2ML,MIDAZOLAM IV SOLN PREFILLED SYRINGE 2 MG/2ML,MIDAZOLAM INJ SOLN PREFILLED SYRINGE 3 MG/3ML,MIDAZOLAM INJ SOLN PREFILLED SYRINGE 5 MG/5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00641605725","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00641605725","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MIDAZOLAM HCL INJ 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 25 MG/5ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 5 MG/ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 50 MG/10ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx00641606101","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00641606101","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MIDAZOLAM HCL INJ 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 25 MG/5ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 5 MG/ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 50 MG/10ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx00641606110","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00641606110","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ONDANSETRON HCL INJ 4 MG/2ML (2 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641607825","type":"CDM"},{"code":"J2405","type":"HCPCS"},{"code":"00641607825","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PROMETHAZINE HCL INJ 25 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00641608401","type":"CDM"},{"code":"J2550","type":"HCPCS"},{"code":"00641608401","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PROMETHAZINE HCL INJ 25 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00641608425","type":"CDM"},{"code":"J2550","type":"HCPCS"},{"code":"00641608425","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR IV SOLN 15 (10-5) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00641611801","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"00641611801","type":"NDC"}],"standard_charges":[{"gross_charge":151.21,"discounted_cash":113.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MORPHINE SULFATE IV SOLN 10 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00641612701","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00641612701","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MORPHINE SULFATE IV SOLN 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641612725","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00641612725","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PHENYLEPHRINE HCL IV SOLN 10 MG/ML","drug_information":{"unit":0.006,"type":"ML"},"code_information":[{"code":"Rx00641614225","type":"CDM"},{"code":"J2371","type":"HCPCS"},{"code":"00641614225","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CAFFEINE CITRATE INJ 60 MG/3ML (10 MG/ML BASE EQUIV)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00641616410","type":"CDM"},{"code":"J0706","type":"HCPCS"},{"code":"00641616410","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"AMIKACIN SULFATE INJ 500 MG/2ML (250 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641616701","type":"CDM"},{"code":"J0278","type":"HCPCS"},{"code":"00641616701","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"AMIKACIN SULFATE INJ 500 MG/2ML (250 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641616710","type":"CDM"},{"code":"J0278","type":"HCPCS"},{"code":"00641616710","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"OCTREOTIDE ACETATE INJ 50 MCG/ML (0.05 MG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641617401","type":"CDM"},{"code":"J2354","type":"HCPCS"},{"code":"00641617401","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LORAZEPAM INJ 2 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00641620725","type":"CDM"},{"code":"J2060","type":"HCPCS"},{"code":"00641620725","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LABETALOL HCL IV SOLN 5 MG/ML,LABETALOL HCL IV SOLN PREFILLED SYRINGE 20 MG/4ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 50 MG/10ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 25 MG/5ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 10 MG/2ML (5 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641625210","type":"CDM"},{"code":"J1921","type":"HCPCS"},{"code":"00641625210","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DILTIAZEM HCL IV SOLN 125 MG/25ML (5 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641921901","type":"CDM"},{"code":"00641921901","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HYDROMORPHONE HCL PRESERVATIVE FREE (PF) INJ 10 MG/ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00703001801","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00703001801","type":"NDC"}],"standard_charges":[{"gross_charge":584.57,"discounted_cash":438.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HYDROMORPHONE HCL PRESERVATIVE FREE (PF) INJ 10 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00703011303","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00703011303","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BLEOMYCIN SULFATE FOR INJ 30 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00703315501","type":"CDM"},{"code":"J9040","type":"HCPCS"},{"code":"00703315501","type":"NDC"}],"standard_charges":[{"gross_charge":746.13,"discounted_cash":559.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"METHOTREXATE SODIUM INJ PF 250 MG/10ML (25 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00703367501","type":"CDM"},{"code":"J9260","type":"HCPCS"},{"code":"00703367501","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CARBOPLATIN IV SOLN 50 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00703424401","type":"CDM"},{"code":"J9045","type":"HCPCS"},{"code":"00703424401","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CARBOPLATIN IV SOLN 150 MG/15ML","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00703424601","type":"CDM"},{"code":"J9045","type":"HCPCS"},{"code":"00703424601","type":"NDC"}],"standard_charges":[{"gross_charge":143.23,"discounted_cash":107.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CARBOPLATIN IV SOLN 450 MG/45ML","drug_information":{"unit":45.0,"type":"ML"},"code_information":[{"code":"Rx00703424801","type":"CDM"},{"code":"J9045","type":"HCPCS"},{"code":"00703424801","type":"NDC"}],"standard_charges":[{"gross_charge":364.13,"discounted_cash":273.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PACLITAXEL IV CONC 100 MG/16.7ML (6 MG/ML)","drug_information":{"unit":16.7,"type":"ML"},"code_information":[{"code":"Rx00703476601","type":"CDM"},{"code":"J9267","type":"HCPCS"},{"code":"00703476601","type":"NDC"}],"standard_charges":[{"gross_charge":296.78,"discounted_cash":222.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DACARBAZINE FOR INJ 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00703507501","type":"CDM"},{"code":"J9130","type":"HCPCS"},{"code":"00703507501","type":"NDC"}],"standard_charges":[{"gross_charge":115.43,"discounted_cash":86.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LEUCOVORIN CALCIUM FOR INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00703514001","type":"CDM"},{"code":"J0640","type":"HCPCS"},{"code":"00703514001","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LEUCOVORIN CALCIUM FOR INJ 350 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00703514591","type":"CDM"},{"code":"J0640","type":"HCPCS"},{"code":"00703514591","type":"NDC"}],"standard_charges":[{"gross_charge":133.3,"discounted_cash":99.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DAUNORUBICIN HCL IV SOLN 20 MG/4ML (BASE EQUIV)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx00703523313","type":"CDM"},{"code":"J9150","type":"HCPCS"},{"code":"00703523313","type":"NDC"}],"standard_charges":[{"gross_charge":943.37,"discounted_cash":707.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ETOPOSIDE INJ 500 MG/25ML (20 MG/ML)","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx00703565691","type":"CDM"},{"code":"J9181","type":"HCPCS"},{"code":"00703565691","type":"NDC"}],"standard_charges":[{"gross_charge":184.46,"discounted_cash":138.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"AMIKACIN SULFATE INJ 1 GM/4ML (250 MG/ML)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx00703904001","type":"CDM"},{"code":"J0278","type":"HCPCS"},{"code":"00703904001","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"AMIKACIN SULFATE INJ 1 GM/4ML (250 MG/ML)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx00703904003","type":"CDM"},{"code":"J0278","type":"HCPCS"},{"code":"00703904003","type":"NDC"}],"standard_charges":[{"gross_charge":164.71,"discounted_cash":123.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM IV SOLN 400-80 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00703951403","type":"CDM"},{"code":"J2865","type":"HCPCS"},{"code":"00703951403","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ACETAMINOPHEN SUPPOS 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00713011812","type":"CDM"},{"code":"00713011812","type":"NDC"}],"standard_charges":[{"gross_charge":0.96,"discounted_cash":0.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PROMETHAZINE HCL SUPPOS 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00713013212","type":"CDM"},{"code":"00713013212","type":"NDC"}],"standard_charges":[{"gross_charge":110.6,"discounted_cash":82.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PROCHLORPERAZINE SUPPOS 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00713013512","type":"CDM"},{"code":"00713013512","type":"NDC"}],"standard_charges":[{"gross_charge":35.92,"discounted_cash":26.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HYDROCORTISONE ACETATE SUPPOS 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00713050324","type":"CDM"},{"code":"00713050324","type":"NDC"}],"standard_charges":[{"gross_charge":45.04,"discounted_cash":33.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PROMETHAZINE HCL SUPPOS 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00713052612","type":"CDM"},{"code":"00713052612","type":"NDC"}],"standard_charges":[{"gross_charge":14.5,"discounted_cash":10.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PROMETHAZINE HCL SUPPOS 12.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00713053612","type":"CDM"},{"code":"00713053612","type":"NDC"}],"standard_charges":[{"gross_charge":18.49,"discounted_cash":13.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TERCONAZOLE VAGINAL SUPPOS 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00713055273","type":"CDM"},{"code":"00713055273","type":"NDC"}],"standard_charges":[{"gross_charge":112.19,"discounted_cash":84.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TRIAMCINOLONE ACETONIDE DENTAL PASTE 0.1%","drug_information":{"unit":5.0,"type":"GM"},"code_information":[{"code":"Rx00713065540","type":"CDM"},{"code":"00713065540","type":"NDC"}],"standard_charges":[{"gross_charge":269.65,"discounted_cash":202.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"GENTAMICIN SULFATE OINT 0.1%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx00713068215","type":"CDM"},{"code":"00713068215","type":"NDC"}],"standard_charges":[{"gross_charge":59.83,"discounted_cash":44.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NYSTATIN OINT 100000 UNIT/GM","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx00713068631","type":"CDM"},{"code":"00713068631","type":"NDC"}],"standard_charges":[{"gross_charge":45.73,"discounted_cash":34.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"METHAZOLAMIDE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781107201","type":"CDM"},{"code":"00781107201","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"AMOXICILLIN (TRIHYDRATE) CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781202001","type":"CDM"},{"code":"00781202001","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"RIBAVIRIN CAP 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781204316","type":"CDM"},{"code":"00781204316","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PYRIDOSTIGMINE BROMIDE IV SOLN 10 MG/2ML (5 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00781304095","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00781304095","type":"NDC"}],"standard_charges":[{"gross_charge":202.33,"discounted_cash":151.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NAFCILLIN SODIUM FOR IV SOLN 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781312915","type":"CDM"},{"code":"00781312915","type":"NDC"}],"standard_charges":[{"gross_charge":166.8,"discounted_cash":125.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"OLANZAPINE FOR IM INJ 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781315972","type":"CDM"},{"code":"J2359","type":"HCPCS"},{"code":"00781315972","type":"NDC"}],"standard_charges":[{"gross_charge":107.38,"discounted_cash":80.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781320785","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00781320785","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781320795","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00781320795","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781320895","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00781320895","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 30 MG/0.3ML","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"Rx00781323863","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00781323863","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 40 MG/0.4ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx00781324664","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00781324664","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 60 MG/0.6ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00781325666","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00781325666","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE IN D5W IV SOLN 300 MG/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00781328809","type":"CDM"},{"code":"J0736","type":"HCPCS"},{"code":"00781328809","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE IN D5W IV SOLN 600 MG/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00781328909","type":"CDM"},{"code":"J0736","type":"HCPCS"},{"code":"00781328909","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE IN D5W IV SOLN 600 MG/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00781328991","type":"CDM"},{"code":"J0736","type":"HCPCS"},{"code":"00781328991","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE IN D5W IV SOLN 900 MG/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00781329009","type":"CDM"},{"code":"J0736","type":"HCPCS"},{"code":"00781329009","type":"NDC"}],"standard_charges":[{"gross_charge":108.66,"discounted_cash":81.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 120 MG/0.8ML","drug_information":{"unit":0.733333333333333,"type":"ML"},"code_information":[{"code":"Rx00781329804","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00781329804","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 120 MG/0.8ML","drug_information":{"unit":0.733333333333333,"type":"ML"},"code_information":[{"code":"Rx00781329868","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00781329868","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 150 MG/ML","drug_information":{"unit":0.866666666666667,"type":"ML"},"code_information":[{"code":"Rx00781329969","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00781329969","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"OXALIPLATIN IV SOLN 50 MG/10ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00781331570","type":"CDM"},{"code":"J9263","type":"HCPCS"},{"code":"00781331570","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM NA FOR INJ 3.375 GM (3-0.375 GM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781335094","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"00781335094","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781340880","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"00781340880","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781340895","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"00781340895","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"COSYNTROPIN FOR INJ 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781344095","type":"CDM"},{"code":"J0834","type":"HCPCS"},{"code":"00781344095","type":"NDC"}],"standard_charges":[{"gross_charge":218.42,"discounted_cash":163.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PHENYLEPHRINE HCL IV SOLN 10 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00781345895","type":"CDM"},{"code":"J2371","type":"HCPCS"},{"code":"00781345895","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DESIPRAMINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781521801","type":"CDM"},{"code":"00781521801","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"AMOXICILLIN (TRIHYDRATE) FOR SUSP 250 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00781604146","type":"CDM"},{"code":"00781604146","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"AMOXICILLIN (TRIHYDRATE) FOR SUSP 250 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00781604155","type":"CDM"},{"code":"00781604155","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"METRONIDAZOLE VAGINAL GEL 0.75%","drug_information":{"unit":70.0,"type":"GM"},"code_information":[{"code":"Rx00781707787","type":"CDM"},{"code":"00781707787","type":"NDC"}],"standard_charges":[{"gross_charge":504.64,"discounted_cash":378.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ESTRADIOL TD PATCH WEEKLY 0.1 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781710454","type":"CDM"},{"code":"00781710454","type":"NDC"}],"standard_charges":[{"gross_charge":52.15,"discounted_cash":39.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ESTRADIOL TD PATCH TWICE WEEKLY 0.05 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781714483","type":"CDM"},{"code":"00781714483","type":"NDC"}],"standard_charges":[{"gross_charge":45.48,"discounted_cash":34.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BETHANECHOL CHLORIDE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832051101","type":"CDM"},{"code":"00832051101","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CLOBAZAM TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832058011","type":"CDM"},{"code":"00832058011","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"WARFARIN SODIUM TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832121101","type":"CDM"},{"code":"00832121101","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"WARFARIN SODIUM TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832121501","type":"CDM"},{"code":"00832121501","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"WARFARIN SODIUM TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832121589","type":"CDM"},{"code":"00832121589","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"WARFARIN SODIUM TAB 6 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832121701","type":"CDM"},{"code":"00832121701","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"WARFARIN SODIUM TAB 7.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832121801","type":"CDM"},{"code":"00832121801","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CHLORPHENIRAMINE MALEATE TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904001261","type":"CDM"},{"code":"00904001261","type":"NDC"}],"standard_charges":[{"gross_charge":0.56,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"AMITRIPTYLINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904020161","type":"CDM"},{"code":"00904020161","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DOXYCYCLINE HYCLATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904043006","type":"CDM"},{"code":"00904043006","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ASCORBIC ACID TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904052361","type":"CDM"},{"code":"00904052361","type":"NDC"}],"standard_charges":[{"gross_charge":0.53,"discounted_cash":0.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DIMENHYDRINATE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904205159","type":"CDM"},{"code":"00904205159","type":"NDC"}],"standard_charges":[{"gross_charge":0.51,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"VITAMIN A CAP 3 MG (10000 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904208560","type":"CDM"},{"code":"00904208560","type":"NDC"}],"standard_charges":[{"gross_charge":0.53,"discounted_cash":0.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NIACIN TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904227160","type":"CDM"},{"code":"00904227160","type":"NDC"}],"standard_charges":[{"gross_charge":0.51,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NIACIN TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904227260","type":"CDM"},{"code":"00904227260","type":"NDC"}],"standard_charges":[{"gross_charge":0.52,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CALAMINE-ZINC OXIDE LOTION","drug_information":{"unit":177.0,"type":"ML"},"code_information":[{"code":"Rx00904253321","type":"CDM"},{"code":"00904253321","type":"NDC"}],"standard_charges":[{"gross_charge":1.91,"discounted_cash":1.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 800-160 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904272561","type":"CDM"},{"code":"00904272561","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"VERAPAMIL HCL TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904292061","type":"CDM"},{"code":"00904292061","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"VERAPAMIL HCL TAB 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904292461","type":"CDM"},{"code":"00904292461","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CARBAMAZEPINE CHEW TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904385461","type":"CDM"},{"code":"00904385461","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SALINE NASAL SPRAY 0.65%","drug_information":{"unit":44.0,"type":"ML"},"code_information":[{"code":"Rx00904386575","type":"CDM"},{"code":"00904386575","type":"NDC"}],"standard_charges":[{"gross_charge":1.46,"discounted_cash":1.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"B-COMPLEX VITAMIN TAB","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904418160","type":"CDM"},{"code":"00904418160","type":"NDC"}],"standard_charges":[{"gross_charge":0.51,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CAPTOPRIL TAB 12.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904504561","type":"CDM"},{"code":"00904504561","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SIMETHICONE CHEW TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904506860","type":"CDM"},{"code":"00904506860","type":"NDC"}],"standard_charges":[{"gross_charge":0.51,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ASPIRIN-ACETAMINOPHEN-CAFFEINE TAB 250-250-65 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904513559","type":"CDM"},{"code":"00904513559","type":"NDC"}],"standard_charges":[{"gross_charge":0.51,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LACTASE TAB 3000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904522452","type":"CDM"},{"code":"00904522452","type":"NDC"}],"standard_charges":[{"gross_charge":0.59,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"RIFAMPIN CAP 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904528261","type":"CDM"},{"code":"00904528261","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DIPHENHYDRAMINE HCL CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904530661","type":"CDM"},{"code":"Q0163","type":"HCPCS"},{"code":"00904530661","type":"NDC"}],"standard_charges":[{"gross_charge":0.53,"discounted_cash":0.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PRENATAL VIT W/ FE FUMARATE-FA TAB 27-0.8 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904531360","type":"CDM"},{"code":"00904531360","type":"NDC"}],"standard_charges":[{"gross_charge":0.53,"discounted_cash":0.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DIPHENHYDRAMINE-ZINC ACETATE CREAM 2-0.1%","drug_information":{"unit":28.0,"type":"GM"},"code_information":[{"code":"Rx00904535431","type":"CDM"},{"code":"00904535431","type":"NDC"}],"standard_charges":[{"gross_charge":2.34,"discounted_cash":1.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PENTOXIFYLLINE TAB ER 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904544861","type":"CDM"},{"code":"00904544861","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MULTIPLE VITAMINS W/ MINERALS TAB","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904549261","type":"CDM"},{"code":"00904549261","type":"NDC"}],"standard_charges":[{"gross_charge":0.54,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DOXAZOSIN MESYLATE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904552261","type":"CDM"},{"code":"00904552261","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FAMOTIDINE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904552952","type":"CDM"},{"code":"00904552952","type":"NDC"}],"standard_charges":[{"gross_charge":0.56,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FLUOXETINE HCL CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904578461","type":"CDM"},{"code":"00904578461","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ACYCLOVIR CAP 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904578961","type":"CDM"},{"code":"00904578961","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"IBUPROFEN TAB 800 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904585561","type":"CDM"},{"code":"00904585561","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ALPRAZOLAM TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904586061","type":"CDM"},{"code":"00904586061","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PRAVASTATIN SODIUM TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904589161","type":"CDM"},{"code":"00904589161","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PRAVASTATIN SODIUM TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904589261","type":"CDM"},{"code":"00904589261","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SIMETHICONE SUSP 40 MG/0.6ML","drug_information":{"unit":0.6,"type":"ML"},"code_information":[{"code":"Rx00904589430","type":"CDM"},{"code":"00904589430","type":"NDC"}],"standard_charges":[{"gross_charge":0.53,"discounted_cash":0.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DIGOXIN TAB 125 MCG (0.125 MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904592161","type":"CDM"},{"code":"00904592161","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DIGOXIN TAB 250 MCG (0.25 MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904592261","type":"CDM"},{"code":"00904592261","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LABETALOL HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904592861","type":"CDM"},{"code":"00904592861","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CLINDAMYCIN HCL CAP 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904595961","type":"CDM"},{"code":"00904595961","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ZOLPIDEM TARTRATE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904608261","type":"CDM"},{"code":"00904608261","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ZOLPIDEM TARTRATE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904608361","type":"CDM"},{"code":"00904608361","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CITALOPRAM HYDROBROMIDE TAB 20 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904608561","type":"CDM"},{"code":"00904608561","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CARBAMAZEPINE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904617261","type":"CDM"},{"code":"00904617261","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PHENYTOIN SODIUM EXTENDED CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904618761","type":"CDM"},{"code":"00904618761","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FEXOFENADINE HCL TAB 180 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904621448","type":"CDM"},{"code":"00904621448","type":"NDC"}],"standard_charges":[{"gross_charge":1.07,"discounted_cash":0.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB 25-250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904623861","type":"CDM"},{"code":"00904623861","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ATORVASTATIN CALCIUM TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904629061","type":"CDM"},{"code":"00904629061","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ATORVASTATIN CALCIUM TAB 20 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904629161","type":"CDM"},{"code":"00904629161","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ATORVASTATIN CALCIUM TAB 40 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904629261","type":"CDM"},{"code":"00904629261","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CLOPIDOGREL BISULFATE TAB 75 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904629461","type":"CDM"},{"code":"00904629461","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CARVEDILOL TAB 3.125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904630061","type":"CDM"},{"code":"00904630061","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CARVEDILOL TAB 6.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904630161","type":"CDM"},{"code":"00904630161","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CARVEDILOL TAB 12.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904630261","type":"CDM"},{"code":"00904630261","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 25 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904632261","type":"CDM"},{"code":"00904632261","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 50 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904632361","type":"CDM"},{"code":"00904632361","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 100 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904632461","type":"CDM"},{"code":"00904632461","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LEVOFLOXACIN TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904635161","type":"CDM"},{"code":"00904635161","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LEVOFLOXACIN TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904635261","type":"CDM"},{"code":"00904635261","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LEVOFLOXACIN TAB 750 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904635361","type":"CDM"},{"code":"00904635361","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"RISPERIDONE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904635961","type":"CDM"},{"code":"00904635961","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"RISPERIDONE TAB 3 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904636161","type":"CDM"},{"code":"00904636161","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DIVALPROEX SODIUM TAB ER 24 HR 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904636345","type":"CDM"},{"code":"00904636345","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"AMLODIPINE BESYLATE TAB 5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904637061","type":"CDM"},{"code":"00904637061","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"AMLODIPINE BESYLATE TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904637161","type":"CDM"},{"code":"00904637161","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ROPINIROLE HYDROCHLORIDE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904637461","type":"CDM"},{"code":"00904637461","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TAMSULOSIN HCL CAP 0.4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904640161","type":"CDM"},{"code":"00904640161","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BISACODYL TAB DELAYED RELEASE 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904640761","type":"CDM"},{"code":"00904640761","type":"NDC"}],"standard_charges":[{"gross_charge":0.52,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MODAFINIL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904642304","type":"CDM"},{"code":"00904642304","type":"NDC"}],"standard_charges":[{"gross_charge":38.61,"discounted_cash":28.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ESCITALOPRAM OXALATE TAB 10 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904642661","type":"CDM"},{"code":"00904642661","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HYDRALAZINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904644061","type":"CDM"},{"code":"00904644061","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HYDRALAZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904644161","type":"CDM"},{"code":"00904644161","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DULOXETINE HCL ENTERIC COATED PELLETS CAP 20 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904645261","type":"CDM"},{"code":"00904645261","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PROMETHAZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904646161","type":"CDM"},{"code":"00904646161","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CLOPIDOGREL BISULFATE TAB 300 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904646707","type":"CDM"},{"code":"00904646707","type":"NDC"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":34.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM EC TAB 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904647461","type":"CDM"},{"code":"00904647461","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BACLOFEN TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904647561","type":"CDM"},{"code":"00904647561","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BACLOFEN TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904647661","type":"CDM"},{"code":"00904647661","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FLUCONAZOLE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904650061","type":"CDM"},{"code":"00904650061","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MEMANTINE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904650561","type":"CDM"},{"code":"00904650561","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MEMANTINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904650661","type":"CDM"},{"code":"00904650661","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ARIPIPRAZOLE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904650904","type":"CDM"},{"code":"00904650904","type":"NDC"}],"standard_charges":[{"gross_charge":25.48,"discounted_cash":19.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MECLIZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904651761","type":"CDM"},{"code":"00904651761","type":"NDC"}],"standard_charges":[{"gross_charge":0.89,"discounted_cash":0.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MIRTAZAPINE TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904651961","type":"CDM"},{"code":"00904651961","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MONTELUKAST SODIUM TAB 10 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904652961","type":"CDM"},{"code":"00904652961","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"METHADONE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904653061","type":"CDM"},{"code":"00904653061","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PROPRANOLOL HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904655061","type":"CDM"},{"code":"00904655061","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LINEZOLID TAB 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904655304","type":"CDM"},{"code":"00904655304","type":"NDC"}],"standard_charges":[{"gross_charge":13.56,"discounted_cash":10.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MORPHINE SULFATE TAB ER 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904655861","type":"CDM"},{"code":"00904655861","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"VALACYCLOVIR HCL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904656561","type":"CDM"},{"code":"00904656561","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"OXYBUTYNIN CHLORIDE TAB ER 24HR 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904657061","type":"CDM"},{"code":"00904657061","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PHENOBARBITAL TAB 32.4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904657561","type":"CDM"},{"code":"00904657561","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BUPROPION HCL TAB ER 12HR 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904658561","type":"CDM"},{"code":"00904658561","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TOLTERODINE TARTRATE CAP ER 24HR 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904659304","type":"CDM"},{"code":"00904659304","type":"NDC"}],"standard_charges":[{"gross_charge":29.06,"discounted_cash":21.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PERPHENAZINE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904659961","type":"CDM"},{"code":"00904659961","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DIVALPROEX SODIUM CAP DELAYED RELEASE SPRINKLE 125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904661561","type":"CDM"},{"code":"00904661561","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HYDROXYZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904661761","type":"CDM"},{"code":"00904661761","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ISOSORBIDE DINITRATE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904662061","type":"CDM"},{"code":"00904662061","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CARBAMIDE PEROXIDE 6.5% OTIC SOLN","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00904662735","type":"CDM"},{"code":"00904662735","type":"NDC"}],"standard_charges":[{"gross_charge":2.06,"discounted_cash":1.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"AMANTADINE HCL CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904663061","type":"CDM"},{"code":"00904663061","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BUPROPION HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904663661","type":"CDM"},{"code":"00904663661","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"QUETIAPINE FUMARATE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904663861","type":"CDM"},{"code":"00904663861","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"QUETIAPINE FUMARATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904664061","type":"CDM"},{"code":"00904664061","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"EZETIMIBE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904666404","type":"CDM"},{"code":"00904666404","type":"NDC"}],"standard_charges":[{"gross_charge":26.52,"discounted_cash":19.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"GABAPENTIN CAP 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904666761","type":"CDM"},{"code":"00904666761","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SILDENAFIL CITRATE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904667106","type":"CDM"},{"code":"00904667106","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"METFORMIN HCL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904668961","type":"CDM"},{"code":"00904668961","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"METFORMIN HCL TAB 850 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904669061","type":"CDM"},{"code":"00904669061","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"AZITHROMYCIN TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904670806","type":"CDM"},{"code":"00904670806","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"GLYCOPYRROLATE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904670961","type":"CDM"},{"code":"00904670961","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CETIRIZINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904671761","type":"CDM"},{"code":"00904671761","type":"NDC"}],"standard_charges":[{"gross_charge":0.66,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PSEUDOEPHEDRINE HCL TAB 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904672760","type":"CDM"},{"code":"00904672760","type":"NDC"}],"standard_charges":[{"gross_charge":0.52,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ACETAMINOPHEN TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904673061","type":"CDM"},{"code":"00904673061","type":"NDC"}],"standard_charges":[{"gross_charge":0.53,"discounted_cash":0.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ASPIRIN TAB DELAYED RELEASE 81 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904675180","type":"CDM"},{"code":"00904675180","type":"NDC"}],"standard_charges":[{"gross_charge":0.5,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"OXYMETAZOLINE HCL NASAL SOLN 0.05%","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00904676130","type":"CDM"},{"code":"00904676130","type":"NDC"}],"standard_charges":[{"gross_charge":2.54,"discounted_cash":1.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ROSUVASTATIN CALCIUM TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904677861","type":"CDM"},{"code":"00904677861","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HALOPERIDOL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904678261","type":"CDM"},{"code":"00904678261","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ASPIRIN CHEW TAB 81 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904679480","type":"CDM"},{"code":"00904679480","type":"NDC"}],"standard_charges":[{"gross_charge":0.5,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LISINOPRIL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904679761","type":"CDM"},{"code":"00904679761","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LISINOPRIL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904679861","type":"CDM"},{"code":"00904679861","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LISINOPRIL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904679961","type":"CDM"},{"code":"00904679961","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MIDODRINE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904681861","type":"CDM"},{"code":"00904681861","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FINASTERIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904683061","type":"CDM"},{"code":"00904683061","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LOPERAMIDE HCL SOLN 1 MG/7.5ML","drug_information":{"unit":7.5,"type":"ML"},"code_information":[{"code":"Rx00904683620","type":"CDM"},{"code":"00904683620","type":"NDC"}],"standard_charges":[{"gross_charge":0.73,"discounted_cash":0.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LORATADINE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904685261","type":"CDM"},{"code":"00904685261","type":"NDC"}],"standard_charges":[{"gross_charge":0.71,"discounted_cash":0.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TRAZODONE HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904686861","type":"CDM"},{"code":"00904686861","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CLARITHROMYCIN TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904687204","type":"CDM"},{"code":"00904687204","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"URSODIOL TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904689004","type":"CDM"},{"code":"00904689004","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CHLORPROMAZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904689361","type":"CDM"},{"code":"00904689361","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SERTRALINE HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904692561","type":"CDM"},{"code":"00904692561","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 50 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904695061","type":"CDM"},{"code":"00904695061","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 75 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904695161","type":"CDM"},{"code":"00904695161","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 150 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904695661","type":"CDM"},{"code":"00904695661","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"OXYCODONE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904696661","type":"CDM"},{"code":"00904696661","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PSEUDOEPHEDRINE HCL TAB 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904699061","type":"CDM"},{"code":"00904699061","type":"NDC"}],"standard_charges":[{"gross_charge":0.53,"discounted_cash":0.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PREGABALIN CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904700161","type":"CDM"},{"code":"00904700161","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"OXYMETAZOLINE HCL NASAL SOLN 0.05%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00904700635","type":"CDM"},{"code":"00904700635","type":"NDC"}],"standard_charges":[{"gross_charge":2.22,"discounted_cash":1.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LAMOTRIGINE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904700861","type":"CDM"},{"code":"00904700861","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PRAZOSIN HCL CAP 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904702061","type":"CDM"},{"code":"00904702061","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"OXYBUTYNIN CHLORIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904702761","type":"CDM"},{"code":"00904702761","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CHLORHEXIDINE GLUCONATE SOLN 0.12%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00904703588","type":"CDM"},{"code":"00904703588","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NALTREXONE HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904703604","type":"CDM"},{"code":"00904703604","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DULOXETINE HCL ENTERIC COATED PELLETS CAP 30 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904704461","type":"CDM"},{"code":"00904704461","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LOSARTAN POTASSIUM TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904704761","type":"CDM"},{"code":"00904704761","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LOSARTAN POTASSIUM TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904704961","type":"CDM"},{"code":"00904704961","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"METHOCARBAMOL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904705761","type":"CDM"},{"code":"00904705761","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"METHOCARBAMOL TAB 750 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904705861","type":"CDM"},{"code":"00904705861","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"POTASSIUM CHLORIDE MICROENCAPSULATED CRYS ER TAB 20 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904708661","type":"CDM"},{"code":"00904708661","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CLOZAPINE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904708961","type":"CDM"},{"code":"00904708961","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"OXYCODONE W/ ACETAMINOPHEN TAB 7.5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904709461","type":"CDM"},{"code":"00904709461","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"OXYCODONE W/ ACETAMINOPHEN TAB 10-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904709561","type":"CDM"},{"code":"00904709561","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CALCIUM ACETATE (PHOSPHATE BINDER) CAP 667 MG (169 MG CA)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904711961","type":"CDM"},{"code":"00904711961","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BUSPIRONE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904712161","type":"CDM"},{"code":"00904712161","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FENOFIBRATE TAB 160 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904712804","type":"CDM"},{"code":"00904712804","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SOTALOL HCL TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904714361","type":"CDM"},{"code":"00904714361","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DOCUSATE SODIUM CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904718361","type":"CDM"},{"code":"00904718361","type":"NDC"}],"standard_charges":[{"gross_charge":0.54,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LURASIDONE HCL TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904735661","type":"CDM"},{"code":"00904735661","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MAGNESIUM CITRATE SOLN","drug_information":{"unit":296.0,"type":"ML"},"code_information":[{"code":"Rx00904741844","type":"CDM"},{"code":"00904741844","type":"NDC"}],"standard_charges":[{"gross_charge":2.86,"discounted_cash":2.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FERROUS SULFATE TAB 325 MG (65 MG ELEMENTAL FE)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904759161","type":"CDM"},{"code":"00904759161","type":"NDC"}],"standard_charges":[{"gross_charge":0.52,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PHENYLEPHRINE IN HARD FAT RECTAL SUPPOS 0.25%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904768822","type":"CDM"},{"code":"00904768822","type":"NDC"}],"standard_charges":[{"gross_charge":0.63,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SKIN PROTECTANTS MISC - CREAM","drug_information":{"unit":454.0,"type":"GM"},"code_information":[{"code":"Rx00904775127","type":"CDM"},{"code":"00904775127","type":"NDC"}],"standard_charges":[{"gross_charge":4.58,"discounted_cash":3.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"IBUPROFEN TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904791461","type":"CDM"},{"code":"00904791461","type":"NDC"}],"standard_charges":[{"gross_charge":0.55,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ETHYL ESTERS OF IODIZED FATTY ACIDS INJECTION","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00930621608","type":"CDM"},{"code":"00930621608","type":"NDC"}],"standard_charges":[{"gross_charge":692.5,"discounted_cash":519.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ANTICOAGULANT CITRATE DEXTROSE SOLUTION A","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00942064103","type":"CDM"},{"code":"00942064103","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ANTICOAGULANT CITRATE DEXTROSE SOLUTION A","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00942064104","type":"CDM"},{"code":"00942064104","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ALBUMIN, HUMAN INJ 25%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00944049301","type":"CDM"},{"code":"P9047","type":"HCPCS"},{"code":"00944049301","type":"NDC"}],"standard_charges":[{"gross_charge":226.49,"discounted_cash":169.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"IMMUNE GLOBULIN (HUMAN) IV OR SUBCUTANEOUS SOLN 5 GM/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00944270004","type":"CDM"},{"code":"J1569","type":"HCPCS"},{"code":"00944270004","type":"NDC"}],"standard_charges":[{"gross_charge":2267.72,"discounted_cash":1700.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"IMMUNE GLOBULIN (HUMAN) IV OR SUBCUTANEOUS SOLN 10 GM/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00944270005","type":"CDM"},{"code":"J1569","type":"HCPCS"},{"code":"00944270005","type":"NDC"}],"standard_charges":[{"gross_charge":3129.32,"discounted_cash":2346.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"IMMUNE GLOBULIN (HUMAN) IV OR SUBCUTANEOUS SOLN 20 GM/200ML","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx00944270006","type":"CDM"},{"code":"J1569","type":"HCPCS"},{"code":"00944270006","type":"NDC"}],"standard_charges":[{"gross_charge":6258.64,"discounted_cash":4693.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"IMMUNE GLOBULIN (HUMAN) IV OR SUBCUTANEOUS SOLN 30 GM/300ML","drug_information":{"unit":300.0,"type":"ML"},"code_information":[{"code":"Rx00944270007","type":"CDM"},{"code":"J1569","type":"HCPCS"},{"code":"00944270007","type":"NDC"}],"standard_charges":[{"gross_charge":9387.96,"discounted_cash":7040.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ALPHA1-PROTEINASE INHIBITOR (HUMAN) FOR IV SOLN 1000 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00944281501","type":"CDM"},{"code":"J0256","type":"HCPCS"},{"code":"00944281501","type":"NDC"}],"standard_charges":[{"gross_charge":2417.99,"discounted_cash":1813.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ALPHA1-PROTEINASE INHIBITOR (HUMAN) INJ 1000 MG/50ML","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00944288401","type":"CDM"},{"code":"J0257","type":"HCPCS"},{"code":"00944288401","type":"NDC"}],"standard_charges":[{"gross_charge":2269.17,"discounted_cash":1701.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ANTIHEMOPHILIC FACTOR RECOMB (RAHF-PFM) FOR INJ 2000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00944304510","type":"CDM"},{"code":"J7192","type":"HCPCS"},{"code":"00944304510","type":"NDC"}],"standard_charges":[{"gross_charge":10970.0,"discounted_cash":8227.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ANTIHEMOPHILIC FACTOR RECOMB (RAHF-PFM) FOR INJ 1000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00944305302","type":"CDM"},{"code":"J7192","type":"HCPCS"},{"code":"00944305302","type":"NDC"}],"standard_charges":[{"gross_charge":4868.81,"discounted_cash":3651.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SEVELAMER CARBONATE TAB 800 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00955105027","type":"CDM"},{"code":"00955105027","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SEVELAMER CARBONATE PACKET 0.8 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00955105201","type":"CDM"},{"code":"00955105201","type":"NDC"}],"standard_charges":[{"gross_charge":39.41,"discounted_cash":29.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SEVELAMER CARBONATE PACKET 0.8 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00955105290","type":"CDM"},{"code":"00955105290","type":"NDC"}],"standard_charges":[{"gross_charge":39.54,"discounted_cash":29.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BISMUTH SUBSALICYLATE CHEW TAB 262 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx01490003977","type":"CDM"},{"code":"01490003977","type":"NDC"}],"standard_charges":[{"gross_charge":0.65,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MAGNESIUM CHLORIDE TAB DR 64 MG (ELEMENTAL MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx10006070013","type":"CDM"},{"code":"10006070013","type":"NDC"}],"standard_charges":[{"gross_charge":0.58,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CALCIUM CARBONATE-CHOLECALCIFEROL TAB 500 MG-5 MCG(200 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx10006070038","type":"CDM"},{"code":"10006070038","type":"NDC"}],"standard_charges":[{"gross_charge":0.54,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MAGNESIUM OXIDE TAB 400 MG (240 MG ELEMENTAL MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx10006073038","type":"CDM"},{"code":"10006073038","type":"NDC"}],"standard_charges":[{"gross_charge":0.52,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ESMOLOL HCL-SODIUM CHLORIDE IV SOLN 2500 MG/250ML","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx10019005561","type":"CDM"},{"code":"J1805","type":"HCPCS"},{"code":"10019005561","type":"NDC"}],"standard_charges":[{"gross_charge":571.63,"discounted_cash":428.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"IFOSFAMIDE FOR INJ 3 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx10019092602","type":"CDM"},{"code":"J9208","type":"HCPCS"},{"code":"10019092602","type":"NDC"}],"standard_charges":[{"gross_charge":756.26,"discounted_cash":567.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CYCLOPHOSPHAMIDE FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx10019095550","type":"CDM"},{"code":"J9075","type":"HCPCS"},{"code":"10019095550","type":"NDC"}],"standard_charges":[{"gross_charge":548.32,"discounted_cash":411.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CYCLOPHOSPHAMIDE FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx10019095616","type":"CDM"},{"code":"J9075","type":"HCPCS"},{"code":"10019095616","type":"NDC"}],"standard_charges":[{"gross_charge":2095.75,"discounted_cash":1571.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CANGRELOR TETRASODIUM FOR IV SOLN 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx10122062001","type":"CDM"},{"code":"C9460","type":"HCPCS"},{"code":"10122062001","type":"NDC"}],"standard_charges":[{"gross_charge":3046.55,"discounted_cash":2284.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"KETOCONAZOLE SHAMPOO 2%","drug_information":{"unit":120.0,"type":"ML"},"code_information":[{"code":"Rx10147075004","type":"CDM"},{"code":"10147075004","type":"NDC"}],"standard_charges":[{"gross_charge":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"KETOCONAZOLE SHAMPOO 2%","drug_information":{"unit":120.0,"type":"ML"},"code_information":[{"code":"Rx10147075005","type":"CDM"},{"code":"10147075005","type":"NDC"}],"standard_charges":[{"gross_charge":93.36,"discounted_cash":70.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BENZOCAINE-MENTHOL-ZINC CL GEL 20-0.26-0.15%","drug_information":{"unit":7.0,"type":"GM"},"code_information":[{"code":"Rx10310028340","type":"CDM"},{"code":"10310028340","type":"NDC"}],"standard_charges":[{"gross_charge":6.66,"discounted_cash":5.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"METHYLPHENIDATE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx10702010001","type":"CDM"},{"code":"10702010001","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HYDROXOCOBALAMIN (ANTIDOTE) FOR IV SOLN 5 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx11704037001","type":"CDM"},{"code":"11704037001","type":"NDC"}],"standard_charges":[{"gross_charge":3584.59,"discounted_cash":2688.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BUPRENORPHINE HCL-NALOXONE HCL SL FILM 2-0.5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx12496120201","type":"CDM"},{"code":"12496120201","type":"NDC"}],"standard_charges":[{"gross_charge":37.46,"discounted_cash":28.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BUPRENORPHINE HCL-NALOXONE HCL SL FILM 8-2 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx12496120801","type":"CDM"},{"code":"12496120801","type":"NDC"}],"standard_charges":[{"gross_charge":67.14,"discounted_cash":50.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MENTHOL LOZENGE 5.8 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx12546062141","type":"CDM"},{"code":"12546062141","type":"NDC"}],"standard_charges":[{"gross_charge":0.56,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SILVER NITRATE-POTASSIUM NITRATE APPLICATOR 75-25%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx12870000101","type":"CDM"},{"code":"12870000101","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"RABIES IMMUNE GLOBULIN (HUMAN) INJ 1500 UNT/5ML (300 UNT/ML),RABIES IMMUNE GLOBULIN (HUMAN) INJ 300 UNIT/ML,RABIES IMMUNE GLOBULIN (HUMAN) INJ 900 UNT/3ML (300 UNT/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx13533031801","type":"CDM"},{"code":"90375","type":"HCPCS"},{"code":"13533031801","type":"NDC"}],"standard_charges":[{"gross_charge":2823.3,"discounted_cash":2117.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"RHO D IMMUNE GLOBULIN IM SOLN PREF SYR 1500 UNIT (300MCG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx13533063102","type":"CDM"},{"code":"J2790","type":"HCPCS"},{"code":"13533063102","type":"NDC"}],"standard_charges":[{"gross_charge":468.42,"discounted_cash":351.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TETANUS IMMUNE GLOBULIN (HUMAN) IM SOLN PREF SYR 250 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx13533063402","type":"CDM"},{"code":"J1670","type":"HCPCS"},{"code":"13533063402","type":"NDC"}],"standard_charges":[{"gross_charge":2282.19,"discounted_cash":1711.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HEPATITIS B IMMUN GLOB (HUMAN) IM SOLN PREF SYR 220 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx13533063602","type":"CDM"},{"code":"90371","type":"HCPCS"},{"code":"13533063602","type":"NDC"}],"standard_charges":[{"gross_charge":906.45,"discounted_cash":679.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HEPATITIS B IMMUNE GLOBULIN (HUMAN) IM SOLN 220 UNIT/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx13533063605","type":"CDM"},{"code":"90371","type":"HCPCS"},{"code":"13533063605","type":"NDC"}],"standard_charges":[{"gross_charge":2912.47,"discounted_cash":2184.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ALPHA1-PROTEINASE INHIBITOR (HUMAN) FOR IV SOLN 1000 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx13533070310","type":"CDM"},{"code":"J0256","type":"HCPCS"},{"code":"13533070310","type":"NDC"}],"standard_charges":[{"gross_charge":2025.6,"discounted_cash":1519.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ALPHA1-PROTEINASE INHIBITOR (HUMAN) INJ 1000 MG/20ML","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx13533070501","type":"CDM"},{"code":"J0256","type":"HCPCS"},{"code":"13533070501","type":"NDC"}],"standard_charges":[{"gross_charge":3038.4,"discounted_cash":2278.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"IMMUNE GLOBULIN (HUMAN) IV OR SUBCUTANEOUS SOLN 5 GM/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx13533080020","type":"CDM"},{"code":"J1561","type":"HCPCS"},{"code":"13533080020","type":"NDC"}],"standard_charges":[{"gross_charge":2060.09,"discounted_cash":1545.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"IMMUNE GLOBULIN (HUMAN) IV OR SUBCUTANEOUS SOLN 20 GM/200ML","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx13533080024","type":"CDM"},{"code":"J1561","type":"HCPCS"},{"code":"13533080024","type":"NDC"}],"standard_charges":[{"gross_charge":5685.62,"discounted_cash":4264.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"IMMUNE GLOBULIN (HUMAN) IV OR SUBCUTANEOUS SOLN 40 GM/400ML","drug_information":{"unit":400.0,"type":"ML"},"code_information":[{"code":"Rx13533080040","type":"CDM"},{"code":"J1561","type":"HCPCS"},{"code":"13533080040","type":"NDC"}],"standard_charges":[{"gross_charge":11371.24,"discounted_cash":8528.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"IMMUNE GLOBULIN (HUMAN) IV OR SUBCUTANEOUS SOLN 10 GM/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx13533080071","type":"CDM"},{"code":"J1561","type":"HCPCS"},{"code":"13533080071","type":"NDC"}],"standard_charges":[{"gross_charge":2842.81,"discounted_cash":2132.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PRAMIPEXOLE DIHYDROCHLORIDE TAB 0.125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx13668009190","type":"CDM"},{"code":"13668009190","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PRAMIPEXOLE DIHYDROCHLORIDE TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx13668009390","type":"CDM"},{"code":"13668009390","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PRAMIPEXOLE DIHYDROCHLORIDE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx13668009490","type":"CDM"},{"code":"13668009490","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FELODIPINE TAB ER 24HR 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx13668013201","type":"CDM"},{"code":"13668013201","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BACITRACIN ZINC OINT 500 UNIT/GM","drug_information":{"unit":28.0,"type":"GM"},"code_information":[{"code":"Rx14428000944","type":"CDM"},{"code":"14428000944","type":"NDC"}],"standard_charges":[{"gross_charge":3.77,"discounted_cash":2.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ANTICOAGULANT CITRATE DEXTROSE SOLUTION A","drug_information":{"unit":750.0,"type":"ML"},"code_information":[{"code":"Rx14537096775","type":"CDM"},{"code":"14537096775","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"},{"gross_charge":98.95,"discounted_cash":74.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"EPHEDRINE SULF-NACL SOLN PREF SYR 25 MG/5ML-0.9% (5 MG/ML),EPHEDRINE SULFATE PREFILLED SYRINGE 25 MG/5ML (5 MG/ML),EPHEDRINE SULF-NACL SOLN PREF SYR 50 MG/10ML-0.9% (5 MG/ML),EPHEDRINE SULFATE PREFILLED SYRINGE 10 MG/2ML (5 MG/ML),EPHEDRINE SULFATE INJ SOLN PREF SYRINGE 25 MG/5ML (5 MG/ML),EPHEDRINE SULFATE INJ SOLN PREF SYRINGE 50 MG/10ML (5 MG/ML),EPHEDRINE SULFATE IV SOLN 5 MG/ML,EPHEDRINE SULFATE PREFILLED SYRINGE 50 MG/10ML (5 MG/ML),EPHEDRINE SULF-NACL SOLN PREF SYR 15 MG/3ML-0.9% (5 MG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx14789025010","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"14789025010","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PROCAINAMIDE HCL INJ 500 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx14789090002","type":"CDM"},{"code":"J2690","type":"HCPCS"},{"code":"14789090002","type":"NDC"}],"standard_charges":[{"gross_charge":2282.6,"discounted_cash":1711.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ASPIRIN TAB DELAYED RELEASE 81 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16103035611","type":"CDM"},{"code":"16103035611","type":"NDC"}],"standard_charges":[{"gross_charge":0.5,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ALUMINUM SULFATE & CALCIUM ACETATE POWD PACK","drug_information":{"unit":12.0,"type":"EA"},"code_information":[{"code":"Rx16500002324","type":"CDM"},{"code":"16500002324","type":"NDC"}],"standard_charges":[{"gross_charge":10.24,"discounted_cash":7.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PHENOBARBITAL TAB 64.8 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16571066701","type":"CDM"},{"code":"16571066701","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PHENOBARBITAL TAB 97.2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16571066801","type":"CDM"},{"code":"16571066801","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BISOPROLOL FUMARATE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16714052901","type":"CDM"},{"code":"16714052901","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"GLIMEPIRIDE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729000201","type":"CDM"},{"code":"16729000201","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PIOGLITAZONE HCL TAB 45 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729002215","type":"CDM"},{"code":"16729002215","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BICALUTAMIDE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729002310","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"16729002310","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ANASTROZOLE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729003515","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"16729003515","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TACROLIMUS CAP 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729004201","type":"CDM"},{"code":"J7507","type":"HCPCS"},{"code":"16729004201","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MITOMYCIN FOR IV SOLN 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729010811","type":"CDM"},{"code":"J9280","type":"HCPCS"},{"code":"16729010811","type":"NDC"}],"standard_charges":[{"gross_charge":876.29,"discounted_cash":657.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ETOPOSIDE INJ 100 MG/5ML (20 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx16729011431","type":"CDM"},{"code":"J9181","type":"HCPCS"},{"code":"16729011431","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"AMITRIPTYLINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729017101","type":"CDM"},{"code":"16729017101","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"AMITRIPTYLINE HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729017301","type":"CDM"},{"code":"16729017301","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HYDROCHLOROTHIAZIDE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729018301","type":"CDM"},{"code":"16729018301","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BUSPIRONE HCL TAB 7.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729020101","type":"CDM"},{"code":"16729020101","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DECITABINE FOR INJ 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729022405","type":"CDM"},{"code":"J0894","type":"HCPCS"},{"code":"16729022405","type":"NDC"}],"standard_charges":[{"gross_charge":345.38,"discounted_cash":259.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DEXMEDETOMIDINE HCL IV SOLN 200 MCG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx16729023993","type":"CDM"},{"code":"16729023993","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ESOMEPRAZOLE SODIUM FOR INTRAVENOUS SOLN 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729025269","type":"CDM"},{"code":"J1370","type":"HCPCS"},{"code":"16729025269","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DOCETAXEL FOR INJ CONC 20 MG/ML,DOCETAXEL FOR INJ CONC 80 MG/4ML (20 MG/ML),DOCETAXEL FOR INJ CONC 160 MG/8ML (20 MG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx16729026763","type":"CDM"},{"code":"J9171","type":"HCPCS"},{"code":"16729026763","type":"NDC"}],"standard_charges":[{"gross_charge":189.83,"discounted_cash":142.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BIVALIRUDIN TRIFLUOROACETATE FOR IV SOLN 250 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729027567","type":"CDM"},{"code":"J0583","type":"HCPCS"},{"code":"16729027567","type":"NDC"}],"standard_charges":[{"gross_charge":297.02,"discounted_cash":222.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TIGECYCLINE FOR IV SOLN 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729036403","type":"CDM"},{"code":"J3244","type":"HCPCS"},{"code":"16729036403","type":"NDC"}],"standard_charges":[{"gross_charge":250.71,"discounted_cash":188.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TIGECYCLINE FOR IV SOLN 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729036468","type":"CDM"},{"code":"J3244","type":"HCPCS"},{"code":"16729036468","type":"NDC"}],"standard_charges":[{"gross_charge":214.74,"discounted_cash":161.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BENZOCAINE-MENTHOL AEROSOL 20-0.5%","drug_information":{"unit":85.0,"type":"GM"},"code_information":[{"code":"Rx16864068003","type":"CDM"},{"code":"16864068003","type":"NDC"}],"standard_charges":[{"gross_charge":5.51,"discounted_cash":4.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"INDOCYANINE GREEN FOR IV SOLN 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx17238042406","type":"CDM"},{"code":"17238042406","type":"NDC"}],"standard_charges":[{"gross_charge":477.64,"discounted_cash":358.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"INDOCYANINE GREEN FOR IV SOLN 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx17238042425","type":"CDM"},{"code":"17238042425","type":"NDC"}],"standard_charges":[{"gross_charge":467.33,"discounted_cash":350.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DICYCLOMINE HCL INJ 10 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx17478001502","type":"CDM"},{"code":"J0500","type":"HCPCS"},{"code":"17478001502","type":"NDC"}],"standard_charges":[{"gross_charge":262.28,"discounted_cash":196.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 250 MCG/5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx17478003005","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"17478003005","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TETRACAINE HCL INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx17478004532","type":"CDM"},{"code":"17478004532","type":"NDC"}],"standard_charges":[{"gross_charge":255.36,"discounted_cash":191.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SUFENTANIL CITRATE INJ 50 MCG/ML","drug_information":{"unit":0.05,"type":"ML"},"code_information":[{"code":"Rx17478005001","type":"CDM"},{"code":"17478005001","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CYCLOPENTOLATE HCL OPHTH SOLN 1%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx17478010012","type":"CDM"},{"code":"17478010012","type":"NDC"}],"standard_charges":[{"gross_charge":115.35,"discounted_cash":86.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TROPICAMIDE OPHTH SOLN 1%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx17478010212","type":"CDM"},{"code":"17478010212","type":"NDC"}],"standard_charges":[{"gross_charge":35.07,"discounted_cash":26.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PHENYLEPHRINE HCL OPHTH SOLN 2.5%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx17478020115","type":"CDM"},{"code":"17478020115","type":"NDC"}],"standard_charges":[{"gross_charge":371.36,"discounted_cash":278.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PHENYLEPHRINE HCL OPHTH SOLN 10%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx17478020510","type":"CDM"},{"code":"17478020510","type":"NDC"}],"standard_charges":[{"gross_charge":68.35,"discounted_cash":51.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ATROPINE SULFATE OPHTH SOLN 1%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx17478021502","type":"CDM"},{"code":"17478021502","type":"NDC"}],"standard_charges":[{"gross_charge":157.99,"discounted_cash":118.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ATROPINE SULFATE OPHTH SOLN 1%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx17478021515","type":"CDM"},{"code":"17478021515","type":"NDC"}],"standard_charges":[{"gross_charge":544.87,"discounted_cash":408.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FLUORESCEIN SODIUM IV SOLN 10%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx17478025310","type":"CDM"},{"code":"A9612","type":"HCPCS"},{"code":"17478025310","type":"NDC"}],"standard_charges":[{"gross_charge":503.27,"discounted_cash":377.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TOBRAMYCIN OPHTH SOLN 0.3%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx17478029010","type":"CDM"},{"code":"17478029010","type":"NDC"}],"standard_charges":[{"gross_charge":48.39,"discounted_cash":36.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FLUORESCEIN SODIUM OPHTH STRIPS 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx17478040401","type":"CDM"},{"code":"17478040401","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"EPHEDRINE SULFATE IV SOLN 50 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx17478041501","type":"CDM"},{"code":"17478041501","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"EPHEDRINE SULFATE IV SOLN 50 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx17478041510","type":"CDM"},{"code":"17478041510","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"EPHEDRINE SULFATE INJ 50 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx17478051500","type":"CDM"},{"code":"17478051500","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MIDAZOLAM HCL INJ 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 25 MG/5ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 5 MG/ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 50 MG/10ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx17478052410","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"17478052410","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ORPHENADRINE CITRATE INJ 30 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx17478053802","type":"CDM"},{"code":"J2360","type":"HCPCS"},{"code":"17478053802","type":"NDC"}],"standard_charges":[{"gross_charge":106.66,"discounted_cash":80.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SODIUM CHLORIDE HYPERTONIC OPHTH OINT 5%","drug_information":{"unit":3.5,"type":"GM"},"code_information":[{"code":"Rx17478062235","type":"CDM"},{"code":"17478062235","type":"NDC"}],"standard_charges":[{"gross_charge":14.11,"discounted_cash":10.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SODIUM CHLORIDE HYPERTONIC OPHTH SOLN 5%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx17478062312","type":"CDM"},{"code":"17478062312","type":"NDC"}],"standard_charges":[{"gross_charge":15.59,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LIDOCAINE HCL OPHTH GEL 3.5%","drug_information":{"unit":0.05,"type":"ML"},"code_information":[{"code":"Rx17478079225","type":"CDM"},{"code":"17478079225","type":"NDC"}],"standard_charges":[{"gross_charge":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DILTIAZEM HCL IV SOLN 25 MG/5ML (5 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx17478093705","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"17478093705","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ADENOSINE IV SOLN 6 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx17478095302","type":"CDM"},{"code":"J0153","type":"HCPCS"},{"code":"17478095302","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HYALURONIDASE HUMAN INJ 150 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx18657011701","type":"CDM"},{"code":"J3473","type":"HCPCS"},{"code":"18657011701","type":"NDC"}],"standard_charges":[{"gross_charge":265.29,"discounted_cash":198.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"INFLUENZA VIRUS VACCINE SPLIT PF SUSP PREF SYRINGE 0.5 ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx19515081052","type":"CDM"},{"code":"90656","type":"HCPCS"},{"code":"19515081052","type":"NDC"}],"standard_charges":[{"gross_charge":106.65,"discounted_cash":79.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LANOLIN CREAM","drug_information":{"unit":59.0,"type":"ML"},"code_information":[{"code":"Rx20451087122","type":"CDM"},{"code":"20451087122","type":"NDC"}],"standard_charges":[{"gross_charge":0.58,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FERROUS GLUCONATE TAB 324 MG (37.5 MG ELEMENTAL IRON)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx20555001900","type":"CDM"},{"code":"20555001900","type":"NDC"}],"standard_charges":[{"gross_charge":0.53,"discounted_cash":0.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MELATONIN TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx20555003901","type":"CDM"},{"code":"20555003901","type":"NDC"}],"standard_charges":[{"gross_charge":0.64,"discounted_cash":0.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ZINC SULFATE CAP 220 MG (50 MG ELEMENTAL ZN)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx20555004000","type":"CDM"},{"code":"20555004000","type":"NDC"}],"standard_charges":[{"gross_charge":0.66,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LEFLUNOMIDE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155004403","type":"CDM"},{"code":"23155004403","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TRANEXAMIC ACID IV SOLN 1000 MG/10ML (100 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx23155016641","type":"CDM"},{"code":"J3290","type":"HCPCS"},{"code":"23155016641","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ADENOSINE IV SOLN 3 MG/ML (DIAGNOSTIC)","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx23155025831","type":"CDM"},{"code":"J0153","type":"HCPCS"},{"code":"23155025831","type":"NDC"}],"standard_charges":[{"gross_charge":188.52,"discounted_cash":141.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PROCHLORPERAZINE EDISYLATE INJ 10 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx23155029442","type":"CDM"},{"code":"J0780","type":"HCPCS"},{"code":"23155029442","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HYDROXYZINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155050001","type":"CDM"},{"code":"23155050001","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ETHOSUXIMIDE CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155053201","type":"CDM"},{"code":"23155053201","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DESIPRAMINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155057901","type":"CDM"},{"code":"23155057901","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SODIUM TETRADECYL SULFATE INJ 3%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx24201020105","type":"CDM"},{"code":"24201020105","type":"NDC"}],"standard_charges":[{"gross_charge":470.3,"discounted_cash":352.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TOBRAMYCIN-DEXAMETHASONE OPHTH SUSP 0.3-0.1%","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx24208029525","type":"CDM"},{"code":"24208029525","type":"NDC"}],"standard_charges":[{"gross_charge":211.5,"discounted_cash":158.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DESMOPRESSIN ACETATE NASAL SPRAY SOLN 0.01% (REFRIGERATED)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx24208034205","type":"CDM"},{"code":"24208034205","type":"NDC"}],"standard_charges":[{"gross_charge":823.99,"discounted_cash":617.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DICLOFENAC SODIUM OPHTH SOLN 0.1%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx24208045705","type":"CDM"},{"code":"24208045705","type":"NDC"}],"standard_charges":[{"gross_charge":35.97,"discounted_cash":26.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DORZOLAMIDE HCL-TIMOLOL MALEATE OPHTH SOLN 2-0.5%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx24208048610","type":"CDM"},{"code":"24208048610","type":"NDC"}],"standard_charges":[{"gross_charge":38.63,"discounted_cash":28.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NEOMYCIN-POLYMYXIN-HC OTIC SUSP 3.5 MG/ML-10000 UNIT/ML-1%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx24208063562","type":"CDM"},{"code":"24208063562","type":"NDC"}],"standard_charges":[{"gross_charge":199.9,"discounted_cash":149.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SULFACETAMIDE SODIUM OPHTH SOLN 10%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx24208067004","type":"CDM"},{"code":"24208067004","type":"NDC"}],"standard_charges":[{"gross_charge":180.38,"discounted_cash":135.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NEOMYCIN-BACITRAC ZN-POLYMYX 5(3.5)MG-400UNT-10000UNT OP OIN","drug_information":{"unit":3.5,"type":"GM"},"code_information":[{"code":"Rx24208078055","type":"CDM"},{"code":"24208078055","type":"NDC"}],"standard_charges":[{"gross_charge":71.19,"discounted_cash":53.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BACITRACIN-POLYMYXIN-NEOMYCIN-HC OPHTH OINT 1%","drug_information":{"unit":3.5,"type":"GM"},"code_information":[{"code":"Rx24208078555","type":"CDM"},{"code":"24208078555","type":"NDC"}],"standard_charges":[{"gross_charge":108.46,"discounted_cash":81.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NEOMYCIN-POLYMY-GRAMICID OP SOL 1.75-10000-0.025MG-UNT-MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx24208079062","type":"CDM"},{"code":"24208079062","type":"NDC"}],"standard_charges":[{"gross_charge":210.38,"discounted_cash":157.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NEOMYCIN-POLYMYXIN-DEXAMETHASONE OPHTH SUSP 0.1%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx24208083060","type":"CDM"},{"code":"24208083060","type":"NDC"}],"standard_charges":[{"gross_charge":65.52,"discounted_cash":49.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ERYTHROMYCIN OPHTH OINT 5 MG/GM","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"Rx24208091019","type":"CDM"},{"code":"24208091019","type":"NDC"}],"standard_charges":[{"gross_charge":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ERYTHROMYCIN OPHTH OINT 5 MG/GM","drug_information":{"unit":3.5,"type":"GM"},"code_information":[{"code":"Rx24208091055","type":"CDM"},{"code":"24208091055","type":"NDC"}],"standard_charges":[{"gross_charge":48.48,"discounted_cash":36.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ERYTHROMYCIN ETHYLSUCCINATE TAB 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx24338010013","type":"CDM"},{"code":"24338010013","type":"NDC"}],"standard_charges":[{"gross_charge":50.74,"discounted_cash":38.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ERYTHROMYCIN TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx24338010213","type":"CDM"},{"code":"24338010213","type":"NDC"}],"standard_charges":[{"gross_charge":33.75,"discounted_cash":25.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ERYTHROMYCIN ETHYLSUCCINATE FOR SUSP 400 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx24338013013","type":"CDM"},{"code":"24338013013","type":"NDC"}],"standard_charges":[{"gross_charge":88.5,"discounted_cash":66.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ALUM (POTASSIUM) POWDER","drug_information":{"unit":10.0,"type":"GM"},"code_information":[{"code":"Rx24357030030","type":"CDM"},{"code":"24357030030","type":"NDC"}],"standard_charges":[{"gross_charge":470.29,"discounted_cash":352.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"POVIDONE-SODIUM HYALURONATE-GLYCYRRHETINIC ACID GEL","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx24477001015","type":"CDM"},{"code":"24477001015","type":"NDC"}],"standard_charges":[{"gross_charge":47.28,"discounted_cash":35.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CEFOXITIN SODIUM FOR IV SOLN 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021011020","type":"CDM"},{"code":"J0694","type":"HCPCS"},{"code":"25021011020","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CIPROFLOXACIN 400 MG/200ML IN D5W","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx25021011487","type":"CDM"},{"code":"J0744","type":"HCPCS"},{"code":"25021011487","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CEFTAZIDIME FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021012720","type":"CDM"},{"code":"J0713","type":"HCPCS"},{"code":"25021012720","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CEFTAZIDIME FOR IV SOLN 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021012850","type":"CDM"},{"code":"J0713","type":"HCPCS"},{"code":"25021012850","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CEFTAZIDIME FOR INJ 6 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021012999","type":"CDM"},{"code":"J0713","type":"HCPCS"},{"code":"25021012999","type":"NDC"}],"standard_charges":[{"gross_charge":150.38,"discounted_cash":112.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NAFCILLIN SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021014010","type":"CDM"},{"code":"J2290","type":"HCPCS"},{"code":"25021014010","type":"NDC"}],"standard_charges":[{"gross_charge":151.28,"discounted_cash":113.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SOD FOR INJ 4.5 GM (4-0.5 GM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021016648","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"25021016648","type":"NDC"}],"standard_charges":[{"gross_charge":98.2,"discounted_cash":73.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DAPTOMYCIN FOR IV SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021017415","type":"CDM"},{"code":"J0878","type":"HCPCS"},{"code":"25021017415","type":"NDC"}],"standard_charges":[{"gross_charge":118.23,"discounted_cash":88.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DAPTOMYCIN FOR IV SOLN 350 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021017915","type":"CDM"},{"code":"J0878","type":"HCPCS"},{"code":"25021017915","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DAPTOMYCIN FOR IV SOLN 350 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021017916","type":"CDM"},{"code":"J0878","type":"HCPCS"},{"code":"25021017916","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FLUCONAZOLE IN NACL 0.9% INJ 400 MG/200ML","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx25021018487","type":"CDM"},{"code":"J1450","type":"HCPCS"},{"code":"25021018487","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FLUCONAZOLE IN NACL 0.9% INJ 400 MG/200ML","drug_information":{"unit":400.0,"type":"ML"},"code_information":[{"code":"Rx25021018487","type":"CDM"},{"code":"J1450","type":"HCPCS"},{"code":"25021018487","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"EPIRUBICIN HCL IV SOLN 50 MG/25ML (2 MG/ML)","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx25021020325","type":"CDM"},{"code":"J9178","type":"HCPCS"},{"code":"25021020325","type":"NDC"}],"standard_charges":[{"gross_charge":425.1,"discounted_cash":318.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"VINORELBINE TARTRATE INJ 50 MG/5ML (10 MG/ML) (BASE EQUIV)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx25021020405","type":"CDM"},{"code":"J9390","type":"HCPCS"},{"code":"25021020405","type":"NDC"}],"standard_charges":[{"gross_charge":200.41,"discounted_cash":150.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TOPOTECAN HCL FOR INJ 4 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021020606","type":"CDM"},{"code":"J9351","type":"HCPCS"},{"code":"25021020606","type":"NDC"}],"standard_charges":[{"gross_charge":394.16,"discounted_cash":295.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NITROPRUSSIDE SODIUM IV SOLN 25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx25021031002","type":"CDM"},{"code":"25021031002","type":"NDC"}],"standard_charges":[{"gross_charge":759.78,"discounted_cash":569.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 5000 UNIT/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx25021040201","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"25021040201","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PROPOFOL IV EMUL 1000 MG/100ML (10 MG/ML),PROPOFOL IV EMUL 500 MG/50ML (10 MG/ML),PROPOFOL IV EMUL 200 MG/20ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 200 MG/20ML (10 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx25021060850","type":"CDM"},{"code":"J2704","type":"HCPCS"},{"code":"25021060850","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PROPOFOL IV EMUL 1000 MG/100ML (10 MG/ML),PROPOFOL IV EMUL 500 MG/50ML (10 MG/ML),PROPOFOL IV EMUL 200 MG/20ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 200 MG/20ML (10 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx25021060851","type":"CDM"},{"code":"J2704","type":"HCPCS"},{"code":"25021060851","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 2 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx25021067187","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"25021067187","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LIDOCAINE HCL URETHRAL/MUCOSAL GEL 2%,LIDOCAINE HCL URETHRAL/MUCOSAL GEL PREFILLED SYRINGE 2%","drug_information":{"unit":6.0,"type":"ML"},"code_information":[{"code":"Rx25021067376","type":"CDM"},{"code":"25021067376","type":"NDC"}],"standard_charges":[{"gross_charge":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LIDOCAINE HCL URETHRAL/MUCOSAL GEL 2%,LIDOCAINE HCL URETHRAL/MUCOSAL GEL PREFILLED SYRINGE 2%","drug_information":{"unit":11.0,"type":"ML"},"code_information":[{"code":"Rx25021067377","type":"CDM"},{"code":"25021067377","type":"NDC"}],"standard_charges":[{"gross_charge":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LEUCOVORIN CALCIUM FOR INJ 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021081310","type":"CDM"},{"code":"J0640","type":"HCPCS"},{"code":"25021081310","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LEVOFLOXACIN IN D5W IV SOLN 250 MG/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx25021082581","type":"CDM"},{"code":"J1956","type":"HCPCS"},{"code":"25021082581","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LEVOFLOXACIN IN D5W IV SOLN 500 MG/100ML,LEVOFLOXACIN IN D5W IV SOLN 750 MG/150ML,LEVOFLOXACIN IN D5W IV SOLN 250 MG/50ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx25021082582","type":"CDM"},{"code":"J1956","type":"HCPCS"},{"code":"25021082582","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TIROFIBAN HCL IV CONC 3.75 MG/15ML (250 MCG/ML) (BASE EQUIV)","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx25208000104","type":"CDM"},{"code":"J3246","type":"HCPCS"},{"code":"25208000104","type":"NDC"}],"standard_charges":[{"gross_charge":294.88,"discounted_cash":221.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TIROFIBAN HCL IN NACL 0.9% IV SOLN 5 MG/100ML (BASE EQUIV)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx25208000201","type":"CDM"},{"code":"J3246","type":"HCPCS"},{"code":"25208000201","type":"NDC"}],"standard_charges":[{"gross_charge":662.19,"discounted_cash":496.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ECULIZUMAB IV SOLN 300 MG/30ML (10 MG/ML) (FOR INFUSION)","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx25682000101","type":"CDM"},{"code":"J1299","type":"HCPCS"},{"code":"25682000101","type":"NDC"}],"standard_charges":[{"gross_charge":28346.79,"discounted_cash":21260.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SIPULEUCEL-T IV SUSP 50,000,000 CELLS","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx30237890006","type":"CDM"},{"code":"Q2043","type":"HCPCS"},{"code":"30237890006","type":"NDC"}],"standard_charges":[{"gross_charge":376885.43,"discounted_cash":282664.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LEVOCARNITINE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx30768003741","type":"CDM"},{"code":"30768003741","type":"NDC"}],"standard_charges":[{"gross_charge":0.84,"discounted_cash":0.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LEVETIRACETAM TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx31722053705","type":"CDM"},{"code":"31722053705","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LITHIUM CARBONATE CAP 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx31722054501","type":"CDM"},{"code":"31722054501","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ATOVAQUONE SUSP 750 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx31722062921","type":"CDM"},{"code":"31722062921","type":"NDC"}],"standard_charges":[{"gross_charge":21.99,"discounted_cash":16.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TOLTERODINE TARTRATE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx31722080660","type":"CDM"},{"code":"31722080660","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ALBENDAZOLE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx31722093502","type":"CDM"},{"code":"31722093502","type":"NDC"}],"standard_charges":[{"gross_charge":123.69,"discounted_cash":92.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FAMCICLOVIR TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx33342002607","type":"CDM"},{"code":"33342002607","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DONEPEZIL HYDROCHLORIDE ORALLY DISINTEGRATING TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx33342002907","type":"CDM"},{"code":"33342002907","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"OLANZAPINE ORALLY DISINTEGRATING TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx33342008307","type":"CDM"},{"code":"33342008307","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"OLANZAPINE ORALLY DISINTEGRATING TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx33342008407","type":"CDM"},{"code":"33342008407","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"RIZATRIPTAN BENZOATE ORAL DISINTEGRATING TAB 5 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx33342009341","type":"CDM"},{"code":"33342009341","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"METRONIDAZOLE IV SOLN 500 MG/100ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx36000000124","type":"CDM"},{"code":"J1836","type":"HCPCS"},{"code":"36000000124","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FLUCONAZOLE IN NACL 0.9% INJ 200 MG/100ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx36000000206","type":"CDM"},{"code":"J1450","type":"HCPCS"},{"code":"36000000206","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CIPROFLOXACIN 400 MG/200ML IN D5W","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx36000000924","type":"CDM"},{"code":"J0744","type":"HCPCS"},{"code":"36000000924","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FLUMAZENIL IV SOLN 1 MG/10ML (0.1 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx36000014901","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"36000014901","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FLUMAZENIL IV SOLN 1 MG/10ML (0.1 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx36000014910","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"36000014910","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NOREPINEPHRINE BITARTRATE IV SOLN 1 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx36000016210","type":"CDM"},{"code":"36000016210","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx36000028225","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"36000028225","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HYDROGEN PEROXIDE SOLN 3%","drug_information":{"unit":237.0,"type":"ML"},"code_information":[{"code":"Rx37205087134","type":"CDM"},{"code":"37205087134","type":"NDC"}],"standard_charges":[{"gross_charge":1.21,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"GLUCOSE GEL 40%","drug_information":{"unit":38.0,"type":"GM"},"code_information":[{"code":"Rx38396066375","type":"CDM"},{"code":"38396066375","type":"NDC"}],"standard_charges":[{"gross_charge":3.2,"discounted_cash":2.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PSYLLIUM POWDER PACKET 95%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx38485080857","type":"CDM"},{"code":"38485080857","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BUPIVACAINE HCL POWDER","drug_information":{"unit":5.0,"type":"GM"},"code_information":[{"code":"Rx38779052403","type":"CDM"},{"code":"38779052403","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SODIUM HYPOCHLORITE SOLN 0.25%","drug_information":{"unit":473.0,"type":"ML"},"code_information":[{"code":"Rx39328006325","type":"CDM"},{"code":"39328006325","type":"NDC"}],"standard_charges":[{"gross_charge":12.79,"discounted_cash":9.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SODIUM HYPOCHLORITE SOLN 0.125%","drug_information":{"unit":237.0,"type":"ML"},"code_information":[{"code":"Rx39328006808","type":"CDM"},{"code":"39328006808","type":"NDC"}],"standard_charges":[{"gross_charge":11.63,"discounted_cash":8.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TOBRAMYCIN SULFATE FOR INJ 1.2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx39822041206","type":"CDM"},{"code":"39822041206","type":"NDC"}],"standard_charges":[{"gross_charge":432.23,"discounted_cash":324.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"AMPHOTERICIN B FOR IV SOLN 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx39822105505","type":"CDM"},{"code":"J0285","type":"HCPCS"},{"code":"39822105505","type":"NDC"}],"standard_charges":[{"gross_charge":253.61,"discounted_cash":190.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NEOMYCIN-POLYMYXIN B GU IRRIGATION SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx39822120105","type":"CDM"},{"code":"39822120105","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DOCETAXEL FOR INJ CONC 20 MG/ML,DOCETAXEL FOR INJ CONC 80 MG/4ML (20 MG/ML),DOCETAXEL FOR INJ CONC 160 MG/8ML (20 MG/ML)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx39822218001","type":"CDM"},{"code":"J9171","type":"HCPCS"},{"code":"39822218001","type":"NDC"}],"standard_charges":[{"gross_charge":581.01,"discounted_cash":435.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PROMETHAZINE HCL INJ 25 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx39822552502","type":"CDM"},{"code":"J2550","type":"HCPCS"},{"code":"39822552502","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PROBIOTIC PRODUCT - CAP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx40985021339","type":"CDM"},{"code":"40985021339","type":"NDC"}],"standard_charges":[{"gross_charge":0.57,"discounted_cash":0.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NIACIN TAB ER 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx40985022849","type":"CDM"},{"code":"40985022849","type":"NDC"}],"standard_charges":[{"gross_charge":0.53,"discounted_cash":0.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TROLAMINE SALICYLATE CREAM 10%","drug_information":{"unit":35.4,"type":"GM"},"code_information":[{"code":"Rx41167005722","type":"CDM"},{"code":"41167005722","type":"NDC"}],"standard_charges":[{"gross_charge":3.57,"discounted_cash":2.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"EPINEPHRINE HCL NASAL SOLN 0.1%","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx42023010301","type":"CDM"},{"code":"42023010301","type":"NDC"}],"standard_charges":[{"gross_charge":1028.89,"discounted_cash":771.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TUBERCULIN PPD INJ 5 UNIT/0.1ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx42023010401","type":"CDM"},{"code":"42023010401","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"KETAMINE HCL INJ 10 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx42023011310","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"42023011310","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"KETAMINE HCL INJ 100 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx42023011510","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"42023011510","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"OXYTOCIN INJ 10 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx42023011602","type":"CDM"},{"code":"J2590","type":"HCPCS"},{"code":"42023011602","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"OXYTOCIN INJ 10 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx42023011625","type":"CDM"},{"code":"J2590","type":"HCPCS"},{"code":"42023011625","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LIOTHYRONINE SODIUM IV SOLN 10 MCG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx42023012001","type":"CDM"},{"code":"42023012001","type":"NDC"}],"standard_charges":[{"gross_charge":2405.27,"discounted_cash":1803.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"EPINEPHRINE INJ 1 MG/ML,EPINEPHRINE PF INJ 1 MG/ML,EPINEPHRINE INJ 1 MG/ML (1:1000),EPINEPHRINE INJ 30 MG/30ML (1 MG/ML) (1:1000),EPINEPHRINE SOLN PREFILLED SYRINGE 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx42023015925","type":"CDM"},{"code":"42023015925","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"EPINEPHRINE INJ 1 MG/ML,EPINEPHRINE PF INJ 1 MG/ML,EPINEPHRINE INJ 1 MG/ML (1:1000),EPINEPHRINE INJ 30 MG/30ML (1 MG/ML) (1:1000),EPINEPHRINE SOLN PREFILLED SYRINGE 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx42023016801","type":"CDM"},{"code":"42023016801","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PHENYLEPHRINE HCL IV SOLN 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx42023021301","type":"CDM"},{"code":"J2371","type":"HCPCS"},{"code":"42023021301","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PHENYLEPHRINE HCL IV SOLN 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx42023021325","type":"CDM"},{"code":"J2371","type":"HCPCS"},{"code":"42023021325","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"VASOPRESSIN-DEXTROSE IV SOLN 20 UNIT/100ML-5% (0.2UNIT/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx42023023701","type":"CDM"},{"code":"J2598","type":"HCPCS"},{"code":"42023023701","type":"NDC"}],"standard_charges":[{"gross_charge":1235.59,"discounted_cash":926.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"THYROID TAB 30 MG (1/2 GRAIN)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42192032901","type":"CDM"},{"code":"42192032901","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"GABAPENTIN ORAL SOLN 250 MG/5ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx42192060806","type":"CDM"},{"code":"42192060806","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CIPROFLOXACIN HCL OTIC SOLN 0.2% (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42195055014","type":"CDM"},{"code":"42195055014","type":"NDC"}],"standard_charges":[{"gross_charge":31.93,"discounted_cash":23.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 88 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42292003820","type":"CDM"},{"code":"42292003820","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 112 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42292003901","type":"CDM"},{"code":"42292003901","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 175 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42292004001","type":"CDM"},{"code":"42292004001","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 175 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42292004020","type":"CDM"},{"code":"42292004020","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DANTROLENE SODIUM FOR IV SUSP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42367054032","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"42367054032","type":"NDC"}],"standard_charges":[{"gross_charge":8128.89,"discounted_cash":6096.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"EMTRICITABINE-TENOFOVIR DISOPROXIL FUMARATE TAB 200-300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42385095330","type":"CDM"},{"code":"42385095330","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE OPHTH SOLN 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx42571013725","type":"CDM"},{"code":"42571013725","type":"NDC"}],"standard_charges":[{"gross_charge":37.14,"discounted_cash":27.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"IVERMECTIN TAB 3 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42799080601","type":"CDM"},{"code":"42799080601","type":"NDC"}],"standard_charges":[{"gross_charge":17.06,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"AZITHROMYCIN FOR SUSP 200 MG/5ML","drug_information":{"unit":6.25,"type":"ML"},"code_information":[{"code":"Rx42806014932","type":"CDM"},{"code":"42806014932","type":"NDC"}],"standard_charges":[{"gross_charge":15.76,"discounted_cash":11.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BENZONATATE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42806071405","type":"CDM"},{"code":"42806071405","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HYDROMORPHONE HCL TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42858030125","type":"CDM"},{"code":"42858030125","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HYDROMORPHONE HCL LIQD 1 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx42858030416","type":"CDM"},{"code":"42858030416","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BUPRENORPHINE TD PATCH WEEKLY 5 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42858075040","type":"CDM"},{"code":"42858075040","type":"NDC"}],"standard_charges":[{"gross_charge":396.98,"discounted_cash":297.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ROCURONIUM BROMIDE IV SOLN 50 MG/5ML (10 MG/ML),ROCURONIUM BROMIDE IV SOLN PREF SYRINGE 50 MG/5ML (10 MG/ML),ROCURONIUM BROMIDE IV SOLN 100 MG/10ML (10 MG/ML),ROCURONIUM BROMIDE IV SOLN PREF SYR 100 MG/10ML (10 MG/ML),ROCURONIUM BROMIDE IV SOLN PREF SYRINGE 20 MG/2ML (10 MG/ML),ROCURONIUM BROMIDE IV SOLN PREF SYR 75 MG/7.5ML (10 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx43066001310","type":"CDM"},{"code":"43066001310","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NICARDIPINE HCL IV SOLN 40 MG/200ML IN SODIUM CHLORIDE 0.83%","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx43066001610","type":"CDM"},{"code":"J2404","type":"HCPCS"},{"code":"43066001610","type":"NDC"}],"standard_charges":[{"gross_charge":652.0,"discounted_cash":489.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NICARDIPINE HCL IV SOLN 20 MG/200ML IN SODIUM CHLORIDE 0.86%","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx43066002610","type":"CDM"},{"code":"J2404","type":"HCPCS"},{"code":"43066002610","type":"NDC"}],"standard_charges":[{"gross_charge":644.37,"discounted_cash":483.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"AMIODARONE HCL IN DEXTROSE 4.21% IV SOLN 150 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx43066015010","type":"CDM"},{"code":"J0283","type":"HCPCS"},{"code":"43066015010","type":"NDC"}],"standard_charges":[{"gross_charge":152.81,"discounted_cash":114.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"AMIODARONE HCL IN DEXTROSE 4.14% IV SOLN 360 MG/200ML","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx43066036020","type":"CDM"},{"code":"J0283","type":"HCPCS"},{"code":"43066036020","type":"NDC"}],"standard_charges":[{"gross_charge":289.77,"discounted_cash":217.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HYOSCYAMINE SULFATE SL TAB 0.125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43199001101","type":"CDM"},{"code":"43199001101","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PEG 3350-KCL-NA BICARB-NACL-NA SULFATE FOR SOLN 236 GM","drug_information":{"unit":4000.0,"type":"ML"},"code_information":[{"code":"Rx43386009019","type":"CDM"},{"code":"43386009019","type":"NDC"}],"standard_charges":[{"gross_charge":71.95,"discounted_cash":53.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"METHYLERGONOVINE MALEATE TAB 0.2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43386014028","type":"CDM"},{"code":"43386014028","type":"NDC"}],"standard_charges":[{"gross_charge":224.06,"discounted_cash":168.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MISOPROSTOL TAB 100 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43386016012","type":"CDM"},{"code":"43386016012","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PHENELZINE SULFATE TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43386036021","type":"CDM"},{"code":"43386036021","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NIFEDIPINE CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43386044024","type":"CDM"},{"code":"43386044024","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FLUCYTOSINE CAP 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43386077001","type":"CDM"},{"code":"43386077001","type":"NDC"}],"standard_charges":[{"gross_charge":83.64,"discounted_cash":62.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ROPINIROLE HYDROCHLORIDE TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43547026910","type":"CDM"},{"code":"43547026910","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ROPINIROLE HYDROCHLORIDE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43547027110","type":"CDM"},{"code":"43547027110","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CLONAZEPAM TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43547040610","type":"CDM"},{"code":"43547040610","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CLONAZEPAM TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43547040710","type":"CDM"},{"code":"43547040710","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"METHYLPREDNISOLONE SOD SUCC FOR INJ 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598012725","type":"CDM"},{"code":"J2919","type":"HCPCS"},{"code":"43598012725","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CIPROFLOXACIN-DEXAMETHASONE OTIC SUSP 0.3-0.1%","drug_information":{"unit":7.5,"type":"ML"},"code_information":[{"code":"Rx43598032675","type":"CDM"},{"code":"43598032675","type":"NDC"}],"standard_charges":[{"gross_charge":475.55,"discounted_cash":356.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SEVELAMER CARBONATE PACKET 2.4 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598047990","type":"CDM"},{"code":"43598047990","type":"NDC"}],"standard_charges":[{"gross_charge":39.54,"discounted_cash":29.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DOXORUBICIN HCL LIPOSOMAL SUSP (FOR IV INFUSION) 2 MG/ML","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx43598054125","type":"CDM"},{"code":"Q2050","type":"HCPCS"},{"code":"43598054125","type":"NDC"}],"standard_charges":[{"gross_charge":4809.8,"discounted_cash":3607.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PROPOFOL IV EMUL 1000 MG/100ML (10 MG/ML),PROPOFOL IV EMUL 500 MG/50ML (10 MG/ML),PROPOFOL IV EMUL 200 MG/20ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 200 MG/20ML (10 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx43598054821","type":"CDM"},{"code":"J2704","type":"HCPCS"},{"code":"43598054821","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PROPOFOL IV EMUL 1000 MG/100ML (10 MG/ML),PROPOFOL IV EMUL 500 MG/50ML (10 MG/ML),PROPOFOL IV EMUL 200 MG/20ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 200 MG/20ML (10 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx43598054850","type":"CDM"},{"code":"J2704","type":"HCPCS"},{"code":"43598054850","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"RHO D IMMUNE GLOBULIN SOL PREF SYR 1500 UNT/2ML (300MCG/2ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx44206030001","type":"CDM"},{"code":"J2791","type":"HCPCS"},{"code":"44206030001","type":"NDC"}],"standard_charges":[{"gross_charge":462.88,"discounted_cash":347.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 3 (2-1) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx44567021110","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"44567021110","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MIDAZOLAM 1 MG/ML PCA SYRINGE,MIDAZOLAM HCL 100 MG/100ML IN NACL 0.9% IV SOLN,MIDAZOLAM HCL 55 MG/55ML-NACL 0.9% IV SOLN PREFILLED SYRINGE,MIDAZOLAM 50 MG/50ML-SODIUM CHLORIDE 0.9% IV SOLN,MIDAZOLAM HCL 50 MG/50ML-SODIUM CHLORIDE 0.9% IV SOLN,MIDAZOLAM HCL 50 MG/50ML-SODIUM CHLORIDE 0.8% IV SOLN,MIDAZOLAM HCL 100 MG/100ML IN NACL 0.8% IV SOLN,MIDAZOLAM IV SOLN 100 MG/100ML,MIDAZOLAM IV SOLN PREFILLED SYRINGE 50 MG/50ML,MIDAZOLAM IV SOLN PREFILLED SYRINGE 30 MG/30ML,MIDAZOLAM 100 MG/100ML-SODIUM CHLORIDE 0.9% IV SOLN,MIDAZOLAM 55 MG/55ML-NACL 0.9% IV SOLN PREFILLED SYRINGE,MIDAZOLAM 50 MG/50ML-NACL 0.9% IV SOLN PREFILLED SYRINGE,MIDAZOLAM 30 MG/30ML-NACL 0.9% IV SOLN PREFILLED SYRINGE,MIDAZOLAM IV SOLN PREFILLED SYRINGE 25 MG/25ML,MIDAZOLAM IV SOLN 50 MG/50ML,MIDAZOLAM 100 MG/100ML-SODIUM CHLORIDE 0.8% PF IV SOLUTION,MIDAZOLAM HCL 30 MG/30ML-NACL 0.9% IV SOLN PREFILLED SYRINGE,MIDAZOLAM HCL 50 MG/50ML-NACL 0.9% IV SOLN PREFILLED SYRINGE,MIDAZOLAM 50 MG/50ML-SODIUM CHLORIDE 0.9% PF IV SOLN,MIDAZOLAM 100 MG/100ML-SODIUM CHLORIDE 0.9% PF IV SOLN,MIDAZOLAM 50 MG/50ML-SODIUM CHLORIDE 0.8% PF IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx44567061101","type":"CDM"},{"code":"J2251","type":"HCPCS"},{"code":"44567061101","type":"NDC"}],"standard_charges":[{"gross_charge":199.37,"discounted_cash":149.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CALCIUM GLUCONATE-NACL IV SOLN 1 GM/50ML-0.675% (20 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx44567062024","type":"CDM"},{"code":"J0613","type":"HCPCS"},{"code":"44567062024","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CALCIUM GLUCONATE-NACL IV SOLN 2 GM/100ML-0.675% (20 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx44567062101","type":"CDM"},{"code":"J0613","type":"HCPCS"},{"code":"44567062101","type":"NDC"}],"standard_charges":[{"gross_charge":186.77,"discounted_cash":140.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NOREPINEPHRINE-NACL IV SOLUTION 4 MG/250ML-0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx44567064001","type":"CDM"},{"code":"44567064001","type":"NDC"}],"standard_charges":[{"gross_charge":271.66,"discounted_cash":203.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CEFAZOLIN SODIUM FOR INJ 10 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx44567070810","type":"CDM"},{"code":"J0690","type":"HCPCS"},{"code":"44567070810","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TOLNAFTATE CREAM 1%","drug_information":{"unit":14.0,"type":"GM"},"code_information":[{"code":"Rx45802003201","type":"CDM"},{"code":"45802003201","type":"NDC"}],"standard_charges":[{"gross_charge":1.77,"discounted_cash":1.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SELENIUM SULFIDE LOTION 2.5%","drug_information":{"unit":120.0,"type":"ML"},"code_information":[{"code":"Rx45802004064","type":"CDM"},{"code":"45802004064","type":"NDC"}],"standard_charges":[{"gross_charge":45.33,"discounted_cash":34.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NYSTATIN CREAM 100000 UNIT/GM","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx45802005935","type":"CDM"},{"code":"45802005935","type":"NDC"}],"standard_charges":[{"gross_charge":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NEOMYCIN-BACITRACIN-POLYMYXIN OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx45802006170","type":"CDM"},{"code":"45802006170","type":"NDC"}],"standard_charges":[{"gross_charge":0.65,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MESALAMINE ENEMA 4 GM","drug_information":{"unit":60.0,"type":"ML"},"code_information":[{"code":"Rx45802009851","type":"CDM"},{"code":"45802009851","type":"NDC"}],"standard_charges":[{"gross_charge":41.28,"discounted_cash":30.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PHENYLEPHRINE-MINERAL OIL-PETROLATUM OINT 0.25-14-74.9%","drug_information":{"unit":57.0,"type":"GM"},"code_information":[{"code":"Rx45802018816","type":"CDM"},{"code":"45802018816","type":"NDC"}],"standard_charges":[{"gross_charge":2.95,"discounted_cash":2.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BENZOYL PEROXIDE GEL 5%","drug_information":{"unit":60.0,"type":"GM"},"code_information":[{"code":"Rx45802021696","type":"CDM"},{"code":"45802021696","type":"NDC"}],"standard_charges":[{"gross_charge":12.08,"discounted_cash":9.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HYDROCORTISONE OINT 1%","drug_information":{"unit":28.0,"type":"GM"},"code_information":[{"code":"Rx45802027603","type":"CDM"},{"code":"45802027603","type":"NDC"}],"standard_charges":[{"gross_charge":2.54,"discounted_cash":1.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NICOTINE POLACRILEX LOZENGE 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx45802034405","type":"CDM"},{"code":"45802034405","type":"NDC"}],"standard_charges":[{"gross_charge":0.85,"discounted_cash":0.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DIPHENHYDRAMINE-ZINC ACETATE CREAM 2-0.1%","drug_information":{"unit":28.0,"type":"GM"},"code_information":[{"code":"Rx45802035803","type":"CDM"},{"code":"45802035803","type":"NDC"}],"standard_charges":[{"gross_charge":2.54,"discounted_cash":1.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"VITAMINS A & D OINT","drug_information":{"unit":113.0,"type":"GM"},"code_information":[{"code":"Rx45802039504","type":"CDM"},{"code":"45802039504","type":"NDC"}],"standard_charges":[{"gross_charge":2.76,"discounted_cash":2.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ACETAMINOPHEN SUPPOS 650 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx45802073030","type":"CDM"},{"code":"45802073030","type":"NDC"}],"standard_charges":[{"gross_charge":0.71,"discounted_cash":0.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BACLOFEN INTRATHECAL SOLN PREFILLED SYRINGE 50 MCG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx45945015101","type":"CDM"},{"code":"J0476","type":"HCPCS"},{"code":"45945015101","type":"NDC"}],"standard_charges":[{"gross_charge":464.87,"discounted_cash":348.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BACLOFEN INTRATHECAL SOLN PREFILLED SYRINGE 10000 MCG/20ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx45945015501","type":"CDM"},{"code":"J0475","type":"HCPCS"},{"code":"45945015501","type":"NDC"}],"standard_charges":[{"gross_charge":1129.9,"discounted_cash":847.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BACLOFEN INTRATHECAL SOLN PREFILLED SYRINGE 20000 MCG/20ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx45945015601","type":"CDM"},{"code":"J0475","type":"HCPCS"},{"code":"45945015601","type":"NDC"}],"standard_charges":[{"gross_charge":2227.52,"discounted_cash":1670.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BACLOFEN INTRATHECAL INJ 40 MG/20ML (2000 MCG/ML)","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx45945015702","type":"CDM"},{"code":"J0475","type":"HCPCS"},{"code":"45945015702","type":"NDC"}],"standard_charges":[{"gross_charge":2802.1,"discounted_cash":2101.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"RANOLAZINE TAB ER 12HR 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx45963041806","type":"CDM"},{"code":"45963041806","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LACTULOSE SOLUTION 10 GM/15ML","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx45963043963","type":"CDM"},{"code":"45963043963","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PACLITAXEL IV CONC 30 MG/5ML (6 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx45963061356","type":"CDM"},{"code":"J9267","type":"HCPCS"},{"code":"45963061356","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"IRINOTECAN HCL INJ 40 MG/2ML (20 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx45963061451","type":"CDM"},{"code":"J9206","type":"HCPCS"},{"code":"45963061451","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CAFFEINE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx46017001816","type":"CDM"},{"code":"46017001816","type":"NDC"}],"standard_charges":[{"gross_charge":0.7,"discounted_cash":0.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ROMIDEPSIN FOR IV INJ 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx46026098301","type":"CDM"},{"code":"J9319","type":"HCPCS"},{"code":"46026098301","type":"NDC"}],"standard_charges":[{"gross_charge":15471.81,"discounted_cash":11603.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SODIUM POLYSTYRENE SULFONATE SUSP 15 GM/60ML","drug_information":{"unit":60.0,"type":"ML"},"code_information":[{"code":"Rx46287000601","type":"CDM"},{"code":"46287000601","type":"NDC"}],"standard_charges":[{"gross_charge":101.99,"discounted_cash":76.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SODIUM POLYSTYRENE SULFONATE SUSP 15 GM/60ML","drug_information":{"unit":60.0,"type":"ML"},"code_information":[{"code":"Rx46287000660","type":"CDM"},{"code":"46287000660","type":"NDC"}],"standard_charges":[{"gross_charge":99.57,"discounted_cash":74.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LIDOCAINE PATCH 4%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx46581083006","type":"CDM"},{"code":"46581083006","type":"NDC"}],"standard_charges":[{"gross_charge":1.61,"discounted_cash":1.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TOBRAMYCIN NEBU SOLN 300 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx47335017149","type":"CDM"},{"code":"J7682","type":"HCPCS"},{"code":"47335017149","type":"NDC"}],"standard_charges":[{"gross_charge":48.45,"discounted_cash":36.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"VECURONIUM BROMIDE FOR INJ 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47335093140","type":"CDM"},{"code":"47335093140","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"VECURONIUM BROMIDE FOR INJ 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47335093144","type":"CDM"},{"code":"47335093144","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"APREPITANT IV EMULSION 130 MG/18ML","drug_information":{"unit":18.0,"type":"ML"},"code_information":[{"code":"Rx47426020101","type":"CDM"},{"code":"J0185","type":"HCPCS"},{"code":"47426020101","type":"NDC"}],"standard_charges":[{"gross_charge":1454.89,"discounted_cash":1091.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BUPIVACAINE-MELOXICAM INJECTION ER SOLN 200-6 MG/7ML","drug_information":{"unit":7.0,"type":"ML"},"code_information":[{"code":"Rx47426030301","type":"CDM"},{"code":"J0668","type":"HCPCS"},{"code":"47426030301","type":"NDC"}],"standard_charges":[{"gross_charge":879.5,"discounted_cash":659.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BUPIVACAINE-MELOXICAM INJECTION ER SOLN 400-12 MG/14ML","drug_information":{"unit":14.0,"type":"ML"},"code_information":[{"code":"Rx47426050102","type":"CDM"},{"code":"J0668","type":"HCPCS"},{"code":"47426050102","type":"NDC"}],"standard_charges":[{"gross_charge":1823.79,"discounted_cash":1367.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NEOMYCIN-BACITRACIN-POLYMYXIN OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47682022335","type":"CDM"},{"code":"47682022335","type":"NDC"}],"standard_charges":[{"gross_charge":0.64,"discounted_cash":0.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ESTRADIOL VAGINAL CREAM 0.01%","drug_information":{"unit":42.5,"type":"GM"},"code_information":[{"code":"Rx47781010444","type":"CDM"},{"code":"47781010444","type":"NDC"}],"standard_charges":[{"gross_charge":699.55,"discounted_cash":524.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"OSELTAMIVIR PHOSPHATE FOR SUSP 6 MG/ML (BASE EQUIV)","drug_information":{"unit":12.5,"type":"ML"},"code_information":[{"code":"Rx47781038426","type":"CDM"},{"code":"47781038426","type":"NDC"}],"standard_charges":[{"gross_charge":87.36,"discounted_cash":65.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"RIVASTIGMINE TD PATCH 24HR 13.3 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781040503","type":"CDM"},{"code":"47781040503","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ETHACRYNIC ACID TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781049701","type":"CDM"},{"code":"47781049701","type":"NDC"}],"standard_charges":[{"gross_charge":62.53,"discounted_cash":46.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TETRACYCLINE HCL CAP 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781050901","type":"CDM"},{"code":"47781050901","type":"NDC"}],"standard_charges":[{"gross_charge":52.52,"discounted_cash":39.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FLUOCINONIDE OINT 0.05%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx47781056972","type":"CDM"},{"code":"47781056972","type":"NDC"}],"standard_charges":[{"gross_charge":169.32,"discounted_cash":126.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ROCURONIUM BROMIDE IV SOLN 50 MG/5ML (10 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx47781061617","type":"CDM"},{"code":"47781061617","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"METHAZOLAMIDE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx48102010101","type":"CDM"},{"code":"48102010101","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MINERAL OIL","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx48433020230","type":"CDM"},{"code":"48433020230","type":"NDC"}],"standard_charges":[{"gross_charge":1.76,"discounted_cash":1.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"IODINE SOLUTION STRONG 5% (LUGOL'S)","drug_information":{"unit":14.0,"type":"ML"},"code_information":[{"code":"Rx48433023015","type":"CDM"},{"code":"48433023015","type":"NDC"}],"standard_charges":[{"gross_charge":139.65,"discounted_cash":104.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FERRIC SUBSULFATE PASTE","drug_information":{"unit":8.0,"type":"ML"},"code_information":[{"code":"Rx48783011208","type":"CDM"},{"code":"48783011208","type":"NDC"}],"standard_charges":[{"gross_charge":87.75,"discounted_cash":65.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TETANUS-DIPHTHERIA TOXOIDS (TD) INJ 5-2 LF/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx49281021515","type":"CDM"},{"code":"90714","type":"HCPCS"},{"code":"49281021515","type":"NDC"}],"standard_charges":[{"gross_charge":494.11,"discounted_cash":370.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TETANUS-DIPHTHERIA TOXOIDS (TD) INJ 5-2 LF/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx49281021588","type":"CDM"},{"code":"90714","type":"HCPCS"},{"code":"49281021588","type":"NDC"}],"standard_charges":[{"gross_charge":324.22,"discounted_cash":243.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BELIMUMAB FOR IV SOLN 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49401010101","type":"CDM"},{"code":"J0490","type":"HCPCS"},{"code":"49401010101","type":"NDC"}],"standard_charges":[{"gross_charge":2813.59,"discounted_cash":2110.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BELIMUMAB FOR IV SOLN 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49401010201","type":"CDM"},{"code":"J0490","type":"HCPCS"},{"code":"49401010201","type":"NDC"}],"standard_charges":[{"gross_charge":9378.0,"discounted_cash":7033.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FRUCTOSE GRANULES","drug_information":{"unit":500.0,"type":"GM"},"code_information":[{"code":"Rx49452320501","type":"CDM"},{"code":"49452320501","type":"NDC"}],"standard_charges":[{"gross_charge":65.25,"discounted_cash":48.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SENNOSIDES TAB 8.6 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49483008010","type":"CDM"},{"code":"49483008010","type":"NDC"}],"standard_charges":[{"gross_charge":0.51,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ASPIRIN TAB DELAYED RELEASE 81 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49483048110","type":"CDM"},{"code":"49483048110","type":"NDC"}],"standard_charges":[{"gross_charge":0.5,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"INSULIN GLARGINE-YFGN INJ 100 UNIT/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx49502039380","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"49502039380","type":"NDC"}],"standard_charges":[{"gross_charge":711.88,"discounted_cash":533.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HYDROGEN PEROXIDE SOLN 3%","drug_information":{"unit":473.0,"type":"ML"},"code_information":[{"code":"Rx49580030002","type":"CDM"},{"code":"49580030002","type":"NDC"}],"standard_charges":[{"gross_charge":1.44,"discounted_cash":1.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LAMIVUDINE ORAL SOLN 10 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx49702020548","type":"CDM"},{"code":"49702020548","type":"NDC"}],"standard_charges":[{"gross_charge":19.2,"discounted_cash":14.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ZIDOVUDINE IV SOLN 10 MG/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx49702021326","type":"CDM"},{"code":"J3485","type":"HCPCS"},{"code":"49702021326","type":"NDC"}],"standard_charges":[{"gross_charge":196.15,"discounted_cash":147.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DOLUTEGRAVIR SODIUM TAB 50 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49702022813","type":"CDM"},{"code":"49702022813","type":"NDC"}],"standard_charges":[{"gross_charge":319.49,"discounted_cash":239.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PERMETHRIN CREME RINSE 1%","drug_information":{"unit":59.0,"type":"ML"},"code_information":[{"code":"Rx49781002802","type":"CDM"},{"code":"49781002802","type":"NDC"}],"standard_charges":[{"gross_charge":7.46,"discounted_cash":5.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"IMIPRAMINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884005401","type":"CDM"},{"code":"49884005401","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"IMIPRAMINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884005501","type":"CDM"},{"code":"49884005501","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"VARENICLINE TARTRATE TAB 0.5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884015576","type":"CDM"},{"code":"49884015576","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"VARENICLINE TARTRATE TAB 1 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884015676","type":"CDM"},{"code":"49884015676","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CALCITONIN (SALMON) NASAL SOLN 200 UNIT/ACT","drug_information":{"unit":3.7,"type":"ML"},"code_information":[{"code":"Rx49884016111","type":"CDM"},{"code":"49884016111","type":"NDC"}],"standard_charges":[{"gross_charge":202.6,"discounted_cash":151.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DOXEPIN HCL CAP 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884022203","type":"CDM"},{"code":"49884022203","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CLONAZEPAM ORALLY DISINTEGRATING TAB 0.125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884030602","type":"CDM"},{"code":"49884030602","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"RISPERIDONE ORALLY DISINTEGRATING TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884031155","type":"CDM"},{"code":"49884031155","type":"NDC"}],"standard_charges":[{"gross_charge":14.62,"discounted_cash":10.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DOXYCYCLINE MONOHYDRATE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884072703","type":"CDM"},{"code":"49884072703","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LIDOCAINE HCL URETHRAL/MUCOSAL GEL 2%,LIDOCAINE HCL URETHRAL/MUCOSAL GEL PREFILLED SYRINGE 2%","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx50090453800","type":"CDM"},{"code":"50090453800","type":"NDC"}],"standard_charges":[{"gross_charge":37.95,"discounted_cash":28.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ULIPRISTAL ACETATE TAB 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50102091101","type":"CDM"},{"code":"50102091101","type":"NDC"}],"standard_charges":[{"gross_charge":148.59,"discounted_cash":111.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"OMALIZUMAB FOR INJ 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50242004062","type":"CDM"},{"code":"J2357","type":"HCPCS"},{"code":"50242004062","type":"NDC"}],"standard_charges":[{"gross_charge":6153.99,"discounted_cash":4615.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ALTEPLASE FOR INJ 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50242004163","type":"CDM"},{"code":"J2997","type":"HCPCS"},{"code":"50242004163","type":"NDC"}],"standard_charges":[{"gross_charge":804.73,"discounted_cash":603.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ALTEPLASE FOR INJ 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50242004164","type":"CDM"},{"code":"J2997","type":"HCPCS"},{"code":"50242004164","type":"NDC"}],"standard_charges":[{"gross_charge":1074.7,"discounted_cash":806.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ALTEPLASE FOR INJ 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50242004413","type":"CDM"},{"code":"J2997","type":"HCPCS"},{"code":"50242004413","type":"NDC"}],"standard_charges":[{"gross_charge":17620.85,"discounted_cash":13215.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"RITUXIMAB IV SOLN 100 MG/10ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx50242005121","type":"CDM"},{"code":"J9312","type":"HCPCS"},{"code":"50242005121","type":"NDC"}],"standard_charges":[{"gross_charge":6683.96,"discounted_cash":5012.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"RITUXIMAB IV SOLN 500 MG/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx50242005306","type":"CDM"},{"code":"J9312","type":"HCPCS"},{"code":"50242005306","type":"NDC"}],"standard_charges":[{"gross_charge":33419.81,"discounted_cash":25064.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BEVACIZUMAB IV SOLN 100 MG/4ML (FOR INFUSION)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx50242006001","type":"CDM"},{"code":"J9035","type":"HCPCS"},{"code":"50242006001","type":"NDC"}],"standard_charges":[{"gross_charge":5669.66,"discounted_cash":4252.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BEVACIZUMAB IV SOLN 400 MG/16ML (FOR INFUSION)","drug_information":{"unit":16.0,"type":"ML"},"code_information":[{"code":"Rx50242006101","type":"CDM"},{"code":"J9035","type":"HCPCS"},{"code":"50242006101","type":"NDC"}],"standard_charges":[{"gross_charge":22678.54,"discounted_cash":17008.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ALTEPLASE FOR INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50242008527","type":"CDM"},{"code":"J2997","type":"HCPCS"},{"code":"50242008527","type":"NDC"}],"standard_charges":[{"gross_charge":35241.65,"discounted_cash":26431.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ADO-TRASTUZUMAB EMTANSINE FOR IV SOLN 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50242008801","type":"CDM"},{"code":"J9354","type":"HCPCS"},{"code":"50242008801","type":"NDC"}],"standard_charges":[{"gross_charge":28383.21,"discounted_cash":21287.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DORNASE ALFA INHAL SOLN 2.5 MG/2.5ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx50242010039","type":"CDM"},{"code":"J7639","type":"HCPCS"},{"code":"50242010039","type":"NDC"}],"standard_charges":[{"gross_charge":516.29,"discounted_cash":387.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DORNASE ALFA INHAL SOLN 2.5 MG/2.5ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx50242010040","type":"CDM"},{"code":"J7639","type":"HCPCS"},{"code":"50242010040","type":"NDC"}],"standard_charges":[{"gross_charge":661.73,"discounted_cash":496.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TENECTEPLASE FOR IV SOLN KIT 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50242012047","type":"CDM"},{"code":"J3101","type":"HCPCS"},{"code":"50242012047","type":"NDC"}],"standard_charges":[{"gross_charge":33226.96,"discounted_cash":24920.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TRASTUZUMAB FOR IV SOLN 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50242013201","type":"CDM"},{"code":"J9355","type":"HCPCS"},{"code":"50242013201","type":"NDC"}],"standard_charges":[{"gross_charge":11087.0,"discounted_cash":8315.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TRASTUZUMAB FOR IV SOLN 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50242013210","type":"CDM"},{"code":"J9355","type":"HCPCS"},{"code":"50242013210","type":"NDC"}],"standard_charges":[{"gross_charge":11086.99,"discounted_cash":8315.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PERTUZUMAB SOLN FOR IV INFUSION 420 MG/14ML (30 MG/ML)","drug_information":{"unit":14.0,"type":"ML"},"code_information":[{"code":"Rx50242014501","type":"CDM"},{"code":"J9306","type":"HCPCS"},{"code":"50242014501","type":"NDC"}],"standard_charges":[{"gross_charge":48522.67,"discounted_cash":36392.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"OCRELIZUMAB SOLN FOR IV INFUSION 300 MG/10ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx50242015001","type":"CDM"},{"code":"J2350","type":"HCPCS"},{"code":"50242015001","type":"NDC"}],"standard_charges":[{"gross_charge":89698.87,"discounted_cash":67274.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TENECTEPLASE FOR IV SOLN KIT 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50242017601","type":"CDM"},{"code":"J3101","type":"HCPCS"},{"code":"50242017601","type":"NDC"}],"standard_charges":[{"gross_charge":33226.96,"discounted_cash":24920.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"OMALIZUMAB SUBCUTANEOUS SOLN PREFILLED SYRINGE 75 MG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx50242021486","type":"CDM"},{"code":"J2357","type":"HCPCS"},{"code":"50242021486","type":"NDC"}],"standard_charges":[{"gross_charge":2524.85,"discounted_cash":1893.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BENAZEPRIL HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268010915","type":"CDM"},{"code":"50268010915","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BENAZEPRIL HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268011015","type":"CDM"},{"code":"50268011015","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CEPHALEXIN CAP 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268015211","type":"CDM"},{"code":"50268015211","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CYCLOBENZAPRINE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268019015","type":"CDM"},{"code":"50268019015","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ESTRADIOL TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268029015","type":"CDM"},{"code":"50268029015","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ERGOCALCIFEROL CAP 1.25 MG (50000 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268029711","type":"CDM"},{"code":"50268029711","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FENOFIBRATE TAB 54 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268031215","type":"CDM"},{"code":"50268031215","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FLUDROCORTISONE ACETATE TAB 0.1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268033011","type":"CDM"},{"code":"50268033011","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FLUDROCORTISONE ACETATE TAB 0.1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268033015","type":"CDM"},{"code":"50268033015","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HYDROXYCHLOROQUINE SULFATE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268041215","type":"CDM"},{"code":"50268041215","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LETROZOLE TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268047615","type":"CDM"},{"code":"50268047615","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LORATADINE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268048911","type":"CDM"},{"code":"50268048911","type":"NDC"}],"standard_charges":[{"gross_charge":0.67,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LORATADINE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268048915","type":"CDM"},{"code":"50268048915","type":"NDC"}],"standard_charges":[{"gross_charge":0.68,"discounted_cash":0.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MECLIZINE HCL TAB 12.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268052215","type":"CDM"},{"code":"50268052215","type":"NDC"}],"standard_charges":[{"gross_charge":0.83,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MELOXICAM TAB 7.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268052511","type":"CDM"},{"code":"50268052511","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MUPIROCIN OINT 2%","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"Rx50268056811","type":"CDM"},{"code":"50268056811","type":"NDC"}],"standard_charges":[{"gross_charge":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MUPIROCIN OINT 2%","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"Rx50268056815","type":"CDM"},{"code":"50268056815","type":"NDC"}],"standard_charges":[{"gross_charge":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NIACIN TAB ER 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268058315","type":"CDM"},{"code":"50268058315","type":"NDC"}],"standard_charges":[{"gross_charge":0.98,"discounted_cash":0.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NAPROXEN TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268059415","type":"CDM"},{"code":"50268059415","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PROCHLORPERAZINE MALEATE TAB 5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268068411","type":"CDM"},{"code":"50268068411","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PROCHLORPERAZINE MALEATE TAB 5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268068415","type":"CDM"},{"code":"50268068415","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PRIMIDONE TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268068715","type":"CDM"},{"code":"50268068715","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 400-80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268072815","type":"CDM"},{"code":"50268072815","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TORSEMIDE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268075511","type":"CDM"},{"code":"50268075511","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TORSEMIDE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268075515","type":"CDM"},{"code":"50268075515","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"URSODIOL CAP 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268079615","type":"CDM"},{"code":"50268079615","type":"NDC"}],"standard_charges":[{"gross_charge":31.84,"discounted_cash":23.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"THIAMINE HCL TAB 100 MG,THIAMINE MONONITRATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268085115","type":"CDM"},{"code":"50268085115","type":"NDC"}],"standard_charges":[{"gross_charge":0.65,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CYANOCOBALAMIN TAB 500 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268085415","type":"CDM"},{"code":"50268085415","type":"NDC"}],"standard_charges":[{"gross_charge":0.65,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CYANOCOBALAMIN TAB 1000 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268085511","type":"CDM"},{"code":"50268085511","type":"NDC"}],"standard_charges":[{"gross_charge":0.53,"discounted_cash":0.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CYANOCOBALAMIN TAB 1000 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268085515","type":"CDM"},{"code":"50268085515","type":"NDC"}],"standard_charges":[{"gross_charge":0.65,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"VITAMIN E CAP 180 MG (400 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268087013","type":"CDM"},{"code":"50268087013","type":"NDC"}],"standard_charges":[{"gross_charge":1.31,"discounted_cash":0.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"WITCH HAZEL-GLYCERIN CLEANSING PADS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50289325001","type":"CDM"},{"code":"50289325001","type":"NDC"}],"standard_charges":[{"gross_charge":0.56,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PHENYLEPHRINE HCL NASAL SOLN 0.5%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx50323000603","type":"CDM"},{"code":"50323000603","type":"NDC"}],"standard_charges":[{"gross_charge":4.49,"discounted_cash":3.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"AMANTADINE HCL SOLN 50 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx50383080716","type":"CDM"},{"code":"50383080716","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LEVONORGESTREL IUD 20 MCG/DAY (INITIAL) (52 MG TOTAL)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50419042301","type":"CDM"},{"code":"J7298","type":"HCPCS"},{"code":"50419042301","type":"NDC"}],"standard_charges":[{"gross_charge":4494.06,"discounted_cash":3370.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PENTOSAN POLYSULFATE SODIUM CAPS 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50458009801","type":"CDM"},{"code":"50458009801","type":"NDC"}],"standard_charges":[{"gross_charge":49.36,"discounted_cash":37.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CANAGLIFLOZIN TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50458014090","type":"CDM"},{"code":"50458014090","type":"NDC"}],"standard_charges":[{"gross_charge":30.07,"discounted_cash":22.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ITRACONAZOLE ORAL SOLN 10 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx50458029515","type":"CDM"},{"code":"50458029515","type":"NDC"}],"standard_charges":[{"gross_charge":94.26,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"RIVAROXABAN TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50458057710","type":"CDM"},{"code":"50458057710","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"RIVAROXABAN TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50458057810","type":"CDM"},{"code":"50458057810","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"RIVAROXABAN TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50458057910","type":"CDM"},{"code":"50458057910","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"RIVAROXABAN TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50458058010","type":"CDM"},{"code":"50458058010","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ROZANOLIXIZUMAB-NOLI SUBCUTANEOUS SOLN 280 MG/2ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx50474098079","type":"CDM"},{"code":"J9333","type":"HCPCS"},{"code":"50474098079","type":"NDC"}],"standard_charges":[{"gross_charge":39929.96,"discounted_cash":29947.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ROZANOLIXIZUMAB-NOLI SUBCUTANEOUS SOLN 420 MG/3ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx50474098183","type":"CDM"},{"code":"J9333","type":"HCPCS"},{"code":"50474098183","type":"NDC"}],"standard_charges":[{"gross_charge":40429.07,"discounted_cash":30321.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ROZANOLIXIZUMAB-NOLI SUBCUTANEOUS SOLN 560 MG/4ML","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx50474098284","type":"CDM"},{"code":"J9333","type":"HCPCS"},{"code":"50474098284","type":"NDC"}],"standard_charges":[{"gross_charge":53905.43,"discounted_cash":40429.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"COLLAGENASE OINT 250 UNIT/GM","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx50484001030","type":"CDM"},{"code":"50484001030","type":"NDC"}],"standard_charges":[{"gross_charge":1164.48,"discounted_cash":873.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"RABIES VACCINE, PCEC FOR INJ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50632001001","type":"CDM"},{"code":"90675","type":"HCPCS"},{"code":"50632001001","type":"NDC"}],"standard_charges":[{"gross_charge":2196.43,"discounted_cash":1647.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CROTALIDAE POLYVALENT IMMUNE FAB (OVINE) FOR IV INFUSION","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50633011012","type":"CDM"},{"code":"J0840","type":"HCPCS"},{"code":"50633011012","type":"NDC"}],"standard_charges":[{"gross_charge":5120.97,"discounted_cash":3840.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DIGOXIN IMMUNE FAB FOR INJ 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50633012011","type":"CDM"},{"code":"J1162","type":"HCPCS"},{"code":"50633012011","type":"NDC"}],"standard_charges":[{"gross_charge":19918.72,"discounted_cash":14939.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CABERGOLINE TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50742011808","type":"CDM"},{"code":"J8515","type":"HCPCS"},{"code":"50742011808","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SCOPOLAMINE TD PATCH 72HR 1 MG/3DAYS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50742050524","type":"CDM"},{"code":"50742050524","type":"NDC"}],"standard_charges":[{"gross_charge":29.29,"discounted_cash":21.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ARTIFICIAL SALIVA - SOLUTION","drug_information":{"unit":59.0,"type":"ML"},"code_information":[{"code":"Rx50930009802","type":"CDM"},{"code":"50930009802","type":"NDC"}],"standard_charges":[{"gross_charge":6.57,"discounted_cash":4.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ARTIFICIAL SALIVA - SOLUTION","drug_information":{"unit":236.0,"type":"ML"},"code_information":[{"code":"Rx50930009808","type":"CDM"},{"code":"50930009808","type":"NDC"}],"standard_charges":[{"gross_charge":12.77,"discounted_cash":9.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"METOLAZONE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079002401","type":"CDM"},{"code":"51079002401","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"METOLAZONE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079002420","type":"CDM"},{"code":"51079002420","type":"NDC"}],"standard_charges":[{"gross_charge":14.38,"discounted_cash":10.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CHLORTHALIDONE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079005801","type":"CDM"},{"code":"51079005801","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CHLORTHALIDONE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079005820","type":"CDM"},{"code":"51079005820","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FUROSEMIDE TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079007301","type":"CDM"},{"code":"51079007301","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FUROSEMIDE TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079007320","type":"CDM"},{"code":"51079007320","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SPIRONOLACTONE & HYDROCHLOROTHIAZIDE TAB 25-25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079010401","type":"CDM"},{"code":"51079010401","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CHLORDIAZEPOXIDE HCL CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079014120","type":"CDM"},{"code":"51079014120","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"VORICONAZOLE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079016503","type":"CDM"},{"code":"51079016503","type":"NDC"}],"standard_charges":[{"gross_charge":135.91,"discounted_cash":101.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CELECOXIB CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079019901","type":"CDM"},{"code":"51079019901","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CELECOXIB CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079019920","type":"CDM"},{"code":"51079019920","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ABACAVIR SULFATE TAB 300 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079020401","type":"CDM"},{"code":"51079020401","type":"NDC"}],"standard_charges":[{"gross_charge":29.64,"discounted_cash":22.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ABACAVIR SULFATE TAB 300 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079020406","type":"CDM"},{"code":"51079020406","type":"NDC"}],"standard_charges":[{"gross_charge":33.93,"discounted_cash":25.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ALLOPURINOL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079020520","type":"CDM"},{"code":"51079020520","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ALLOPURINOL TAB 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079020620","type":"CDM"},{"code":"51079020620","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"METOPROLOL TARTRATE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079025520","type":"CDM"},{"code":"51079025520","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ENTACAPONE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079027303","type":"CDM"},{"code":"51079027303","type":"NDC"}],"standard_charges":[{"gross_charge":19.5,"discounted_cash":14.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CLONIDINE HCL TAB 0.2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079030020","type":"CDM"},{"code":"51079030020","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"POLYETHYLENE GLYCOL 3350 ORAL PACKET 17 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079030601","type":"CDM"},{"code":"51079030601","type":"NDC"}],"standard_charges":[{"gross_charge":1.84,"discounted_cash":1.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"POLYETHYLENE GLYCOL 3350 ORAL PACKET 17 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079030630","type":"CDM"},{"code":"51079030630","type":"NDC"}],"standard_charges":[{"gross_charge":1.9,"discounted_cash":1.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MYCOPHENOLATE MOFETIL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079037920","type":"CDM"},{"code":"J7517","type":"HCPCS"},{"code":"51079037920","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LORAZEPAM TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079038720","type":"CDM"},{"code":"51079038720","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DOXEPIN HCL CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079043620","type":"CDM"},{"code":"51079043620","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DOXEPIN HCL CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079043820","type":"CDM"},{"code":"51079043820","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 100 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079044201","type":"CDM"},{"code":"51079044201","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 100 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079044220","type":"CDM"},{"code":"51079044220","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 125 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079044301","type":"CDM"},{"code":"51079044301","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 125 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079044320","type":"CDM"},{"code":"51079044320","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 25 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079044401","type":"CDM"},{"code":"51079044401","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 25 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079044420","type":"CDM"},{"code":"51079044420","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"THIORIDAZINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079056501","type":"CDM"},{"code":"51079056501","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TRIFLUOPERAZINE HCL TAB 5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079057401","type":"CDM"},{"code":"51079057401","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TRIFLUOPERAZINE HCL TAB 5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079057420","type":"CDM"},{"code":"51079057420","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"AZATHIOPRINE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079062006","type":"CDM"},{"code":"J7500","type":"HCPCS"},{"code":"51079062006","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PRAZOSIN HCL CAP 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079063220","type":"CDM"},{"code":"51079063220","type":"NDC"}],"standard_charges":[{"gross_charge":18.69,"discounted_cash":14.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"METHOTREXATE SODIUM TAB 2.5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079067005","type":"CDM"},{"code":"J8610","type":"HCPCS"},{"code":"51079067005","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ATENOLOL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079068420","type":"CDM"},{"code":"51079068420","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LOPERAMIDE HCL CAP 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079069020","type":"CDM"},{"code":"51079069020","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MYCOPHENOLATE MOFETIL CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079072120","type":"CDM"},{"code":"J7517","type":"HCPCS"},{"code":"51079072120","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HALOPERIDOL TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079073420","type":"CDM"},{"code":"51079073420","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HALOPERIDOL TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079073520","type":"CDM"},{"code":"51079073520","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ATENOLOL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079075901","type":"CDM"},{"code":"51079075901","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ATENOLOL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079075920","type":"CDM"},{"code":"51079075920","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PAROXETINE HCL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079077420","type":"CDM"},{"code":"51079077420","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PRAVASTATIN SODIUM TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079078201","type":"CDM"},{"code":"51079078201","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PRAVASTATIN SODIUM TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079078220","type":"CDM"},{"code":"51079078220","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"METOPROLOL TARTRATE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079080101","type":"CDM"},{"code":"51079080101","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"METOPROLOL TARTRATE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079080120","type":"CDM"},{"code":"51079080120","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"GLIPIZIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079081020","type":"CDM"},{"code":"51079081020","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NADOLOL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079081220","type":"CDM"},{"code":"51079081220","type":"NDC"}],"standard_charges":[{"gross_charge":21.43,"discounted_cash":16.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB ER 50-200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079092320","type":"CDM"},{"code":"51079092320","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TERAZOSIN HCL CAP 1 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079093601","type":"CDM"},{"code":"51079093601","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TERAZOSIN HCL CAP 1 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079093620","type":"CDM"},{"code":"51079093620","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BUPROPION HCL TAB 75 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079094320","type":"CDM"},{"code":"51079094320","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB ER 25-100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079097820","type":"CDM"},{"code":"51079097820","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SPIRONOLACTONE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079097901","type":"CDM"},{"code":"51079097901","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BUSPIRONE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079098501","type":"CDM"},{"code":"51079098501","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BUSPIRONE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079098520","type":"CDM"},{"code":"51079098520","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BRENTUXIMAB VEDOTIN FOR IV SOLN 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51144005001","type":"CDM"},{"code":"J9042","type":"HCPCS"},{"code":"51144005001","type":"NDC"}],"standard_charges":[{"gross_charge":63508.94,"discounted_cash":47631.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PHENTOLAMINE MESYLATE FOR INJ 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51224001220","type":"CDM"},{"code":"J2760","type":"HCPCS"},{"code":"51224001220","type":"NDC"}],"standard_charges":[{"gross_charge":1851.84,"discounted_cash":1388.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BENZOCAINE-MENTHOL AEROSOL 20-0.5%","drug_information":{"unit":78.0,"type":"GM"},"code_information":[{"code":"Rx51409000722","type":"CDM"},{"code":"51409000722","type":"NDC"}],"standard_charges":[{"gross_charge":4.79,"discounted_cash":3.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"COLLODION FLEXIBLE","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx51552011704","type":"CDM"},{"code":"51552011704","type":"NDC"}],"standard_charges":[{"gross_charge":15.5,"discounted_cash":11.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FLUOCINONIDE CREAM 0.05%","drug_information":{"unit":60.0,"type":"GM"},"code_information":[{"code":"Rx51672125303","type":"CDM"},{"code":"51672125303","type":"NDC"}],"standard_charges":[{"gross_charge":248.25,"discounted_cash":186.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CLOBETASOL PROPIONATE CREAM 0.05%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx51672125801","type":"CDM"},{"code":"51672125801","type":"NDC"}],"standard_charges":[{"gross_charge":41.21,"discounted_cash":30.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CLOBETASOL PROPIONATE CREAM 0.05%","drug_information":{"unit":60.0,"type":"GM"},"code_information":[{"code":"Rx51672125803","type":"CDM"},{"code":"51672125803","type":"NDC"}],"standard_charges":[{"gross_charge":164.87,"discounted_cash":123.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CLOBETASOL PROPIONATE OINT 0.05%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx51672125901","type":"CDM"},{"code":"51672125901","type":"NDC"}],"standard_charges":[{"gross_charge":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NYSTATIN-TRIAMCINOLONE CREAM 100000-0.1 UNIT/GM-%","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx51672126302","type":"CDM"},{"code":"51672126302","type":"NDC"}],"standard_charges":[{"gross_charge":123.04,"discounted_cash":92.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NYSTATIN-TRIAMCINOLONE OINT 100000-0.1 UNIT/GM-%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx51672127201","type":"CDM"},{"code":"51672127201","type":"NDC"}],"standard_charges":[{"gross_charge":65.23,"discounted_cash":48.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DESONIDE CREAM 0.05%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx51672128001","type":"CDM"},{"code":"51672128001","type":"NDC"}],"standard_charges":[{"gross_charge":79.73,"discounted_cash":59.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"KETOCONAZOLE CREAM 2%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx51672129801","type":"CDM"},{"code":"51672129801","type":"NDC"}],"standard_charges":[{"gross_charge":94.84,"discounted_cash":71.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TERCONAZOLE VAGINAL CREAM 0.4%","drug_information":{"unit":45.0,"type":"GM"},"code_information":[{"code":"Rx51672130406","type":"CDM"},{"code":"51672130406","type":"NDC"}],"standard_charges":[{"gross_charge":94.1,"discounted_cash":70.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MUPIROCIN OINT 2%","drug_information":{"unit":22.0,"type":"GM"},"code_information":[{"code":"Rx51672131200","type":"CDM"},{"code":"51672131200","type":"NDC"}],"standard_charges":[{"gross_charge":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FLUOCINONIDE CREAM 0.05%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx51672138601","type":"CDM"},{"code":"51672138601","type":"NDC"}],"standard_charges":[{"gross_charge":50.59,"discounted_cash":37.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FLUOCINONIDE CREAM 0.05%","drug_information":{"unit":60.0,"type":"GM"},"code_information":[{"code":"Rx51672138603","type":"CDM"},{"code":"51672138603","type":"NDC"}],"standard_charges":[{"gross_charge":124.66,"discounted_cash":93.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MICONAZOLE NITRATE CREAM 2%","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx51672200102","type":"CDM"},{"code":"51672200102","type":"NDC"}],"standard_charges":[{"gross_charge":4.13,"discounted_cash":3.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MICONAZOLE NITRATE VAGINAL CREAM 2%","drug_information":{"unit":45.0,"type":"GM"},"code_information":[{"code":"Rx51672203506","type":"CDM"},{"code":"51672203506","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":3.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ACETAMINOPHEN SUPPOS 325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51672211602","type":"CDM"},{"code":"51672211602","type":"NDC"}],"standard_charges":[{"gross_charge":1.1,"discounted_cash":0.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"KETOCONAZOLE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51672402606","type":"CDM"},{"code":"51672402606","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CARBAMAZEPINE SUSP 100 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx51672404709","type":"CDM"},{"code":"51672404709","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"AMIODARONE HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51672405506","type":"CDM"},{"code":"51672405506","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FLUPHENAZINE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51672423501","type":"CDM"},{"code":"51672423501","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MAGNESIUM SULFATE INJ 50%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx51754100004","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"51754100004","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SODIUM BICARBONATE IV SOLN 8.4%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx51754500105","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"51754500105","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"POTASSIUM BICARBONATE-CITRIC ACID EFFER TAB 20 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51801001101","type":"CDM"},{"code":"51801001101","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"POTASSIUM BICARBONATE-CITRIC ACID EFFER TAB 20 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51801001130","type":"CDM"},{"code":"51801001130","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"POTASSIUM BICARBONATE-CITRIC ACID EFFER TAB 10 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51801001330","type":"CDM"},{"code":"51801001330","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PRAMOXINE HCL PERIANAL FOAM 1%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx51862018015","type":"CDM"},{"code":"51862018015","type":"NDC"}],"standard_charges":[{"gross_charge":38.07,"discounted_cash":28.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LIOTHYRONINE SODIUM TAB 25 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51862032101","type":"CDM"},{"code":"51862032101","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BUTALBITAL-ACETAMINOPHEN-CAFF W/ COD CAP 50-325-40-30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51991007301","type":"CDM"},{"code":"51991007301","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FIDAXOMICIN TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx52015008001","type":"CDM"},{"code":"52015008001","type":"NDC"}],"standard_charges":[{"gross_charge":525.85,"discounted_cash":394.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SOD SULFATE-POT SULF-MG SULF ORAL SOL 17.5-3.13-1.6 GM/177ML","drug_information":{"unit":177.0,"type":"ML"},"code_information":[{"code":"Rx52268001101","type":"CDM"},{"code":"52268001101","type":"NDC"}],"standard_charges":[{"gross_charge":139.3,"discounted_cash":104.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SOD SULFATE-POT SULF-MG SULF ORAL SOL 17.5-3.13-1.6 GM/177ML","drug_information":{"unit":177.0,"type":"ML"},"code_information":[{"code":"Rx52268001201","type":"CDM"},{"code":"52268001201","type":"NDC"}],"standard_charges":[{"gross_charge":245.97,"discounted_cash":184.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HYDROGEN PEROXIDE SOLN 3%","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx52380001301","type":"CDM"},{"code":"52380001301","type":"NDC"}],"standard_charges":[{"gross_charge":0.84,"discounted_cash":0.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"GENTAMICIN SULFATE OINT 0.1%","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx52565009030","type":"CDM"},{"code":"52565009030","type":"NDC"}],"standard_charges":[{"gross_charge":290.88,"discounted_cash":218.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"EMOLLIENT - LOTION","drug_information":{"unit":177.0,"type":"ML"},"code_information":[{"code":"Rx52800048816","type":"CDM"},{"code":"52800048816","type":"NDC"}],"standard_charges":[{"gross_charge":3.68,"discounted_cash":2.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"EMOLLIENT - LOTION","drug_information":{"unit":177.0,"type":"ML"},"code_information":[{"code":"Rx52800048826","type":"CDM"},{"code":"52800048826","type":"NDC"}],"standard_charges":[{"gross_charge":3.68,"discounted_cash":2.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CYPROHEPTADINE HCL TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx52817021010","type":"CDM"},{"code":"52817021010","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"RHO D IMMUNE GLOBULIN (HUMAN) INJ 5000 UNIT/4.4ML","drug_information":{"unit":4.4,"type":"ML"},"code_information":[{"code":"Rx53270310001","type":"CDM"},{"code":"J2792","type":"HCPCS"},{"code":"53270310001","type":"NDC"}],"standard_charges":[{"gross_charge":5607.62,"discounted_cash":4205.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MINERAL OIL ENEMA","drug_information":{"unit":133.0,"type":"ML"},"code_information":[{"code":"Rx53329000611","type":"CDM"},{"code":"53329000611","type":"NDC"}],"standard_charges":[{"gross_charge":1.69,"discounted_cash":1.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HYDROGEN PEROXIDE SOLN 3%","drug_information":{"unit":118.0,"type":"ML"},"code_information":[{"code":"Rx53329098004","type":"CDM"},{"code":"53329098004","type":"NDC"}],"standard_charges":[{"gross_charge":0.73,"discounted_cash":0.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PATIROMER SORBITEX CALCIUM FOR SUSP PACKET 8.4 GM (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx53436008404","type":"CDM"},{"code":"53436008404","type":"NDC"}],"standard_charges":[{"gross_charge":189.69,"discounted_cash":142.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SPIRONOLACTONE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx53746051101","type":"CDM"},{"code":"53746051101","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MESALAMINE CAP ER 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx54092018981","type":"CDM"},{"code":"54092018981","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SORBITOL ORAL SOLUTION 70%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx54162070016","type":"CDM"},{"code":"54162070016","type":"NDC"}],"standard_charges":[{"gross_charge":0.6,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SORBITOL ORAL SOLUTION 70%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx54162070030","type":"CDM"},{"code":"54162070030","type":"NDC"}],"standard_charges":[{"gross_charge":0.92,"discounted_cash":0.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"EPINEPHRINE INJ 1 MG/ML,EPINEPHRINE PF INJ 1 MG/ML,EPINEPHRINE INJ 1 MG/ML (1:1000),EPINEPHRINE INJ 30 MG/30ML (1 MG/ML) (1:1000),EPINEPHRINE SOLN PREFILLED SYRINGE 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx54288010310","type":"CDM"},{"code":"54288010310","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DEHYDRATED ALCOHOL INTRA-ARTERIAL SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx54288010502","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"54288010502","type":"NDC"}],"standard_charges":[{"gross_charge":3319.56,"discounted_cash":2489.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DEHYDRATED ALCOHOL INTRA-ARTERIAL SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx54288010515","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"54288010515","type":"NDC"}],"standard_charges":[{"gross_charge":2557.82,"discounted_cash":1918.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PAPAVERINE HCL INJ 30 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx54288014210","type":"CDM"},{"code":"J2440","type":"HCPCS"},{"code":"54288014210","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"METHYLENE BLUE IV SOLN 1%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx54288014701","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"54288014701","type":"NDC"}],"standard_charges":[{"gross_charge":503.9,"discounted_cash":377.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LEVOCARNITINE INJ 200 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx54482014701","type":"CDM"},{"code":"J1955","type":"HCPCS"},{"code":"54482014701","type":"NDC"}],"standard_charges":[{"gross_charge":261.16,"discounted_cash":195.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CALCIUM CIT-VITAMIN D TAB 315 MG-5 MCG(200 UNIT) (ELEM CA)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx54629077401","type":"CDM"},{"code":"54629077401","type":"NDC"}],"standard_charges":[{"gross_charge":0.58,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MULTIPLE VITAMIN IV SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx54643564901","type":"CDM"},{"code":"54643564901","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"GLUCOSE GEL 40%","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx54758006289","type":"CDM"},{"code":"54758006289","type":"NDC"}],"standard_charges":[{"gross_charge":2.84,"discounted_cash":2.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HYOSCYAMINE SULFATE SOLN 0.125 MG/ML","drug_information":{"unit":0.125,"type":"ML"},"code_information":[{"code":"Rx54838050615","type":"CDM"},{"code":"54838050615","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DOXEPIN HCL CONC 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx54838051240","type":"CDM"},{"code":"54838051240","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FLUCONAZOLE TAB 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55111014512","type":"CDM"},{"code":"55111014512","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ZIPRASIDONE HCL CAP 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55111025660","type":"CDM"},{"code":"55111025660","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FONDAPARINUX SODIUM SUBCUTANEOUS INJ 2.5 MG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx55111067810","type":"CDM"},{"code":"J1652","type":"HCPCS"},{"code":"55111067810","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FONDAPARINUX SODIUM SUBCUTANEOUS INJ 10 MG/0.8ML","drug_information":{"unit":0.8,"type":"ML"},"code_information":[{"code":"Rx55111068110","type":"CDM"},{"code":"J1652","type":"HCPCS"},{"code":"55111068110","type":"NDC"}],"standard_charges":[{"gross_charge":213.23,"discounted_cash":159.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150011310","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"55150011310","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NAFCILLIN SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150012315","type":"CDM"},{"code":"J2290","type":"HCPCS"},{"code":"55150012315","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ACYCLOVIR SODIUM IV SOLN 50 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx55150015410","type":"CDM"},{"code":"J0133","type":"HCPCS"},{"code":"55150015410","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 2%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx55150016505","type":"CDM"},{"code":"55150016505","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SUMATRIPTAN SUCCINATE INJ 6 MG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx55150017301","type":"CDM"},{"code":"J3030","type":"HCPCS"},{"code":"55150017301","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ESMOLOL HCL INJ 100 MG/10ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx55150019410","type":"CDM"},{"code":"J1805","type":"HCPCS"},{"code":"55150019410","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 5 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx55150019720","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"55150019720","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 5 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx55150019830","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"55150019830","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FONDAPARINUX SODIUM SUBCUTANEOUS INJ 5 MG/0.4ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx55150023100","type":"CDM"},{"code":"J1652","type":"HCPCS"},{"code":"55150023100","type":"NDC"}],"standard_charges":[{"gross_charge":196.18,"discounted_cash":147.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FONDAPARINUX SODIUM SUBCUTANEOUS INJ 5 MG/0.4ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx55150023110","type":"CDM"},{"code":"J1652","type":"HCPCS"},{"code":"55150023110","type":"NDC"}],"standard_charges":[{"gross_charge":106.83,"discounted_cash":80.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FONDAPARINUX SODIUM SUBCUTANEOUS INJ 7.5 MG/0.6ML","drug_information":{"unit":0.6,"type":"ML"},"code_information":[{"code":"Rx55150023210","type":"CDM"},{"code":"J1652","type":"HCPCS"},{"code":"55150023210","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ERTAPENEM SODIUM FOR INJ 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150028220","type":"CDM"},{"code":"J1335","type":"HCPCS"},{"code":"55150028220","type":"NDC"}],"standard_charges":[{"gross_charge":172.93,"discounted_cash":129.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DEXMEDETOMIDINE HCL IN NACL 0.9% IV SOLN 400 MCG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx55150029701","type":"CDM"},{"code":"55150029701","type":"NDC"}],"standard_charges":[{"gross_charge":374.67,"discounted_cash":281.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NALOXONE HCL INJ 0.4 MG/ML,NALOXONE HCL INJ 4 MG/10ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx55150032710","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"55150032710","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"VASOPRESSIN IV SOLN 20 UNIT/ML (FOR IV INFUSION)","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx55150037125","type":"CDM"},{"code":"J2598","type":"HCPCS"},{"code":"55150037125","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"KETAMINE HCL INJ 100 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx55150044010","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"55150044010","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LEUCOVORIN CALCIUM FOR INJ 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55390005110","type":"CDM"},{"code":"J0640","type":"HCPCS"},{"code":"55390005110","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CINACALCET HCL TAB 30 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55513007330","type":"CDM"},{"code":"55513007330","type":"NDC"}],"standard_charges":[{"gross_charge":72.09,"discounted_cash":54.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DARBEPOETIN ALFA SOLN PREFILLED SYRINGE 300 MCG/0.6ML","drug_information":{"unit":0.6,"type":"ML"},"code_information":[{"code":"Rx55513011101","type":"CDM"},{"code":"J0881","type":"HCPCS"},{"code":"55513011101","type":"NDC"}],"standard_charges":[{"gross_charge":9286.28,"discounted_cash":6964.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PEGFILGRASTIM SOLN PREFILLED SYRINGE 6 MG/0.6ML","drug_information":{"unit":0.6,"type":"ML"},"code_information":[{"code":"Rx55513019001","type":"CDM"},{"code":"J2506","type":"HCPCS"},{"code":"55513019001","type":"NDC"}],"standard_charges":[{"gross_charge":28190.09,"discounted_cash":21142.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PEGFILGRASTIM SOLN PREFILL SYR/INFUSION DEV 6 MG/0.6ML","drug_information":{"unit":0.6,"type":"ML"},"code_information":[{"code":"Rx55513019201","type":"CDM"},{"code":"J2506","type":"HCPCS"},{"code":"55513019201","type":"NDC"}],"standard_charges":[{"gross_charge":28180.86,"discounted_cash":21135.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ROMIPLOSTIM FOR INJ 250 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55513022101","type":"CDM"},{"code":"J2802","type":"HCPCS"},{"code":"55513022101","type":"NDC"}],"standard_charges":[{"gross_charge":11962.52,"discounted_cash":8971.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ROMIPLOSTIM FOR INJ 500 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55513022201","type":"CDM"},{"code":"J2802","type":"HCPCS"},{"code":"55513022201","type":"NDC"}],"standard_charges":[{"gross_charge":23924.95,"discounted_cash":17943.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DENOSUMAB INJ SOLN PREFILLED SYRINGE 60 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx55513071001","type":"CDM"},{"code":"J0897","type":"HCPCS"},{"code":"55513071001","type":"NDC"}],"standard_charges":[{"gross_charge":7507.83,"discounted_cash":5630.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DENOSUMAB INJ 120 MG/1.7ML","drug_information":{"unit":1.7,"type":"ML"},"code_information":[{"code":"Rx55513073001","type":"CDM"},{"code":"J0897","type":"HCPCS"},{"code":"55513073001","type":"NDC"}],"standard_charges":[{"gross_charge":13813.34,"discounted_cash":10360.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ROMOSOZUMAB-AQQG INJ SOLN PREFILLED SYRINGE 105 MG/1.17ML","drug_information":{"unit":2.34,"type":"ML"},"code_information":[{"code":"Rx55513088001","type":"CDM"},{"code":"J3111","type":"HCPCS"},{"code":"55513088001","type":"NDC"}],"standard_charges":[{"gross_charge":11423.31,"discounted_cash":8567.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ROMOSOZUMAB-AQQG INJ SOLN PREFILLED SYRINGE 105 MG/1.17ML","drug_information":{"unit":2.34,"type":"ML"},"code_information":[{"code":"Rx55513088002","type":"CDM"},{"code":"J3111","type":"HCPCS"},{"code":"55513088002","type":"NDC"}],"standard_charges":[{"gross_charge":11423.31,"discounted_cash":8567.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PANITUMUMAB IV SOLN 100 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx55513095401","type":"CDM"},{"code":"J9303","type":"HCPCS"},{"code":"55513095401","type":"NDC"}],"standard_charges":[{"gross_charge":11871.78,"discounted_cash":8903.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DEGARELIX ACETATE FOR INJ 120 MG/VIAL (240 MG DOSE)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55566840301","type":"CDM"},{"code":"J9155","type":"HCPCS"},{"code":"55566840301","type":"NDC"}],"standard_charges":[{"gross_charge":4994.48,"discounted_cash":3745.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"GLUCOSE CHEW TAB 4 GM (ROUNDED)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx56151161051","type":"CDM"},{"code":"56151161051","type":"NDC"}],"standard_charges":[{"gross_charge":0.57,"discounted_cash":0.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FLUCONAZOLE FOR SUSP 40 MG/ML","drug_information":{"unit":1.25,"type":"ML"},"code_information":[{"code":"Rx57237015035","type":"CDM"},{"code":"57237015035","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PIOGLITAZONE HCL TAB 30 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57237022090","type":"CDM"},{"code":"57237022090","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"OXYCODONE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57664022388","type":"CDM"},{"code":"57664022388","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TIZANIDINE HCL TAB 4 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57664050389","type":"CDM"},{"code":"57664050389","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"AMPHOTERICIN B LIPID INJ SUSP (FOR IV INFUSION) 5 MG/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx57665010141","type":"CDM"},{"code":"J0287","type":"HCPCS"},{"code":"57665010141","type":"NDC"}],"standard_charges":[{"gross_charge":609.19,"discounted_cash":456.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"INFLIXIMAB FOR IV INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57894003001","type":"CDM"},{"code":"J1745","type":"HCPCS"},{"code":"57894003001","type":"NDC"}],"standard_charges":[{"gross_charge":4674.28,"discounted_cash":3505.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"USTEKINUMAB IV SOLN 130 MG/26ML (5 MG/ML) (FOR IV INFUSION)","drug_information":{"unit":26.0,"type":"ML"},"code_information":[{"code":"Rx57894005427","type":"CDM"},{"code":"J3358","type":"HCPCS"},{"code":"57894005427","type":"NDC"}],"standard_charges":[{"gross_charge":9211.37,"discounted_cash":6908.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"INFLIXIMAB FOR IV INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57894016001","type":"CDM"},{"code":"J1745","type":"HCPCS"},{"code":"57894016001","type":"NDC"}],"standard_charges":[{"gross_charge":2755.51,"discounted_cash":2066.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DARATUMUMAB IV SOLN 100 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx57894050205","type":"CDM"},{"code":"J9145","type":"HCPCS"},{"code":"57894050205","type":"NDC"}],"standard_charges":[{"gross_charge":5518.01,"discounted_cash":4138.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DARATUMUMAB IV SOLN 400 MG/20ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx57894050220","type":"CDM"},{"code":"J9145","type":"HCPCS"},{"code":"57894050220","type":"NDC"}],"standard_charges":[{"gross_charge":20925.19,"discounted_cash":15693.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DALBAVANCIN HCL FOR IV SOLN 500 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57970010001","type":"CDM"},{"code":"J0875","type":"HCPCS"},{"code":"57970010001","type":"NDC"}],"standard_charges":[{"gross_charge":4003.25,"discounted_cash":3002.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DIPH, ACELLULAR PERT & TET TOX INJ 25 LF-58 MCG-10 LF/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx58160081043","type":"CDM"},{"code":"90700","type":"HCPCS"},{"code":"58160081043","type":"NDC"}],"standard_charges":[{"gross_charge":175.04,"discounted_cash":131.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DIPH, ACELLULAR PERT & TET TOX INJ 25 LF-58 MCG-10 LF/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx58160081052","type":"CDM"},{"code":"90700","type":"HCPCS"},{"code":"58160081052","type":"NDC"}],"standard_charges":[{"gross_charge":156.33,"discounted_cash":117.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HEPATITIS B VACCINE (RECOMBINANT) SUSP PREF SYR 10 MCG/0.5ML,HEPATITIS B VACCINE (RECOMBINANT) 10 MCG/0.5ML,HEPATITIS B VACCINE (RECOMBINANT) SUSP 10 MCG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx58160082043","type":"CDM"},{"code":"90744","type":"HCPCS"},{"code":"58160082043","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HEPATITIS B VACCINE (RECOMBINANT) SUSP PREF SYR 10 MCG/0.5ML,HEPATITIS B VACCINE (RECOMBINANT) 10 MCG/0.5ML,HEPATITIS B VACCINE (RECOMBINANT) SUSP 10 MCG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx58160082052","type":"CDM"},{"code":"90744","type":"HCPCS"},{"code":"58160082052","type":"NDC"}],"standard_charges":[{"gross_charge":139.16,"discounted_cash":104.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MENINGOCOCCAL (A, C, Y, AND W-135) OLIGO CONJ VAC IM SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx58160082703","type":"CDM"},{"code":"90733","type":"HCPCS"},{"code":"58160082703","type":"NDC"}],"standard_charges":[{"gross_charge":483.57,"discounted_cash":362.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TET-DIPH-ACELL PERTUSS AD PREF SYR 5-2.5-18.5 LF-MCG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx58160084243","type":"CDM"},{"code":"90715","type":"HCPCS"},{"code":"58160084243","type":"NDC"}],"standard_charges":[{"gross_charge":294.35,"discounted_cash":220.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BACLOFEN INTRATHECAL INJ 0.05 MG/ML (50 MCG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx58281056201","type":"CDM"},{"code":"J0476","type":"HCPCS"},{"code":"58281056201","type":"NDC"}],"standard_charges":[{"gross_charge":462.09,"discounted_cash":346.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"THYROTROPIN ALFA FOR INJ 0.9 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx58468003002","type":"CDM"},{"code":"J3240","type":"HCPCS"},{"code":"58468003002","type":"NDC"}],"standard_charges":[{"gross_charge":7752.46,"discounted_cash":5814.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"AGALSIDASE BETA FOR IV SOLN 35 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx58468004001","type":"CDM"},{"code":"J0180","type":"HCPCS"},{"code":"58468004001","type":"NDC"}],"standard_charges":[{"gross_charge":31452.23,"discounted_cash":23589.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"AGALSIDASE BETA FOR IV SOLN 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx58468004101","type":"CDM"},{"code":"J0180","type":"HCPCS"},{"code":"58468004101","type":"NDC"}],"standard_charges":[{"gross_charge":4492.42,"discounted_cash":3369.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CLOFARABINE IV SOLN 1 MG/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx58468010001","type":"CDM"},{"code":"J9027","type":"HCPCS"},{"code":"58468010001","type":"NDC"}],"standard_charges":[{"gross_charge":19093.21,"discounted_cash":14319.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"IMIGLUCERASE FOR INJ 400 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx58468466301","type":"CDM"},{"code":"J1786","type":"HCPCS"},{"code":"58468466301","type":"NDC"}],"standard_charges":[{"gross_charge":7387.46,"discounted_cash":5540.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MESALAMINE SUPPOS 1000 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx58914050156","type":"CDM"},{"code":"58914050156","type":"NDC"}],"standard_charges":[{"gross_charge":159.63,"discounted_cash":119.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"GLYCERIN SUPPOS 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx58980040912","type":"CDM"},{"code":"58980040912","type":"NDC"}],"standard_charges":[{"gross_charge":0.83,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"GLYCERIN SUPPOS 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx58980041012","type":"CDM"},{"code":"58980041012","type":"NDC"}],"standard_charges":[{"gross_charge":0.64,"discounted_cash":0.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"UREA CREAM 20%","drug_information":{"unit":85.0,"type":"GM"},"code_information":[{"code":"Rx58980061030","type":"CDM"},{"code":"58980061030","type":"NDC"}],"standard_charges":[{"gross_charge":8.4,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"OXYCODONE HCL TAB ER 12HR DETER 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59011041020","type":"CDM"},{"code":"59011041020","type":"NDC"}],"standard_charges":[{"gross_charge":35.26,"discounted_cash":26.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"OXYCODONE HCL TAB ER 12HR DETER 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59011041520","type":"CDM"},{"code":"59011041520","type":"NDC"}],"standard_charges":[{"gross_charge":51.88,"discounted_cash":38.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"OXYCODONE HCL TAB ER 12HR DETER 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59011042020","type":"CDM"},{"code":"59011042020","type":"NDC"}],"standard_charges":[{"gross_charge":65.7,"discounted_cash":49.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"OXYCODONE HCL TAB ER 12HR DETER 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59011044010","type":"CDM"},{"code":"59011044010","type":"NDC"}],"standard_charges":[{"gross_charge":109.71,"discounted_cash":82.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"OXYCODONE HCL TAB ER 12HR DETER 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59011044020","type":"CDM"},{"code":"59011044020","type":"NDC"}],"standard_charges":[{"gross_charge":112.48,"discounted_cash":84.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BUPRENORPHINE TD PATCH WEEKLY 10 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59011075104","type":"CDM"},{"code":"59011075104","type":"NDC"}],"standard_charges":[{"gross_charge":512.69,"discounted_cash":384.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TOLVAPTAN TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59148002050","type":"CDM"},{"code":"59148002050","type":"NDC"}],"standard_charges":[{"gross_charge":2327.78,"discounted_cash":1745.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FERUMOXYTOL INJ 510 MG/17ML (30 MG/ML) (ELEMENTAL FE)","drug_information":{"unit":17.0,"type":"ML"},"code_information":[{"code":"Rx59338077501","type":"CDM"},{"code":"Q0138","type":"HCPCS"},{"code":"59338077501","type":"NDC"}],"standard_charges":[{"gross_charge":853.99,"discounted_cash":640.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"AZACITIDINE FOR INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59572010201","type":"CDM"},{"code":"J9025","type":"HCPCS"},{"code":"59572010201","type":"NDC"}],"standard_charges":[{"gross_charge":4163.51,"discounted_cash":3122.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"EPOETIN ALFA INJ 2000 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx59676030201","type":"CDM"},{"code":"J0885","type":"HCPCS"},{"code":"59676030201","type":"NDC"}],"standard_charges":[{"gross_charge":351.98,"discounted_cash":263.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"EPOETIN ALFA INJ 4000 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx59676030401","type":"CDM"},{"code":"J0885","type":"HCPCS"},{"code":"59676030401","type":"NDC"}],"standard_charges":[{"gross_charge":607.83,"discounted_cash":455.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"EPOETIN ALFA INJ 10000 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx59676031002","type":"CDM"},{"code":"J0885","type":"HCPCS"},{"code":"59676031002","type":"NDC"}],"standard_charges":[{"gross_charge":837.29,"discounted_cash":627.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DARUNAVIR TAB 800 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59676056630","type":"CDM"},{"code":"59676056630","type":"NDC"}],"standard_charges":[{"gross_charge":296.54,"discounted_cash":222.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"METHYLPREDNISOLONE TAB 16 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59746000314","type":"CDM"},{"code":"J7509","type":"HCPCS"},{"code":"59746000314","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PROCHLORPERAZINE MALEATE TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59746011506","type":"CDM"},{"code":"59746011506","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TERAZOSIN HCL CAP 5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59746038506","type":"CDM"},{"code":"59746038506","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CLINDAMYCIN PALMITATE HCL FOR SOLN 75 MG/5ML (BASE EQUIV)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx59762001601","type":"CDM"},{"code":"59762001601","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MEDROXYPROGESTERONE ACETATE TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762005501","type":"CDM"},{"code":"59762005501","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HYDROCORTISONE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762007401","type":"CDM"},{"code":"59762007401","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MESALAMINE CAP DR 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762011701","type":"CDM"},{"code":"59762011701","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"RIFABUTIN CAP 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762135001","type":"CDM"},{"code":"59762135001","type":"NDC"}],"standard_charges":[{"gross_charge":48.55,"discounted_cash":36.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"EPLERENONE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762171001","type":"CDM"},{"code":"59762171001","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"EPLERENONE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762171002","type":"CDM"},{"code":"59762171002","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NITROGLYCERIN SL TAB 0.4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762330403","type":"CDM"},{"code":"59762330403","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MEDROXYPROGESTERONE ACETATE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762374101","type":"CDM"},{"code":"59762374101","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SULFASALAZINE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762500005","type":"CDM"},{"code":"59762500005","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"POT & SOD CITRATES W/ CIT AC SYRUP 550-500-334 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx60258000216","type":"CDM"},{"code":"60258000216","type":"NDC"}],"standard_charges":[{"gross_charge":1.08,"discounted_cash":0.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"POTASSIUM CITRATE & CITRIC ACID SOLN 1100-334 MG/5ML","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx60258000316","type":"CDM"},{"code":"60258000316","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"POTASSIUM & SODIUM PHOSPHATES POWDER PACK 280-160-250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60258000601","type":"CDM"},{"code":"60258000601","type":"NDC"}],"standard_charges":[{"gross_charge":0.81,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"B-COMPLEX W/ C & FOLIC ACID TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60258016101","type":"CDM"},{"code":"60258016101","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SODIUM THIOSULFATE IV SOLN 250 MG/ML (25%)","drug_information":{"unit":1.6,"type":"ML"},"code_information":[{"code":"Rx60267070550","type":"CDM"},{"code":"J0209","type":"HCPCS"},{"code":"60267070550","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PHENYTOIN SUSP 125 MG/5ML","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx60432013108","type":"CDM"},{"code":"60432013108","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NYSTATIN SUSP 100000 UNIT/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx60432053716","type":"CDM"},{"code":"60432053716","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PROMETHAZINE HCL ORAL SOLN 6.25 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx60432060816","type":"CDM"},{"code":"Q0169","type":"HCPCS"},{"code":"60432060816","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DOXEPIN HCL CONC 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx60432065104","type":"CDM"},{"code":"60432065104","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CYCLOSPORINE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505013400","type":"CDM"},{"code":"J7502","type":"HCPCS"},{"code":"60505013400","type":"NDC"}],"standard_charges":[{"gross_charge":36.99,"discounted_cash":27.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"GLIPIZIDE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505014200","type":"CDM"},{"code":"60505014200","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MOXIFLOXACIN HCL OPHTH SOLN 0.5% (BASE EQUIV)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx60505058204","type":"CDM"},{"code":"60505058204","type":"NDC"}],"standard_charges":[{"gross_charge":275.94,"discounted_cash":206.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FLUTICASONE PROPIONATE NASAL SUSP 50 MCG/ACT","drug_information":{"unit":16.0,"type":"GM"},"code_information":[{"code":"Rx60505082901","type":"CDM"},{"code":"60505082901","type":"NDC"}],"standard_charges":[{"gross_charge":6.22,"discounted_cash":4.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CILOSTAZOL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505252201","type":"CDM"},{"code":"60505252201","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TRAZODONE HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505265401","type":"CDM"},{"code":"60505265401","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TRIAMTERENE & HYDROCHLOROTHIAZIDE TAB 37.5-25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505265601","type":"CDM"},{"code":"60505265601","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TRIAMTERENE & HYDROCHLOROTHIAZIDE TAB 37.5-25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505265605","type":"CDM"},{"code":"60505265605","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PRASUGREL HCL TAB 10 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505464303","type":"CDM"},{"code":"60505464303","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CEFEPIME HCL FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505614600","type":"CDM"},{"code":"J0692","type":"HCPCS"},{"code":"60505614600","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CEFEPIME HCL FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505614604","type":"CDM"},{"code":"J0692","type":"HCPCS"},{"code":"60505614604","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CEFEPIME HCL FOR IV SOLN 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505614700","type":"CDM"},{"code":"J0692","type":"HCPCS"},{"code":"60505614700","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CEFEPIME HCL FOR IV SOLN 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505614704","type":"CDM"},{"code":"J0692","type":"HCPCS"},{"code":"60505614704","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM NA FOR INJ 3.375 GM (3-0.375 GM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505615700","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"60505615700","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PALONOSETRON HCL IV SOLN 0.25 MG/5ML (BASE EQUIVALENT)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx60505619301","type":"CDM"},{"code":"J2469","type":"HCPCS"},{"code":"60505619301","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ATROPINE SULFATE OPHTH SOLN 1%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx60505622601","type":"CDM"},{"code":"60505622601","type":"NDC"}],"standard_charges":[{"gross_charge":134.46,"discounted_cash":100.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CEFAZOLIN SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505623100","type":"CDM"},{"code":"J0690","type":"HCPCS"},{"code":"60505623100","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CEFAZOLIN SODIUM FOR INJ 3 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505626600","type":"CDM"},{"code":"J0690","type":"HCPCS"},{"code":"60505626600","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 25 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505700602","type":"CDM"},{"code":"60505700602","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 50 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505700702","type":"CDM"},{"code":"60505700702","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 100 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505700902","type":"CDM"},{"code":"60505700902","type":"NDC"}],"standard_charges":[{"gross_charge":69.79,"discounted_cash":52.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 75 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505708300","type":"CDM"},{"code":"60505708300","type":"NDC"}],"standard_charges":[{"gross_charge":49.39,"discounted_cash":37.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MEDROXYPROGESTERONE ACETATE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687010521","type":"CDM"},{"code":"60687010521","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CLONIDINE HCL TAB 0.1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687011301","type":"CDM"},{"code":"60687011301","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ACAMPROSATE CALCIUM TAB DELAYED RELEASE 333 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687012195","type":"CDM"},{"code":"60687012195","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CEPHALEXIN CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687015201","type":"CDM"},{"code":"60687015201","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PHENYTOIN CHEW TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687015625","type":"CDM"},{"code":"60687015625","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DILTIAZEM HCL COATED BEADS CAP ER 24HR 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687019501","type":"CDM"},{"code":"60687019501","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DILTIAZEM HCL COATED BEADS CAP ER 24HR 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687019511","type":"CDM"},{"code":"60687019511","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DILTIAZEM HCL COATED BEADS CAP ER 24HR 180 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687020601","type":"CDM"},{"code":"60687020601","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DIVALPROEX SODIUM TAB DELAYED RELEASE 125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687021121","type":"CDM"},{"code":"60687021121","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PROPRANOLOL HCL CAP ER 24HR 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687021501","type":"CDM"},{"code":"60687021501","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DILTIAZEM HCL COATED BEADS CAP ER 24HR 240 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687021701","type":"CDM"},{"code":"60687021701","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PROPRANOLOL HCL CAP ER 24HR 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687022601","type":"CDM"},{"code":"60687022601","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DILTIAZEM HCL COATED BEADS CAP ER 24HR 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687022801","type":"CDM"},{"code":"60687022801","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SERTRALINE HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687025301","type":"CDM"},{"code":"60687025301","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SERTRALINE HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687025311","type":"CDM"},{"code":"60687025311","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CEFUROXIME AXETIL TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687027294","type":"CDM"},{"code":"60687027294","type":"NDC"}],"standard_charges":[{"gross_charge":15.58,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NORTRIPTYLINE HCL CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687028101","type":"CDM"},{"code":"60687028101","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NORTRIPTYLINE HCL CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687028111","type":"CDM"},{"code":"60687028111","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NORTRIPTYLINE HCL CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687029301","type":"CDM"},{"code":"60687029301","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BUPROPION HCL TAB ER 24HR 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687031211","type":"CDM"},{"code":"60687031211","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CALCITRIOL CAP 0.25 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687034501","type":"CDM"},{"code":"60687034501","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"METHIMAZOLE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687035701","type":"CDM"},{"code":"60687035701","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BENZTROPINE MESYLATE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687036801","type":"CDM"},{"code":"60687036801","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BENZTROPINE MESYLATE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687036811","type":"CDM"},{"code":"60687036811","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DRONABINOL CAP 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687037511","type":"CDM"},{"code":"60687037511","type":"NDC"}],"standard_charges":[{"gross_charge":38.52,"discounted_cash":28.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 7.5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687040711","type":"CDM"},{"code":"60687040711","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CLOZAPINE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687041511","type":"CDM"},{"code":"60687041511","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"AMIODARONE HCL TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687043701","type":"CDM"},{"code":"60687043701","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CELECOXIB CAP 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687044701","type":"CDM"},{"code":"60687044701","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SPIRONOLACTONE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687047601","type":"CDM"},{"code":"60687047601","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NAPROXEN TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687049101","type":"CDM"},{"code":"60687049101","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ERGOCALCIFEROL CAP 1.25 MG (50000 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687050001","type":"CDM"},{"code":"60687050001","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"VERAPAMIL HCL TAB ER 180 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687050411","type":"CDM"},{"code":"60687050411","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"METRONIDAZOLE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687055001","type":"CDM"},{"code":"60687055001","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 137 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687056311","type":"CDM"},{"code":"60687056311","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FAMOTIDINE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687059511","type":"CDM"},{"code":"60687059511","type":"NDC"}],"standard_charges":[{"gross_charge":0.63,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"METFORMIN HCL TAB ER 24HR 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687064001","type":"CDM"},{"code":"60687064001","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TIMOLOL MALEATE OPHTH SOLN 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx60758080105","type":"CDM"},{"code":"60758080105","type":"NDC"}],"standard_charges":[{"gross_charge":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PENICILLIN G BENZATHINE IM SUSP PREF SYR 600000 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx60793070001","type":"CDM"},{"code":"J0561","type":"HCPCS"},{"code":"60793070001","type":"NDC"}],"standard_charges":[{"gross_charge":1236.14,"discounted_cash":927.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PENICILLIN G BENZATHINE IM SUSP PREF SYR 1200000 UNIT/2ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx60793070110","type":"CDM"},{"code":"J0561","type":"HCPCS"},{"code":"60793070110","type":"NDC"}],"standard_charges":[{"gross_charge":1070.86,"discounted_cash":803.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PEGLOTICASE INJ 8 MG/ML (FOR IV INFUSION)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx60809080101","type":"CDM"},{"code":"J2507","type":"HCPCS"},{"code":"60809080101","type":"NDC"}],"standard_charges":[{"gross_charge":81162.39,"discounted_cash":60871.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PRALIDOXIME CHLORIDE FOR IV SOLN 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60977014101","type":"CDM"},{"code":"J2730","type":"HCPCS"},{"code":"60977014101","type":"NDC"}],"standard_charges":[{"gross_charge":503.15,"discounted_cash":377.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PRALIDOXIME CHLORIDE FOR IV SOLN 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60977014127","type":"CDM"},{"code":"J2730","type":"HCPCS"},{"code":"60977014127","type":"NDC"}],"standard_charges":[{"gross_charge":508.69,"discounted_cash":381.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PROPARACAINE HCL OPHTH SOLN 0.5%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx61314001601","type":"CDM"},{"code":"61314001601","type":"NDC"}],"standard_charges":[{"gross_charge":126.08,"discounted_cash":94.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DORZOLAMIDE HCL OPHTH SOLN 2%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx61314001910","type":"CDM"},{"code":"61314001910","type":"NDC"}],"standard_charges":[{"gross_charge":44.92,"discounted_cash":33.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TRIFLURIDINE OPHTH SOLN 1%","drug_information":{"unit":7.5,"type":"ML"},"code_information":[{"code":"Rx61314004475","type":"CDM"},{"code":"61314004475","type":"NDC"}],"standard_charges":[{"gross_charge":807.92,"discounted_cash":605.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BRIMONIDINE TARTRATE OPHTH SOLN 0.2%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx61314014305","type":"CDM"},{"code":"61314014305","type":"NDC"}],"standard_charges":[{"gross_charge":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BRIMONIDINE TARTRATE OPHTH SOLN 0.2%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx61314014310","type":"CDM"},{"code":"61314014310","type":"NDC"}],"standard_charges":[{"gross_charge":47.31,"discounted_cash":35.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PILOCARPINE HCL OPHTH SOLN 1%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx61314020315","type":"CDM"},{"code":"61314020315","type":"NDC"}],"standard_charges":[{"gross_charge":175.86,"discounted_cash":131.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PILOCARPINE HCL OPHTH SOLN 2%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx61314020415","type":"CDM"},{"code":"61314020415","type":"NDC"}],"standard_charges":[{"gross_charge":172.49,"discounted_cash":129.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TIMOLOL MALEATE OPHTH SOLN 0.25%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx61314022605","type":"CDM"},{"code":"61314022605","type":"NDC"}],"standard_charges":[{"gross_charge":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TIMOLOL MALEATE OPHTH SOLN 0.25%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx61314022615","type":"CDM"},{"code":"61314022615","type":"NDC"}],"standard_charges":[{"gross_charge":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"OLOPATADINE HCL OPHTH SOLN 0.1% (BASE EQUIVALENT)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx61314027105","type":"CDM"},{"code":"61314027105","type":"NDC"}],"standard_charges":[{"gross_charge":6.77,"discounted_cash":5.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LATANOPROST OPHTH SOLN 0.005%","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx61314054701","type":"CDM"},{"code":"61314054701","type":"NDC"}],"standard_charges":[{"gross_charge":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PREDNISOLONE ACETATE OPHTH SUSP 1%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx61314063705","type":"CDM"},{"code":"61314063705","type":"NDC"}],"standard_charges":[{"gross_charge":133.79,"discounted_cash":100.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NEOMYCIN-POLYMYXIN-HC OPHTH SUSP","drug_information":{"unit":7.5,"type":"ML"},"code_information":[{"code":"Rx61314064175","type":"CDM"},{"code":"61314064175","type":"NDC"}],"standard_charges":[{"gross_charge":568.17,"discounted_cash":426.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ATROPINE SULFATE IV SOLN PREFILL SYR 1 MG/2.5ML (0.4 MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx61553032471","type":"CDM"},{"code":"J0461","type":"HCPCS"},{"code":"61553032471","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CYTARABINE INJ PF 20 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx61703030538","type":"CDM"},{"code":"J9100","type":"HCPCS"},{"code":"61703030538","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"VINCRISTINE SULFATE IV SOLN 1 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx61703030906","type":"CDM"},{"code":"J9370","type":"HCPCS"},{"code":"61703030906","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BLEOMYCIN SULFATE FOR INJ 15 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx61703033218","type":"CDM"},{"code":"J9040","type":"HCPCS"},{"code":"61703033218","type":"NDC"}],"standard_charges":[{"gross_charge":354.43,"discounted_cash":265.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"OXALIPLATIN IV SOLN 100 MG/20ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx61703036322","type":"CDM"},{"code":"J9263","type":"HCPCS"},{"code":"61703036322","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PYRAZINAMIDE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx61748001201","type":"CDM"},{"code":"61748001201","type":"NDC"}],"standard_charges":[{"gross_charge":20.31,"discounted_cash":15.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BICTEGRAVIR-EMTRICITABINE-TENOFOVIR AF TAB 50-200-25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx61958250101","type":"CDM"},{"code":"61958250101","type":"NDC"}],"standard_charges":[{"gross_charge":579.51,"discounted_cash":434.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"REMDESIVIR FOR IV SOLN 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx61958290102","type":"CDM"},{"code":"J0248","type":"HCPCS"},{"code":"61958290102","type":"NDC"}],"standard_charges":[{"gross_charge":2827.83,"discounted_cash":2120.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"REMDESIVIR IV SOLN 100 MG/20ML (5 MG/ML)","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx61958290201","type":"CDM"},{"code":"J0248","type":"HCPCS"},{"code":"61958290201","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"THEOPHYLLINE TAB ER 12HR 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62332002531","type":"CDM"},{"code":"62332002531","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"UREA PACKET 15 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62530000011","type":"CDM"},{"code":"62530000011","type":"NDC"}],"standard_charges":[{"gross_charge":5.1,"discounted_cash":3.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HYDROCORTISONE ENEMA 100 MG/60ML","drug_information":{"unit":60.0,"type":"ML"},"code_information":[{"code":"Rx62559013807","type":"CDM"},{"code":"62559013807","type":"NDC"}],"standard_charges":[{"gross_charge":31.03,"discounted_cash":23.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FLUVOXAMINE MALEATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62559016001","type":"CDM"},{"code":"62559016001","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NIMODIPINE CAP 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62559021031","type":"CDM"},{"code":"62559021031","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ERYTHROMYCIN ETHYLSUCCINATE FOR SUSP 200 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx62559063001","type":"CDM"},{"code":"62559063001","type":"NDC"}],"standard_charges":[{"gross_charge":43.39,"discounted_cash":32.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DEMECLOCYCLINE HCL TAB 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62584015911","type":"CDM"},{"code":"62584015911","type":"NDC"}],"standard_charges":[{"gross_charge":24.01,"discounted_cash":18.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FOLIC ACID TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62584089701","type":"CDM"},{"code":"62584089701","type":"NDC"}],"standard_charges":[{"gross_charge":0.63,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"WARFARIN SODIUM TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62584099401","type":"CDM"},{"code":"62584099401","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LIOTHYRONINE SODIUM TAB 5 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62756058988","type":"CDM"},{"code":"62756058988","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DIVALPROEX SODIUM TAB DELAYED RELEASE 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62756079888","type":"CDM"},{"code":"62756079888","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PERAMPANEL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62856028030","type":"CDM"},{"code":"62856028030","type":"NDC"}],"standard_charges":[{"gross_charge":285.62,"discounted_cash":214.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ERIBULIN MESYLATE INJ 1 MG/2ML (0.5 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx62856038901","type":"CDM"},{"code":"J9179","type":"HCPCS"},{"code":"62856038901","type":"NDC"}],"standard_charges":[{"gross_charge":10031.09,"discounted_cash":7523.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LEUPROLIDE ACETATE (3 MONTH) FOR SUBCUTANEOUS INJ KIT 22.5MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62935022305","type":"CDM"},{"code":"J9217","type":"HCPCS"},{"code":"62935022305","type":"NDC"}],"standard_charges":[{"gross_charge":2152.12,"discounted_cash":1614.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LEUPROLIDE ACETATE (4 MONTH) FOR SUBCUTANEOUS INJ KIT 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62935030330","type":"CDM"},{"code":"J9217","type":"HCPCS"},{"code":"62935030330","type":"NDC"}],"standard_charges":[{"gross_charge":2869.5,"discounted_cash":2152.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LEUPROLIDE ACETATE (6 MONTH) FOR SUBCUTANEOUS INJ KIT 45 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62935045345","type":"CDM"},{"code":"J9217","type":"HCPCS"},{"code":"62935045345","type":"NDC"}],"standard_charges":[{"gross_charge":4012.43,"discounted_cash":3009.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LEUPROLIDE ACETATE FOR SUBCUTANEOUS INJ KIT 7.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62935075375","type":"CDM"},{"code":"J9217","type":"HCPCS"},{"code":"62935075375","type":"NDC"}],"standard_charges":[{"gross_charge":717.37,"discounted_cash":538.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BORTEZOMIB FOR INJ 3.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63020004901","type":"CDM"},{"code":"J9041","type":"HCPCS"},{"code":"63020004901","type":"NDC"}],"standard_charges":[{"gross_charge":11404.17,"discounted_cash":8553.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TALC INTRAPLEURAL POWDER FOR SUSP 5 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63256020005","type":"CDM"},{"code":"63256020005","type":"NDC"}],"standard_charges":[{"gross_charge":667.81,"discounted_cash":500.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FELODIPINE TAB ER 24HR 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63304043501","type":"CDM"},{"code":"63304043501","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"GENTAMICIN SULFATE INJ 40 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323001002","type":"CDM"},{"code":"J1580","type":"HCPCS"},{"code":"63323001002","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"GENTAMICIN SULFATE INJ 40 MG/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx63323001020","type":"CDM"},{"code":"J1580","type":"HCPCS"},{"code":"63323001020","type":"NDC"}],"standard_charges":[{"gross_charge":167.56,"discounted_cash":125.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CHLORAMPHENICOL SODIUM SUCCINATE FOR IV INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323001115","type":"CDM"},{"code":"J0720","type":"HCPCS"},{"code":"63323001115","type":"NDC"}],"standard_charges":[{"gross_charge":265.4,"discounted_cash":199.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"OXYTOCIN INJ 10 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323001211","type":"CDM"},{"code":"J2590","type":"HCPCS"},{"code":"63323001211","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MANNITOL IV SOLN 25%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx63323002425","type":"CDM"},{"code":"J2151","type":"HCPCS"},{"code":"63323002425","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CYANOCOBALAMIN INJ 1000 MCG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323004401","type":"CDM"},{"code":"J3420","type":"HCPCS"},{"code":"63323004401","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 5000 UNIT/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx63323004710","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"63323004710","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MAGNESIUM SULFATE INJ 50%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323006411","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"63323006411","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MAGNESIUM SULFATE INJ 50%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323006423","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"63323006423","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"POTASSIUM PHOSPHATES INJ 15 MM/5ML (PHOS) 22 MEQ/5ML (K)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323008605","type":"CDM"},{"code":"63323008605","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"POTASSIUM PHOSPHATES INJ 150 MM/50ML (PHOS) 220 MEQ/50ML (K)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx63323008650","type":"CDM"},{"code":"63323008650","type":"NDC"}],"standard_charges":[{"gross_charge":535.41,"discounted_cash":401.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 4 MEQ/ML (23.4%)","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx63323008861","type":"CDM"},{"code":"63323008861","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CISPLATIN INJ 50 MG/50ML (1 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx63323010351","type":"CDM"},{"code":"J9060","type":"HCPCS"},{"code":"63323010351","type":"NDC"}],"standard_charges":[{"gross_charge":120.41,"discounted_cash":90.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CISPLATIN INJ 200 MG/200ML (1 MG/ML)","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx63323010364","type":"CDM"},{"code":"J9060","type":"HCPCS"},{"code":"63323010364","type":"NDC"}],"standard_charges":[{"gross_charge":481.67,"discounted_cash":361.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CISPLATIN INJ 100 MG/100ML (1 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx63323010365","type":"CDM"},{"code":"J9060","type":"HCPCS"},{"code":"63323010365","type":"NDC"}],"standard_charges":[{"gross_charge":240.83,"discounted_cash":180.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MAGNESIUM SULFATE IV SOLN 4 GM/100ML (40 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx63323010600","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"63323010600","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MAGNESIUM SULFATE IV SOLN 2 GM/50ML (40 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx63323010602","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"63323010602","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PENTAMIDINE ISETHIONATE FOR INJ SOLN 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323011310","type":"CDM"},{"code":"S0080","type":"HCPCS"},{"code":"63323011310","type":"NDC"}],"standard_charges":[{"gross_charge":329.14,"discounted_cash":246.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FLUOROURACIL IV SOLN 500 MG/10ML (50 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx63323011710","type":"CDM"},{"code":"J9190","type":"HCPCS"},{"code":"63323011710","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FLUOROURACIL IV SOLN 2.5 GM/50ML (50 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx63323011759","type":"CDM"},{"code":"J9190","type":"HCPCS"},{"code":"63323011759","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DOXYCYCLINE HYCLATE FOR INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323013011","type":"CDM"},{"code":"J1271","type":"HCPCS"},{"code":"63323013011","type":"NDC"}],"standard_charges":[{"gross_charge":110.79,"discounted_cash":83.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MITOXANTRONE HCL INJ CONC 25 MG/12.5ML (2 MG/ML)","drug_information":{"unit":12.5,"type":"ML"},"code_information":[{"code":"Rx63323013212","type":"CDM"},{"code":"J9293","type":"HCPCS"},{"code":"63323013212","type":"NDC"}],"standard_charges":[{"gross_charge":739.77,"discounted_cash":554.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CLADRIBINE IV SOLN 10 MG/10ML (1 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx63323014010","type":"CDM"},{"code":"J9065","type":"HCPCS"},{"code":"63323014010","type":"NDC"}],"standard_charges":[{"gross_charge":759.25,"discounted_cash":569.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"IFOSFAMIDE FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323014210","type":"CDM"},{"code":"J9208","type":"HCPCS"},{"code":"63323014210","type":"NDC"}],"standard_charges":[{"gross_charge":407.81,"discounted_cash":305.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE INJ 15 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323016101","type":"CDM"},{"code":"J1885","type":"HCPCS"},{"code":"63323016101","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SODIUM PHOSPHATES INJ 15 MM/5ML (PHOS) 20 MEQ/5ML (NA),SODIUM PHOSPHATES INJ 45 MM/15ML (PHOS) 60 MEQ/15ML (NA),SODIUM PHOSPHATES INJ 150 MM/50ML (PHOS) 200 MEQ/50ML (NA)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323017005","type":"CDM"},{"code":"63323017005","type":"NDC"}],"standard_charges":[{"gross_charge":109.29,"discounted_cash":81.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"GENTAMICIN SULFATE INJ 10 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323017302","type":"CDM"},{"code":"J1580","type":"HCPCS"},{"code":"63323017302","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PYRIDOXINE HCL INJ 100 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323018001","type":"CDM"},{"code":"J3415","type":"HCPCS"},{"code":"63323018001","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FOLIC ACID INJ 5 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx63323018410","type":"CDM"},{"code":"J1808","type":"HCPCS"},{"code":"63323018410","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SODIUM CHLORIDE PRESERVATIVE FREE (PF) INJ 0.9%","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx63323018603","type":"CDM"},{"code":"63323018603","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 4 MEQ/ML (23.4%)","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx63323018730","type":"CDM"},{"code":"63323018730","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FLUDARABINE PHOSPHATE INJ 25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323019202","type":"CDM"},{"code":"J9185","type":"HCPCS"},{"code":"63323019202","type":"NDC"}],"standard_charges":[{"gross_charge":1911.97,"discounted_cash":1433.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323020102","type":"CDM"},{"code":"63323020102","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323020110","type":"CDM"},{"code":"63323020110","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PROTAMINE SULFATE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323022905","type":"CDM"},{"code":"J2720","type":"HCPCS"},{"code":"63323022905","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PROTAMINE SULFATE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323022930","type":"CDM"},{"code":"J2720","type":"HCPCS"},{"code":"63323022930","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SODIUM GLYCEROPHOSPHATE IV SOLN 1 MMOLE/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx63323024120","type":"CDM"},{"code":"63323024120","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MINERAL OIL LIGHT (BULK)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323025402","type":"CDM"},{"code":"63323025402","type":"NDC"}],"standard_charges":[{"gross_charge":18.56,"discounted_cash":13.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MINERAL OIL LIGHT (BULK)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx63323025410","type":"CDM"},{"code":"63323025410","type":"NDC"}],"standard_charges":[{"gross_charge":21.38,"discounted_cash":16.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PROPOFOL IV EMUL 100 MG/10ML (10 MG/ML),PROPOFOL IV EMUL 200 MG/20ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 200 MG/20ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 100 MG/10ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 50 MG/5ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 150 MG/15ML (10 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323026929","type":"CDM"},{"code":"J2704","type":"HCPCS"},{"code":"63323026929","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SUMATRIPTAN SUCCINATE INJ 6 MG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx63323027301","type":"CDM"},{"code":"J3030","type":"HCPCS"},{"code":"63323027301","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"VINBLASTINE SULFATE INJ 1 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx63323027810","type":"CDM"},{"code":"J9360","type":"HCPCS"},{"code":"63323027810","type":"NDC"}],"standard_charges":[{"gross_charge":374.06,"discounted_cash":280.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323028004","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"63323028004","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 2 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323028523","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"63323028523","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MEPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 1.5%","drug_information":{"unit":1.33333333333333,"type":"ML"},"code_information":[{"code":"Rx63323029301","type":"CDM"},{"code":"J0670","type":"HCPCS"},{"code":"63323029301","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MEPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 2%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323029427","type":"CDM"},{"code":"J0670","type":"HCPCS"},{"code":"63323029427","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MEPIVACAINE HCL INJ 2%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323029650","type":"CDM"},{"code":"J0670","type":"HCPCS"},{"code":"63323029650","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TOBRAMYCIN SULFATE FOR INJ 1.2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323030351","type":"CDM"},{"code":"63323030351","type":"NDC"}],"standard_charges":[{"gross_charge":377.25,"discounted_cash":282.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TOBRAMYCIN SULFATE INJ 80 MG/2ML (40 MG/ML) (BASE EQUIV)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323030602","type":"CDM"},{"code":"J3260","type":"HCPCS"},{"code":"63323030602","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TOBRAMYCIN SULFATE INJ 1.2 GM/30ML (40 MG/ML) (BASE EQUIV)","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx63323030656","type":"CDM"},{"code":"J3260","type":"HCPCS"},{"code":"63323030656","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CALCIUM GLUCONATE INJ 10%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx63323031159","type":"CDM"},{"code":"J0612","type":"HCPCS"},{"code":"63323031159","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"IMIPENEM-CILASTATIN INTRAVENOUS FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323032225","type":"CDM"},{"code":"J0743","type":"HCPCS"},{"code":"63323032225","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CALCIUM GLUCONATE INJ 10%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323036019","type":"CDM"},{"code":"J0612","type":"HCPCS"},{"code":"63323036019","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"OCTREOTIDE ACETATE INJ 100 MCG/ML (0.1 MG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323037601","type":"CDM"},{"code":"J2354","type":"HCPCS"},{"code":"63323037601","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"OCTREOTIDE ACETATE INJ 500 MCG/ML (0.5 MG/ML)","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx63323037700","type":"CDM"},{"code":"J2354","type":"HCPCS"},{"code":"63323037700","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"OCTREOTIDE ACETATE INJ 500 MCG/ML (0.5 MG/ML)","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx63323037701","type":"CDM"},{"code":"J2354","type":"HCPCS"},{"code":"63323037701","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"COLISTIMETHATE SOD FOR INJ 150 MG (COLISTIN BASE ACTIVITY)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323039306","type":"CDM"},{"code":"J0770","type":"HCPCS"},{"code":"63323039306","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"AZTREONAM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323040120","type":"CDM"},{"code":"J0457","type":"HCPCS"},{"code":"63323040120","type":"NDC"}],"standard_charges":[{"gross_charge":148.27,"discounted_cash":111.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"AZTREONAM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323040220","type":"CDM"},{"code":"J0457","type":"HCPCS"},{"code":"63323040220","type":"NDC"}],"standard_charges":[{"gross_charge":302.8,"discounted_cash":227.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FOSPHENYTOIN SODIUM INJ 100 MG/2ML (PHENYTOIN EQUIV)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323040302","type":"CDM"},{"code":"Q2009","type":"HCPCS"},{"code":"63323040302","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MIDAZOLAM HCL INJ 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 25 MG/5ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 5 MG/ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 50 MG/10ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx63323041202","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"63323041202","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CISATRACURIUM BESYLATE (PF) IV SOLN 200 MG/20ML (10 MG/ML)","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx63323041820","type":"CDM"},{"code":"63323041820","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MORPHINE SULFATE INJ PF 10 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx63323045100","type":"CDM"},{"code":"J2272","type":"HCPCS"},{"code":"63323045100","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MORPHINE SULFATE INJ PF 2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323045201","type":"CDM"},{"code":"J2272","type":"HCPCS"},{"code":"63323045201","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MORPHINE SULFATE INJ PF 4 MG/ML","drug_information":{"unit":0.75,"type":"ML"},"code_information":[{"code":"Rx63323045400","type":"CDM"},{"code":"J2272","type":"HCPCS"},{"code":"63323045400","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MORPHINE SULFATE INJ PF 4 MG/ML","drug_information":{"unit":0.75,"type":"ML"},"code_information":[{"code":"Rx63323045401","type":"CDM"},{"code":"J2272","type":"HCPCS"},{"code":"63323045401","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BUPIVACAINE INJ 0.25% W/ EPINEPHRINE 1:200000","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323046157","type":"CDM"},{"code":"63323046157","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BUPIVACAINE INJ 0.5% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323046201","type":"CDM"},{"code":"63323046201","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BUPIVACAINE INJ 0.5% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323046217","type":"CDM"},{"code":"63323046217","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BUPIVACAINE INJ 0.5% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323046237","type":"CDM"},{"code":"63323046237","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BUPIVACAINE INJ 0.5% W/ EPINEPHRINE 1:200000","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323046357","type":"CDM"},{"code":"63323046357","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.25%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323046437","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"63323046437","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BUPIVACAINE HCL INJ 0.25%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323046557","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"63323046557","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323046617","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"63323046617","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BUPIVACAINE INJ 0.25% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323046817","type":"CDM"},{"code":"63323046817","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BUPIVACAINE INJ 0.25% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323046837","type":"CDM"},{"code":"63323046837","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HALOPERIDOL DECANOATE IM SOLN 100 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx63323047101","type":"CDM"},{"code":"J1631","type":"HCPCS"},{"code":"63323047101","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.75%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323047217","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"63323047217","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HALOPERIDOL LACTATE INJ 5 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323047401","type":"CDM"},{"code":"J1630","type":"HCPCS"},{"code":"63323047401","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CHLOROPROCAINE HCL PRESERVATIVE FREE (PF) INJ 2%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323047727","type":"CDM"},{"code":"J2401","type":"HCPCS"},{"code":"63323047727","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CHLOROPROCAINE HCL PRESERVATIVE FREE (PF) INJ 3%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323047827","type":"CDM"},{"code":"J2401","type":"HCPCS"},{"code":"63323047827","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LIDOCAINE INJ 0.5% W/ EPINEPHRINE-1:200000","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323048157","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"63323048157","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LIDOCAINE INJ 1% W/ EPINEPHRINE-1:100000","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323048201","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"63323048201","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LIDOCAINE INJ 1% W/ EPINEPHRINE-1:100000","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323048227","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"63323048227","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LIDOCAINE INJ 2% W/ EPINEPHRINE-1:100000","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323048327","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"63323048327","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL INJ 0.5%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323048457","type":"CDM"},{"code":"63323048457","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL INJ 2%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323048617","type":"CDM"},{"code":"63323048617","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL INJ 2%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323048657","type":"CDM"},{"code":"63323048657","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LIDOCAINE INJ 1% W/ EPINEPHRINE-1:200000 (PF)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323048717","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"63323048717","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LIDOCAINE INJ 1% W/ EPINEPHRINE-1:200000 (PF)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323048737","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"63323048737","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LIDOCAINE INJ 1.5% W/ EPINEPHRINE-1:200000 (PF)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx63323048837","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"63323048837","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LIDOCAINE INJ 2% W/ EPINEPHRINE-1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323048927","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"63323048927","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323049227","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"63323049227","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323049391","type":"CDM"},{"code":"63323049391","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323049397","type":"CDM"},{"code":"63323049397","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 2%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323049527","type":"CDM"},{"code":"63323049527","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE INJ 10 MG/ML,DEXAMETHASONE SOD PHOSPHATE PRESERVATIVE FREE INJ 10 MG/ML,DEXAMETHASONE SOD PHOS INJ SOL PREF SYR 10 MG/ML (PF)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323050601","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"63323050601","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MEROPENEM IV FOR SOLN 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323050830","type":"CDM"},{"code":"J2185","type":"HCPCS"},{"code":"63323050830","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE INJ 100 MG/10ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx63323051610","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"63323051610","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323054015","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"63323054015","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML,HEPARIN SODIUM (PORCINE) PF INJ 1000 UNIT/ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx63323054031","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"63323054031","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 80 MG/0.8ML","drug_information":{"unit":0.7,"type":"ML"},"code_information":[{"code":"Rx63323058499","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323058499","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 100 MG/ML","drug_information":{"unit":0.9,"type":"ML"},"code_information":[{"code":"Rx63323058696","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323058696","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"GLUCAGON HCL DIAGNOSTIC FOR INJ 1 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323059611","type":"CDM"},{"code":"J1611","type":"HCPCS"},{"code":"63323059611","type":"NDC"}],"standard_charges":[{"gross_charge":670.16,"discounted_cash":502.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DEFEROXAMINE MESYLATE FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323059710","type":"CDM"},{"code":"J0895","type":"HCPCS"},{"code":"63323059710","type":"NDC"}],"standard_charges":[{"gross_charge":99.1,"discounted_cash":74.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PROPRANOLOL HCL INJ 1 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323060401","type":"CDM"},{"code":"J1800","type":"HCPCS"},{"code":"63323060401","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MILRINONE LACTATE IV SOLN 10 MG/10ML (BASE EQUIVALENT)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx63323061710","type":"CDM"},{"code":"J2260","type":"HCPCS"},{"code":"63323061710","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM FOR IV INJ 100 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323064907","type":"CDM"},{"code":"J0651","type":"HCPCS"},{"code":"63323064907","type":"NDC"}],"standard_charges":[{"gross_charge":487.78,"discounted_cash":365.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CHLOROTHIAZIDE SODIUM FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323065820","type":"CDM"},{"code":"J1205","type":"HCPCS"},{"code":"63323065820","type":"NDC"}],"standard_charges":[{"gross_charge":285.57,"discounted_cash":214.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"INDOMETHACIN SODIUM IV FOR SOLN 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323065903","type":"CDM"},{"code":"63323065903","type":"NDC"}],"standard_charges":[{"gross_charge":1683.84,"discounted_cash":1262.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LEUCOVORIN CALCIUM FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323071100","type":"CDM"},{"code":"J0640","type":"HCPCS"},{"code":"63323071100","type":"NDC"}],"standard_charges":[{"gross_charge":316.31,"discounted_cash":237.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"REMIFENTANIL HCL FOR IV SOLN 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323072303","type":"CDM"},{"code":"63323072303","type":"NDC"}],"standard_charges":[{"gross_charge":492.48,"discounted_cash":369.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MICAFUNGIN SODIUM FOR IV SOLN 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323072901","type":"CDM"},{"code":"J2248","type":"HCPCS"},{"code":"63323072901","type":"NDC"}],"standard_charges":[{"gross_charge":319.25,"discounted_cash":239.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FAMOTIDINE PRESERVATIVE FREE INJ 20 MG/2ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323073912","type":"CDM"},{"code":"J1308","type":"HCPCS"},{"code":"63323073912","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PACLITAXEL IV CONC 300 MG/50ML (6 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx63323076350","type":"CDM"},{"code":"J9267","type":"HCPCS"},{"code":"63323076350","type":"NDC"}],"standard_charges":[{"gross_charge":908.89,"discounted_cash":681.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 1000 MCG/20ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx63323080620","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"63323080620","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FAT EMULSION FISH OIL AND PLANT BASED IV EMUL 20%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx63323082001","type":"CDM"},{"code":"63323082001","type":"NDC"}],"standard_charges":[{"gross_charge":225.25,"discounted_cash":168.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FAT EMULSION FISH OIL AND PLANT BASED IV EMUL 20%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx63323082004","type":"CDM"},{"code":"63323082004","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HYDROMORPHONE HCL PRESERVATIVE FREE (PF) INJ 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx63323085203","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"63323085203","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PENTAMIDINE ISETHIONATE FOR NEBULIZATION SOLN 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323087715","type":"CDM"},{"code":"J2545","type":"HCPCS"},{"code":"63323087715","type":"NDC"}],"standard_charges":[{"gross_charge":399.31,"discounted_cash":299.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SODIUM PHOSPHATES INJ 15 MM/5ML (PHOS) 20 MEQ/5ML (NA),SODIUM PHOSPHATES INJ 45 MM/15ML (PHOS) 60 MEQ/15ML (NA),SODIUM PHOSPHATES INJ 150 MM/50ML (PHOS) 200 MEQ/50ML (NA)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx63323088601","type":"CDM"},{"code":"63323088601","type":"NDC"}],"standard_charges":[{"gross_charge":701.36,"discounted_cash":526.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"POTASSIUM CHLORIDE INJ 2 MEQ/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323096505","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"63323096505","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"POTASSIUM CHLORIDE INJ 2 MEQ/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx63323096510","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"63323096510","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"POTASSIUM CHLORIDE INJ 2 MEQ/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx63323096520","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"63323096520","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"POTASSIUM CHLORIDE INJ 2 MEQ/ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx63323096730","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"63323096730","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"RITUXIMAB-ABBS IV SOLN 100 MG/10ML (10 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx63459010310","type":"CDM"},{"code":"Q5115","type":"HCPCS"},{"code":"63459010310","type":"NDC"}],"standard_charges":[{"gross_charge":3991.2,"discounted_cash":2993.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"RITUXIMAB-ABBS IV SOLN 500 MG/50ML (10 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx63459010450","type":"CDM"},{"code":"Q5115","type":"HCPCS"},{"code":"63459010450","type":"NDC"}],"standard_charges":[{"gross_charge":18009.77,"discounted_cash":13507.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BENDAMUSTINE HCL IV SOLN 100 MG/4ML (25 MG/ML)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx63459034804","type":"CDM"},{"code":"J9034","type":"HCPCS"},{"code":"63459034804","type":"NDC"}],"standard_charges":[{"gross_charge":14266.96,"discounted_cash":10700.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BENDAMUSTINE HCL FOR IV SOLN 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63459039008","type":"CDM"},{"code":"J9033","type":"HCPCS"},{"code":"63459039008","type":"NDC"}],"standard_charges":[{"gross_charge":3697.32,"discounted_cash":2772.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BENDAMUSTINE HCL FOR IV SOLN 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63459039120","type":"CDM"},{"code":"J9033","type":"HCPCS"},{"code":"63459039120","type":"NDC"}],"standard_charges":[{"gross_charge":15690.38,"discounted_cash":11767.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TBO-FILGRASTIM SOLN PREFILLED SYRINGE 300 MCG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx63459091011","type":"CDM"},{"code":"J1447","type":"HCPCS"},{"code":"63459091011","type":"NDC"}],"standard_charges":[{"gross_charge":797.58,"discounted_cash":598.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TBO-FILGRASTIM SOLN PREFILLED SYRINGE 480 MCG/0.8ML","drug_information":{"unit":0.8,"type":"ML"},"code_information":[{"code":"Rx63459091211","type":"CDM"},{"code":"J1447","type":"HCPCS"},{"code":"63459091211","type":"NDC"}],"standard_charges":[{"gross_charge":1276.12,"discounted_cash":957.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"GELATIN ABSORBABLE SPONGE 12-7 MM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63713001972","type":"CDM"},{"code":"63713001972","type":"NDC"}],"standard_charges":[{"gross_charge":37.01,"discounted_cash":27.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"GELATIN ABSORBABLE SPONGE SIZE 50","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63713001973","type":"CDM"},{"code":"63713001973","type":"NDC"}],"standard_charges":[{"gross_charge":111.34,"discounted_cash":83.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"GELATIN ABSORBABLE SPONGE SIZE 100","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63713001974","type":"CDM"},{"code":"63713001974","type":"NDC"}],"standard_charges":[{"gross_charge":180.68,"discounted_cash":135.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"GELATIN ABSORBABLE MT POWDER","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"Rx63713001978","type":"CDM"},{"code":"63713001978","type":"NDC"}],"standard_charges":[{"gross_charge":680.62,"discounted_cash":510.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BENZOCAINE RECTAL OINTMENT 20%","drug_information":{"unit":28.0,"type":"GM"},"code_information":[{"code":"Rx63736003751","type":"CDM"},{"code":"63736003751","type":"NDC"}],"standard_charges":[{"gross_charge":5.42,"discounted_cash":4.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CLINDAMYCIN HCL CAP 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739005910","type":"CDM"},{"code":"63739005910","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DIAZEPAM TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739007310","type":"CDM"},{"code":"63739007310","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB 10-100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739010710","type":"CDM"},{"code":"63739010710","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TAMOXIFEN CITRATE TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739026910","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"63739026910","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HYDROMORPHONE HCL TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739027510","type":"CDM"},{"code":"63739027510","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FAMOTIDINE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739064510","type":"CDM"},{"code":"63739064510","type":"NDC"}],"standard_charges":[{"gross_charge":0.57,"discounted_cash":0.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LAMOTRIGINE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739067010","type":"CDM"},{"code":"63739067010","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TRAMADOL HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739067110","type":"CDM"},{"code":"63739067110","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TEMAZEPAM CAP 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739087710","type":"CDM"},{"code":"63739087710","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"GUAIFENESIN TAB ER 12HR 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63824000850","type":"CDM"},{"code":"63824000850","type":"NDC"}],"standard_charges":[{"gross_charge":0.76,"discounted_cash":0.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ANTIHEMOPHILIC FACTOR/VWF (HUMAN) FOR INJ 250-600 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63833061502","type":"CDM"},{"code":"J7187","type":"HCPCS"},{"code":"63833061502","type":"NDC"}],"standard_charges":[{"gross_charge":2221.22,"discounted_cash":1665.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ANTIHEMOPHILIC FACTOR/VWF (HUMAN) FOR INJ 500-1200 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63833061602","type":"CDM"},{"code":"J7187","type":"HCPCS"},{"code":"63833061602","type":"NDC"}],"standard_charges":[{"gross_charge":4437.3,"discounted_cash":3327.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"C1 ESTERASE INHIBITOR (HUMAN) FOR IV INJ KIT 500 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63833082502","type":"CDM"},{"code":"J0597","type":"HCPCS"},{"code":"63833082502","type":"NDC"}],"standard_charges":[{"gross_charge":15950.23,"discounted_cash":11962.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ANTIINHIBITOR COAGULANT COMPLEX FOR IV SOLN 1000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64193042402","type":"CDM"},{"code":"J7198","type":"HCPCS"},{"code":"64193042402","type":"NDC"}],"standard_charges":[{"gross_charge":7431.05,"discounted_cash":5573.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ANTIINHIBITOR COAGULANT COMPLEX FOR IV SOLN 2500 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64193042502","type":"CDM"},{"code":"J7198","type":"HCPCS"},{"code":"64193042502","type":"NDC"}],"standard_charges":[{"gross_charge":18659.4,"discounted_cash":13994.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NATALIZUMAB FOR IV INJ CONC 300 MG/15ML","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx64406000801","type":"CDM"},{"code":"J2323","type":"HCPCS"},{"code":"64406000801","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"},{"gross_charge":15185.47,"discounted_cash":11389.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NUSINERSEN INTRATHECAL SOLN 12 MG/5ML (2.4 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx64406005801","type":"CDM"},{"code":"J2326","type":"HCPCS"},{"code":"64406005801","type":"NDC"}],"standard_charges":[{"gross_charge":787500.0,"discounted_cash":590625.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"VEDOLIZUMAB FOR IV SOLUTION 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64764030020","type":"CDM"},{"code":"J3380","type":"HCPCS"},{"code":"64764030020","type":"NDC"}],"standard_charges":[{"gross_charge":40675.1,"discounted_cash":30506.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FEBUXOSTAT TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64764091830","type":"CDM"},{"code":"64764091830","type":"NDC"}],"standard_charges":[{"gross_charge":45.35,"discounted_cash":34.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"OXYCODONE HCL SOLN 5 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx64950035455","type":"CDM"},{"code":"64950035455","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"COCAINE HCL NASAL SOLN 40 MG/ML (4%)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx64950036204","type":"CDM"},{"code":"C9046","type":"HCPCS"},{"code":"64950036204","type":"NDC"}],"standard_charges":[{"gross_charge":1664.88,"discounted_cash":1248.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"POT PHOS MONOBASIC W/SOD PHOS DI & MONOBAS TAB 155-852-130MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64980010401","type":"CDM"},{"code":"64980010401","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DIPYRIDAMOLE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64980013301","type":"CDM"},{"code":"64980013301","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"OFLOXACIN OPHTH SOLN 0.3%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx64980051505","type":"CDM"},{"code":"64980051505","type":"NDC"}],"standard_charges":[{"gross_charge":62.73,"discounted_cash":47.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SALINE W/ PHENOL INJ","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx65044999002","type":"CDM"},{"code":"65044999002","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SALINE W/ PHENOL INJ","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx65044999007","type":"CDM"},{"code":"65044999007","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE INJ 30 MG/ML","drug_information":{"unit":0.333333333333333,"type":"ML"},"code_information":[{"code":"Rx65145014525","type":"CDM"},{"code":"J1885","type":"HCPCS"},{"code":"65145014525","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"OXYCODONE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162004710","type":"CDM"},{"code":"65162004710","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NAPROXEN TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162018810","type":"CDM"},{"code":"65162018810","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PALIPERIDONE TAB ER 24HR 6 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162028203","type":"CDM"},{"code":"65162028203","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ONDANSETRON HCL ORAL SOLN 4 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx65162069179","type":"CDM"},{"code":"Q0162","type":"HCPCS"},{"code":"65162069179","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BUDESONIDE DELAYED RELEASE PARTICLES CAP 3 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162077810","type":"CDM"},{"code":"65162077810","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PROGESTERONE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162080710","type":"CDM"},{"code":"65162080710","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ACYCLOVIR OINT 5%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx65162083594","type":"CDM"},{"code":"65162083594","type":"NDC"}],"standard_charges":[{"gross_charge":51.67,"discounted_cash":38.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ARIPIPRAZOLE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162089703","type":"CDM"},{"code":"65162089703","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FAT EMULSION PLANT BASED (SOY) IV EMULSION 20%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx65219053325","type":"CDM"},{"code":"65219053325","type":"NDC"}],"standard_charges":[{"gross_charge":175.45,"discounted_cash":131.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TOCILIZUMAB-AAZG IV INJ 200 MG/10ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx65219059210","type":"CDM"},{"code":"Q5135","type":"HCPCS"},{"code":"65219059210","type":"NDC"}],"standard_charges":[{"gross_charge":3841.61,"discounted_cash":2881.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TOCILIZUMAB-AAZG IV INJ 400 MG/20ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx65219059420","type":"CDM"},{"code":"Q5135","type":"HCPCS"},{"code":"65219059420","type":"NDC"}],"standard_charges":[{"gross_charge":7683.23,"discounted_cash":5762.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BUPIVACAINE LIPOSOME INJ 1.3% (13.3 MG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx65250026609","type":"CDM"},{"code":"J0666","type":"HCPCS"},{"code":"65250026609","type":"NDC"}],"standard_charges":[{"gross_charge":129.27,"discounted_cash":96.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DIPHENHYD-LIDOCAINE-AL HYDROXIDE-MG HYDROXIDE-SIMETH","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx65628005004","type":"CDM"},{"code":"65628005004","type":"NDC"}],"standard_charges":[{"gross_charge":15.58,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LANSOPRAZOLE SUSP 3 MG/ML (COMPOUND KIT)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx65628008005","type":"CDM"},{"code":"65628008005","type":"NDC"}],"standard_charges":[{"gross_charge":24.03,"discounted_cash":18.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"VANCOMYCIN HCL FOR ORAL SOLN 50 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx65628020605","type":"CDM"},{"code":"65628020605","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"RIFAXIMIN TAB 550 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65649030303","type":"CDM"},{"code":"65649030303","type":"NDC"}],"standard_charges":[{"gross_charge":237.93,"discounted_cash":178.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"METHYLNALTREXONE BROMIDE INJ 12 MG/0.6ML (20 MG/ML),METHYLNALTREXONE BROMIDE SOLN PREF SYR 12 MG/0.6ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx65649055102","type":"CDM"},{"code":"J2212","type":"HCPCS"},{"code":"65649055102","type":"NDC"}],"standard_charges":[{"gross_charge":657.47,"discounted_cash":493.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"METHYLNALTREXONE BROMIDE INJ 12 MG/0.6ML (20 MG/ML),METHYLNALTREXONE BROMIDE SOLN PREF SYR 12 MG/0.6ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx65649055103","type":"CDM"},{"code":"J2212","type":"HCPCS"},{"code":"65649055103","type":"NDC"}],"standard_charges":[{"gross_charge":657.28,"discounted_cash":492.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NALTREXONE FOR IM EXTENDED RELEASE SUSP 380 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65757030001","type":"CDM"},{"code":"J2315","type":"HCPCS"},{"code":"65757030001","type":"NDC"}],"standard_charges":[{"gross_charge":6766.88,"discounted_cash":5075.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ARIPIPRAZOLE LAUROXIL IM ER SUSP PREFILLED SYR 882 MG/3.2ML","drug_information":{"unit":3.2,"type":"ML"},"code_information":[{"code":"Rx65757040303","type":"CDM"},{"code":"J1944","type":"HCPCS"},{"code":"65757040303","type":"NDC"}],"standard_charges":[{"gross_charge":12738.32,"discounted_cash":9553.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ZIDOVUDINE SYRUP 10 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx65862004824","type":"CDM"},{"code":"65862004824","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ZIDOVUDINE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862010701","type":"CDM"},{"code":"65862010701","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SUMATRIPTAN SUCCINATE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862014636","type":"CDM"},{"code":"65862014636","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PENICILLIN V POTASSIUM TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862017501","type":"CDM"},{"code":"65862017501","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PENICILLIN V POTASSIUM TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862017601","type":"CDM"},{"code":"65862017601","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CEFDINIR CAP 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862017760","type":"CDM"},{"code":"65862017760","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"RIBAVIRIN TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862020768","type":"CDM"},{"code":"65862020768","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM SUSP 200-40 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx65862049647","type":"CDM"},{"code":"65862049647","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE TAB 500-125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862050220","type":"CDM"},{"code":"65862050220","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE FOR SUSP 400-57 MG/5ML","drug_information":{"unit":7.5,"type":"ML"},"code_information":[{"code":"Rx65862053401","type":"CDM"},{"code":"65862053401","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"VALSARTAN TAB 160 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862057290","type":"CDM"},{"code":"65862057290","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"RIVASTIGMINE TARTRATE CAP 1.5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862064860","type":"CDM"},{"code":"65862064860","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ALPRAZOLAM TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862067701","type":"CDM"},{"code":"65862067701","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CEFAZOLIN SODIUM (BULK) FOR INJ 100 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx66288110001","type":"CDM"},{"code":"J0690","type":"HCPCS"},{"code":"66288110001","type":"NDC"}],"standard_charges":[{"gross_charge":830.81,"discounted_cash":623.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CALCIUM CARBONATE (ANTACID) CHEW TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx66553000401","type":"CDM"},{"code":"66553000401","type":"NDC"}],"standard_charges":[{"gross_charge":0.62,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LEVETIRACETAM ORAL SOLN 100 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx66689002801","type":"CDM"},{"code":"66689002801","type":"NDC"}],"standard_charges":[{"gross_charge":16.84,"discounted_cash":12.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LEVETIRACETAM ORAL SOLN 100 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx66689002850","type":"CDM"},{"code":"66689002850","type":"NDC"}],"standard_charges":[{"gross_charge":27.38,"discounted_cash":20.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PHENYTOIN SUSP 125 MG/5ML","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx66689003601","type":"CDM"},{"code":"66689003601","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NYSTATIN SUSP 100000 UNIT/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx66689003701","type":"CDM"},{"code":"66689003701","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NYSTATIN SUSP 100000 UNIT/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx66689003750","type":"CDM"},{"code":"66689003750","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CETUXIMAB IV SOLN 100 MG/50ML (2 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx66733094823","type":"CDM"},{"code":"J9055","type":"HCPCS"},{"code":"66733094823","type":"NDC"}],"standard_charges":[{"gross_charge":5484.05,"discounted_cash":4113.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CETUXIMAB IV SOLN 200 MG/100ML (2 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx66733095823","type":"CDM"},{"code":"J9055","type":"HCPCS"},{"code":"66733095823","type":"NDC"}],"standard_charges":[{"gross_charge":10968.1,"discounted_cash":8226.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DOCETAXEL SOLN FOR IV INFUSION 20 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx66758005001","type":"CDM"},{"code":"J9171","type":"HCPCS"},{"code":"66758005001","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DOCETAXEL SOLN FOR IV INFUSION 80 MG/8ML","drug_information":{"unit":8.0,"type":"ML"},"code_information":[{"code":"Rx66758005002","type":"CDM"},{"code":"J9171","type":"HCPCS"},{"code":"66758005002","type":"NDC"}],"standard_charges":[{"gross_charge":235.62,"discounted_cash":176.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ISOFLURANE INHAL SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx66794001710","type":"CDM"},{"code":"66794001710","type":"NDC"}],"standard_charges":[{"gross_charge":62.06,"discounted_cash":46.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BACLOFEN INTRATHECAL INJ 10 MG/20ML (500 MCG/ML)","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx66794015502","type":"CDM"},{"code":"J0475","type":"HCPCS"},{"code":"66794015502","type":"NDC"}],"standard_charges":[{"gross_charge":1065.33,"discounted_cash":799.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BACLOFEN INTRATHECAL INJ 20 MG/20ML (1000 MCG/ML)","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx66794015602","type":"CDM"},{"code":"J0475","type":"HCPCS"},{"code":"66794015602","type":"NDC"}],"standard_charges":[{"gross_charge":2130.67,"discounted_cash":1598.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BACLOFEN INTRATHECAL SOLN PREFILLED SYRINGE 40000 MCG/20ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx66794015701","type":"CDM"},{"code":"J0475","type":"HCPCS"},{"code":"66794015701","type":"NDC"}],"standard_charges":[{"gross_charge":2891.2,"discounted_cash":2168.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MORPHINE SULF FOR MICROINFUSION PF INJ 500 MG/20ML (25MG/ML)","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx66794016202","type":"CDM"},{"code":"J2274","type":"HCPCS"},{"code":"66794016202","type":"NDC"}],"standard_charges":[{"gross_charge":1858.23,"discounted_cash":1393.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 1.5 (1-0.5) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx66794020602","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"66794020602","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 1.5 (1-0.5) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx66794020641","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"66794020641","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LANTHANUM CARBONATE CHEW TAB 500 MG (ELEMENTAL)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx66993042285","type":"CDM"},{"code":"66993042285","type":"NDC"}],"standard_charges":[{"gross_charge":45.14,"discounted_cash":33.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"RALOXIFENE HCL TAB 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx66993066130","type":"CDM"},{"code":"66993066130","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ASCORBIC ACID IV SOLN 25000 MG/50ML (500 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx67157010150","type":"CDM"},{"code":"67157010150","type":"NDC"}],"standard_charges":[{"gross_charge":1570.15,"discounted_cash":1177.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ASCORBIC ACID IV SOLN 25000 MG/50ML (500 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx67157010151","type":"CDM"},{"code":"67157010151","type":"NDC"}],"standard_charges":[{"gross_charge":1552.43,"discounted_cash":1164.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PENICILLIN V POTASSIUM FOR SOLN 125 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx67253020210","type":"CDM"},{"code":"67253020210","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ALPRAZOLAM TAB 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67253090010","type":"CDM"},{"code":"67253090010","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ASCORBIC ACID INJ 500 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx67457011850","type":"CDM"},{"code":"67457011850","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"B-COMPLEX VITAMIN INJ SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx67457014630","type":"CDM"},{"code":"67457014630","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"AMIODARONE HCL INJ 150 MG/3ML (50 MG/ML)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx67457015303","type":"CDM"},{"code":"J0282","type":"HCPCS"},{"code":"67457015303","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SODIUM TETRADECYL SULFATE INJ 1%","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx67457016202","type":"CDM"},{"code":"67457016202","type":"NDC"}],"standard_charges":[{"gross_charge":124.61,"discounted_cash":93.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ALLOPURINOL SODIUM FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457018750","type":"CDM"},{"code":"J0206","type":"HCPCS"},{"code":"67457018750","type":"NDC"}],"standard_charges":[{"gross_charge":10015.79,"discounted_cash":7511.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"THIAMINE HCL INJ 100 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx67457019602","type":"CDM"},{"code":"J3411","type":"HCPCS"},{"code":"67457019602","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FOMEPIZOLE INJ 1 GM/ML (FOR IV INFUSION)","drug_information":{"unit":1.5,"type":"ML"},"code_information":[{"code":"Rx67457021102","type":"CDM"},{"code":"J1451","type":"HCPCS"},{"code":"67457021102","type":"NDC"}],"standard_charges":[{"gross_charge":3947.18,"discounted_cash":2960.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ISOSULFAN BLUE SUBCUTANEOUS SOLN 1%","drug_information":{"unit":1.5,"type":"ML"},"code_information":[{"code":"Rx67457022005","type":"CDM"},{"code":"Q9968","type":"HCPCS"},{"code":"67457022005","type":"NDC"}],"standard_charges":[{"gross_charge":1828.14,"discounted_cash":1371.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"AZACITIDINE FOR INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457025430","type":"CDM"},{"code":"J9025","type":"HCPCS"},{"code":"67457025430","type":"NDC"}],"standard_charges":[{"gross_charge":1161.08,"discounted_cash":870.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML,HEPARIN SODIUM (PORCINE) PF INJ 1000 UNIT/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx67457038599","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"67457038599","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"},{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ZOLEDRONIC ACID INJ CONC FOR IV INFUSION 4 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx67457039054","type":"CDM"},{"code":"J3489","type":"HCPCS"},{"code":"67457039054","type":"NDC"}],"standard_charges":[{"gross_charge":235.14,"discounted_cash":176.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE INJ 4 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx67457042312","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"67457042312","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DOXORUBICIN HCL FOR INJ 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457043650","type":"CDM"},{"code":"J9000","type":"HCPCS"},{"code":"67457043650","type":"NDC"}],"standard_charges":[{"gross_charge":1229.57,"discounted_cash":922.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PAMIDRONATE DISODIUM IV SOLN 9 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx67457044610","type":"CDM"},{"code":"J2430","type":"HCPCS"},{"code":"67457044610","type":"NDC"}],"standard_charges":[{"gross_charge":188.52,"discounted_cash":141.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DOXORUBICIN HCL FOR INJ 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457047810","type":"CDM"},{"code":"J9000","type":"HCPCS"},{"code":"67457047810","type":"NDC"}],"standard_charges":[{"gross_charge":376.36,"discounted_cash":282.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM NA FOR INJ 3.375 GM (3-0.375 GM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457052237","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"67457052237","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"IBANDRONATE SODIUM IV SOLN 3 MG/3ML (BASE EQUIVALENT)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx67457052433","type":"CDM"},{"code":"J1740","type":"HCPCS"},{"code":"67457052433","type":"NDC"}],"standard_charges":[{"gross_charge":1421.53,"discounted_cash":1066.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ZOLEDRONIC ACID IV SOLN 5 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx67457079410","type":"CDM"},{"code":"J3489","type":"HCPCS"},{"code":"67457079410","type":"NDC"}],"standard_charges":[{"gross_charge":677.4,"discounted_cash":508.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ACETAZOLAMIDE SODIUM FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457085350","type":"CDM"},{"code":"J1120","type":"HCPCS"},{"code":"67457085350","type":"NDC"}],"standard_charges":[{"gross_charge":268.64,"discounted_cash":201.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SENNOSIDES-DOCUSATE SODIUM TAB 8.6-50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67618011060","type":"CDM"},{"code":"67618011060","type":"NDC"}],"standard_charges":[{"gross_charge":0.84,"discounted_cash":0.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ETHIODIZED INJ OIL 480 MG/ML (IODINE EQUIVALENT)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx67684190102","type":"CDM"},{"code":"67684190102","type":"NDC"}],"standard_charges":[{"gross_charge":1549.58,"discounted_cash":1162.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SILVER SULFADIAZINE CREAM 1%","drug_information":{"unit":400.0,"type":"GM"},"code_information":[{"code":"Rx67877012440","type":"CDM"},{"code":"67877012440","type":"NDC"}],"standard_charges":[{"gross_charge":170.89,"discounted_cash":128.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SILVER SULFADIAZINE CREAM 1%","drug_information":{"unit":50.0,"type":"GM"},"code_information":[{"code":"Rx67877012450","type":"CDM"},{"code":"67877012450","type":"NDC"}],"standard_charges":[{"gross_charge":41.15,"discounted_cash":30.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"GABAPENTIN CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877022201","type":"CDM"},{"code":"67877022201","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"GABAPENTIN CAP 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877022310","type":"CDM"},{"code":"67877022310","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MYCOPHENOLATE MOFETIL FOR ORAL SUSP 200 MG/ML","drug_information":{"unit":1.25,"type":"ML"},"code_information":[{"code":"Rx67877023022","type":"CDM"},{"code":"J7517","type":"HCPCS"},{"code":"67877023022","type":"NDC"}],"standard_charges":[{"gross_charge":37.9,"discounted_cash":28.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TRIAMCINOLONE ACETONIDE CREAM 0.1%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx67877025115","type":"CDM"},{"code":"67877025115","type":"NDC"}],"standard_charges":[{"gross_charge":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TRIAMCINOLONE ACETONIDE CREAM 0.1%","drug_information":{"unit":80.0,"type":"GM"},"code_information":[{"code":"Rx67877025180","type":"CDM"},{"code":"67877025180","type":"NDC"}],"standard_charges":[{"gross_charge":36.33,"discounted_cash":27.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ITRACONAZOLE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877045430","type":"CDM"},{"code":"67877045430","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LIDOCAINE OINT 5%","drug_information":{"unit":50.0,"type":"GM"},"code_information":[{"code":"Rx67877047380","type":"CDM"},{"code":"67877047380","type":"NDC"}],"standard_charges":[{"gross_charge":55.54,"discounted_cash":41.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CEPHALEXIN FOR SUSP 250 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx67877054588","type":"CDM"},{"code":"67877054588","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"VENLAFAXINE HCL TAB ER 24HR 37.5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877072630","type":"CDM"},{"code":"67877072630","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"VENLAFAXINE HCL TAB ER 24HR 75 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877072790","type":"CDM"},{"code":"67877072790","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FOSFOMYCIN TROMETHAMINE POWD PACK 3 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877074957","type":"CDM"},{"code":"67877074957","type":"NDC"}],"standard_charges":[{"gross_charge":244.56,"discounted_cash":183.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ALVIMOPAN CAP 12 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67919002010","type":"CDM"},{"code":"67919002010","type":"NDC"}],"standard_charges":[{"gross_charge":817.78,"discounted_cash":613.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CEFTOLOZANE-TAZOBACTAM FOR INJ 1.5 GM (1-0.5 GM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67919003001","type":"CDM"},{"code":"J0695","type":"HCPCS"},{"code":"67919003001","type":"NDC"}],"standard_charges":[{"gross_charge":1287.67,"discounted_cash":965.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BUDESONIDE TAB ER 24HR 9 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68012030930","type":"CDM"},{"code":"68012030930","type":"NDC"}],"standard_charges":[{"gross_charge":246.34,"discounted_cash":184.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NIFEDIPINE CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084002211","type":"CDM"},{"code":"68084002211","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MISOPROSTOL TAB 200 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084004101","type":"CDM"},{"code":"68084004101","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MISOPROSTOL TAB 200 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084004111","type":"CDM"},{"code":"68084004111","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PAROXETINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084004401","type":"CDM"},{"code":"68084004401","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NABUMETONE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084005101","type":"CDM"},{"code":"68084005101","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CIPROFLOXACIN HCL TAB 250 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084006901","type":"CDM"},{"code":"68084006901","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ISOSORBIDE DINITRATE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084008201","type":"CDM"},{"code":"68084008201","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ISOSORBIDE DINITRATE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084008211","type":"CDM"},{"code":"68084008211","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"OMEPRAZOLE CAP DELAYED RELEASE 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084012811","type":"CDM"},{"code":"68084012811","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"METHYLPREDNISOLONE TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084014901","type":"CDM"},{"code":"J7509","type":"HCPCS"},{"code":"68084014901","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"OXYCODONE HCL TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084018401","type":"CDM"},{"code":"68084018401","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LISINOPRIL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084019601","type":"CDM"},{"code":"68084019601","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LISINOPRIL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084019611","type":"CDM"},{"code":"68084019611","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PRIMIDONE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084020201","type":"CDM"},{"code":"68084020201","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MINOXIDIL TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084020401","type":"CDM"},{"code":"68084020401","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BUPROPION HCL TAB ER 24HR 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084025211","type":"CDM"},{"code":"68084025211","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BUPROPION HCL TAB ER 24HR 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084025221","type":"CDM"},{"code":"68084025221","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HYDROXYUREA CAP 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084028401","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"68084028401","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DANTROLENE SODIUM CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084030011","type":"CDM"},{"code":"68084030011","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DANTROLENE SODIUM CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084030021","type":"CDM"},{"code":"68084030021","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"GLIMEPIRIDE TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084032701","type":"CDM"},{"code":"68084032701","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TOPIRAMATE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084034201","type":"CDM"},{"code":"68084034201","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TOPIRAMATE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084034211","type":"CDM"},{"code":"68084034211","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TOPIRAMATE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084034301","type":"CDM"},{"code":"68084034301","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TOPIRAMATE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084034311","type":"CDM"},{"code":"68084034311","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TOPIRAMATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084034401","type":"CDM"},{"code":"68084034401","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DIVALPROEX SODIUM TAB ER 24 HR 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084041501","type":"CDM"},{"code":"68084041501","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NITROFURANTOIN MONOHYDRATE MACROCRYSTALLINE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084044601","type":"CDM"},{"code":"68084044601","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PYRIDOSTIGMINE BROMIDE TAB 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084049401","type":"CDM"},{"code":"68084049401","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PYRIDOSTIGMINE BROMIDE TAB 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084049411","type":"CDM"},{"code":"68084049411","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TORSEMIDE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084053901","type":"CDM"},{"code":"68084053901","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TORSEMIDE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084053911","type":"CDM"},{"code":"68084053911","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ACETAZOLAMIDE TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084054101","type":"CDM"},{"code":"68084054101","type":"NDC"}],"standard_charges":[{"gross_charge":14.49,"discounted_cash":10.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CARBAMAZEPINE TAB ER 12HR 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084056111","type":"CDM"},{"code":"68084056111","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CARBAMAZEPINE TAB ER 12HR 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084056121","type":"CDM"},{"code":"68084056121","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ISOSORBIDE MONONITRATE TAB ER 24HR 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084059101","type":"CDM"},{"code":"68084059101","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ISOSORBIDE MONONITRATE TAB ER 24HR 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084059201","type":"CDM"},{"code":"68084059201","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NIFEDIPINE TAB ER 24HR OSMOTIC RELEASE 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084059701","type":"CDM"},{"code":"68084059701","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"POTASSIUM CHLORIDE MICROENCAPSULATED CRYS ER TAB 10 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084063211","type":"CDM"},{"code":"68084063211","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TIZANIDINE HCL TAB 4 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084064501","type":"CDM"},{"code":"68084064501","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TIZANIDINE HCL TAB 4 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084064511","type":"CDM"},{"code":"68084064511","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LITHIUM CARBONATE TAB ER 450 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084065501","type":"CDM"},{"code":"68084065501","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LITHIUM CARBONATE TAB ER 450 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084065511","type":"CDM"},{"code":"68084065511","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DULOXETINE HCL ENTERIC COATED PELLETS CAP 30 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084068301","type":"CDM"},{"code":"68084068301","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DULOXETINE HCL ENTERIC COATED PELLETS CAP 30 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084068311","type":"CDM"},{"code":"68084068311","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"GALANTAMINE HYDROBROMIDE TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084072921","type":"CDM"},{"code":"68084072921","type":"NDC"}],"standard_charges":[{"gross_charge":14.42,"discounted_cash":10.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"GUANFACINE HCL TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084074825","type":"CDM"},{"code":"68084074825","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DIVALPROEX SODIUM TAB DELAYED RELEASE 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084077601","type":"CDM"},{"code":"68084077601","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"METHYLPHENIDATE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084082311","type":"CDM"},{"code":"68084082311","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"METHYLPHENIDATE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084082321","type":"CDM"},{"code":"68084082321","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PERPHENAZINE TAB 16 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084084225","type":"CDM"},{"code":"68084084225","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PERPHENAZINE TAB 16 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084084295","type":"CDM"},{"code":"68084084295","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"OXCARBAZEPINE TAB 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084085301","type":"CDM"},{"code":"68084085301","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"VENLAFAXINE HCL TAB 75 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084085601","type":"CDM"},{"code":"68084085601","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LEVETIRACETAM TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084087011","type":"CDM"},{"code":"68084087011","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CYCLOSPORINE CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084087925","type":"CDM"},{"code":"J7515","type":"HCPCS"},{"code":"68084087925","type":"NDC"}],"standard_charges":[{"gross_charge":21.26,"discounted_cash":15.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084089501","type":"CDM"},{"code":"68084089501","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084089509","type":"CDM"},{"code":"68084089509","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084089511","type":"CDM"},{"code":"68084089511","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"VALGANCICLOVIR HCL TAB 450 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084096525","type":"CDM"},{"code":"68084096525","type":"NDC"}],"standard_charges":[{"gross_charge":65.1,"discounted_cash":48.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"OXYCODONE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084096811","type":"CDM"},{"code":"68084096811","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MORPHINE SULFATE ORAL SOLN 10 MG/5ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx68094000159","type":"CDM"},{"code":"68094000159","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CARBAMAZEPINE SUSP 100 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx68094000759","type":"CDM"},{"code":"68094000759","type":"NDC"}],"standard_charges":[{"gross_charge":25.22,"discounted_cash":18.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CARBAMAZEPINE SUSP 100 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx68094000762","type":"CDM"},{"code":"68094000762","type":"NDC"}],"standard_charges":[{"gross_charge":25.13,"discounted_cash":18.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"VALPROATE SODIUM ORAL SOLN 250 MG/5ML (BASE EQUIV)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx68094019362","type":"CDM"},{"code":"68094019362","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MEGESTROL ACETATE SUSP 40 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx68094025059","type":"CDM"},{"code":"68094025059","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MORPHINE SULFATE ORAL SOLN 100 MG/5ML (20 MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx68094075458","type":"CDM"},{"code":"68094075458","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FUROSEMIDE ORAL SOLN 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx68094075659","type":"CDM"},{"code":"68094075659","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FUROSEMIDE ORAL SOLN 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx68094075662","type":"CDM"},{"code":"68094075662","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LITHIUM ORAL SOLUTION 8 MEQ/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx68094075762","type":"CDM"},{"code":"68094075762","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ONDANSETRON HCL ORAL SOLN 4 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx68094076359","type":"CDM"},{"code":"Q0162","type":"HCPCS"},{"code":"68094076359","type":"NDC"}],"standard_charges":[{"gross_charge":47.08,"discounted_cash":35.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ONDANSETRON HCL ORAL SOLN 4 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx68094076362","type":"CDM"},{"code":"Q0162","type":"HCPCS"},{"code":"68094076362","type":"NDC"}],"standard_charges":[{"gross_charge":63.95,"discounted_cash":47.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"OXYCODONE HCL CONC 100 MG/5ML (20 MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx68094080101","type":"CDM"},{"code":"68094080101","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"OXYCODONE HCL CONC 100 MG/5ML (20 MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx68094080158","type":"CDM"},{"code":"68094080158","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LEVOLEUCOVORIN CALCIUM FOR IV INJ 50 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68152010100","type":"CDM"},{"code":"J0641","type":"HCPCS"},{"code":"68152010100","type":"NDC"}],"standard_charges":[{"gross_charge":357.72,"discounted_cash":268.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FAMOTIDINE FOR SUSP 40 MG/5ML","drug_information":{"unit":1.25,"type":"ML"},"code_information":[{"code":"Rx68180015001","type":"CDM"},{"code":"68180015001","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LAMIVUDINE TAB 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180060207","type":"CDM"},{"code":"68180060207","type":"NDC"}],"standard_charges":[{"gross_charge":23.69,"discounted_cash":17.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DOXYCYCLINE MONOHYDRATE FOR SUSP 25 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx68180065701","type":"CDM"},{"code":"68180065701","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"OSELTAMIVIR PHOSPHATE CAP 30 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180067511","type":"CDM"},{"code":"68180067511","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"OSELTAMIVIR PHOSPHATE CAP 75 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180067711","type":"CDM"},{"code":"68180067711","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CEFDINIR FOR SUSP 250 MG/5ML","drug_information":{"unit":6.0,"type":"ML"},"code_information":[{"code":"Rx68180072310","type":"CDM"},{"code":"68180072310","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LEVONORGESTREL TAB 1.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180085211","type":"CDM"},{"code":"68180085211","type":"NDC"}],"standard_charges":[{"gross_charge":10.93,"discounted_cash":8.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LISINOPRIL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180098003","type":"CDM"},{"code":"68180098003","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NYSTATIN TOPICAL POWDER 100000 UNIT/GM","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx68308015215","type":"CDM"},{"code":"68308015215","type":"NDC"}],"standard_charges":[{"gross_charge":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NYSTATIN TOPICAL POWDER 100000 UNIT/GM","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx68308015230","type":"CDM"},{"code":"68308015230","type":"NDC"}],"standard_charges":[{"gross_charge":58.55,"discounted_cash":43.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TOPIRAMATE SPRINKLE CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382000514","type":"CDM"},{"code":"68382000514","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"RIBAVIRIN CAP 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382026012","type":"CDM"},{"code":"68382026012","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MINOCYCLINE HCL CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382031601","type":"CDM"},{"code":"68382031601","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MINOCYCLINE HCL CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382031818","type":"CDM"},{"code":"68382031818","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CHOLESTYRAMINE LIGHT POWDER PACKETS 4 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382052960","type":"CDM"},{"code":"68382052960","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ZOLMITRIPTAN ORALLY DISINTEGRATING TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382071569","type":"CDM"},{"code":"68382071569","type":"NDC"}],"standard_charges":[{"gross_charge":29.15,"discounted_cash":21.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LABETALOL HCL TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382079901","type":"CDM"},{"code":"68382079901","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BENZTROPINE MESYLATE INJ 1 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx68382086002","type":"CDM"},{"code":"J0515","type":"HCPCS"},{"code":"68382086002","type":"NDC"}],"standard_charges":[{"gross_charge":119.88,"discounted_cash":89.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ZONISAMIDE CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462012901","type":"CDM"},{"code":"68462012901","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ONDANSETRON ORALLY DISINTEGRATING TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462015713","type":"CDM"},{"code":"68462015713","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NAPROXEN TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462018801","type":"CDM"},{"code":"68462018801","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"VERAPAMIL HCL TAB ER 240 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462026001","type":"CDM"},{"code":"68462026001","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ROSUVASTATIN CALCIUM TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462026390","type":"CDM"},{"code":"68462026390","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"VERAPAMIL HCL TAB ER 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462029201","type":"CDM"},{"code":"68462029201","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CICLOPIROX OLAMINE CREAM 0.77% (BASE EQUIV)","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx68462029717","type":"CDM"},{"code":"68462029717","type":"NDC"}],"standard_charges":[{"gross_charge":64.28,"discounted_cash":48.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CICLOPIROX OLAMINE CREAM 0.77% (BASE EQUIV)","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx68462029735","type":"CDM"},{"code":"68462029735","type":"NDC"}],"standard_charges":[{"gross_charge":113.19,"discounted_cash":84.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"INDOMETHACIN CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462040601","type":"CDM"},{"code":"68462040601","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FACTOR IX COMPLEX FOR INJ 500 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68516320101","type":"CDM"},{"code":"J7194","type":"HCPCS"},{"code":"68516320101","type":"NDC"}],"standard_charges":[{"gross_charge":2536.64,"discounted_cash":1902.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FACTOR IX COMPLEX FOR INJ 1000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68516320502","type":"CDM"},{"code":"J7194","type":"HCPCS"},{"code":"68516320502","type":"NDC"}],"standard_charges":[{"gross_charge":5109.98,"discounted_cash":3832.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ALBUMIN, HUMAN INJ 5%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx68516521401","type":"CDM"},{"code":"P9045","type":"HCPCS"},{"code":"68516521401","type":"NDC"}],"standard_charges":[{"gross_charge":230.89,"discounted_cash":173.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ALBUMIN, HUMAN INJ 5%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx68516521402","type":"CDM"},{"code":"P9045","type":"HCPCS"},{"code":"68516521402","type":"NDC"}],"standard_charges":[{"gross_charge":230.89,"discounted_cash":173.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ALBUMIN, HUMAN INJ 25%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx68516521602","type":"CDM"},{"code":"P9047","type":"HCPCS"},{"code":"68516521602","type":"NDC"}],"standard_charges":[{"gross_charge":231.62,"discounted_cash":173.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ETHACRYNATE SODIUM FOR INJ 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68682001227","type":"CDM"},{"code":"J1807","type":"HCPCS"},{"code":"68682001227","type":"NDC"}],"standard_charges":[{"gross_charge":2684.83,"discounted_cash":2013.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CHLORDIAZEPOXIDE HCL-CLIDINIUM BROMIDE CAP 5-2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68682040910","type":"CDM"},{"code":"68682040910","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PACLITAXEL PROTEIN-BOUND PARTICLES FOR IV SUSP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68817013450","type":"CDM"},{"code":"J9264","type":"HCPCS"},{"code":"68817013450","type":"NDC"}],"standard_charges":[{"gross_charge":10355.2,"discounted_cash":7766.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ETHAMBUTOL HCL TAB 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68850001201","type":"CDM"},{"code":"68850001201","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ETHAMBUTOL HCL TAB 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68850001202","type":"CDM"},{"code":"68850001202","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PROTHROMBIN COMPLEX CONCENTRATE HUMAN-LANS FOR INJ 500 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68982026101","type":"CDM"},{"code":"J7165","type":"HCPCS"},{"code":"68982026101","type":"NDC"}],"standard_charges":[{"gross_charge":3415.39,"discounted_cash":2561.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ALBUMIN, HUMAN INJ 5%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx68982062302","type":"CDM"},{"code":"P9045","type":"HCPCS"},{"code":"68982062302","type":"NDC"}],"standard_charges":[{"gross_charge":199.74,"discounted_cash":149.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"IMMUNE GLOBULIN (HUMAN) IV SOLN 20 GM/200ML","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx68982085004","type":"CDM"},{"code":"J1568","type":"HCPCS"},{"code":"68982085004","type":"NDC"}],"standard_charges":[{"gross_charge":7966.67,"discounted_cash":5975.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ALBUTEROL SULFATE INHAL AERO 108 MCG/ACT (90MCG BASE EQUIV)","drug_information":{"unit":6.7,"type":"GM"},"code_information":[{"code":"Rx69097014260","type":"CDM"},{"code":"69097014260","type":"NDC"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":48.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ISOPROTERENOL HCL INJ 0.2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx69097052131","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"69097052131","type":"NDC"}],"standard_charges":[{"gross_charge":444.92,"discounted_cash":333.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ISOPROTERENOL HCL INJ 0.2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx69097052235","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"69097052235","type":"NDC"}],"standard_charges":[{"gross_charge":569.16,"discounted_cash":426.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DICLOFENAC SODIUM GEL 1% (1.16% DIETHYLAMINE EQUIV)","drug_information":{"unit":100.0,"type":"GM"},"code_information":[{"code":"Rx69097052444","type":"CDM"},{"code":"69097052444","type":"NDC"}],"standard_charges":[{"gross_charge":14.3,"discounted_cash":10.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PHYTONADIONE INJ 1 MG/0.5ML (2 MG/ML)","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx69097070996","type":"CDM"},{"code":"J3430","type":"HCPCS"},{"code":"69097070996","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"GEMFIBROZIL TAB 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69097082103","type":"CDM"},{"code":"69097082103","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CYCLOBENZAPRINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69097084607","type":"CDM"},{"code":"69097084607","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TERBINAFINE HCL TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69097085907","type":"CDM"},{"code":"69097085907","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PREGABALIN CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69238131109","type":"CDM"},{"code":"69238131109","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PREGABALIN CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69238131309","type":"CDM"},{"code":"69238131309","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ERYTHROMYCIN TAB DELAYED RELEASE 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69238147103","type":"CDM"},{"code":"69238147103","type":"NDC"}],"standard_charges":[{"gross_charge":27.67,"discounted_cash":20.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BUMETANIDE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69238149001","type":"CDM"},{"code":"69238149001","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"POTASSIUM CHLORIDE POWDER PACKET 20 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69238161708","type":"CDM"},{"code":"69238161708","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FLURBIPROFEN SODIUM OPHTH SOLN 0.03%","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx69292072225","type":"CDM"},{"code":"69292072225","type":"NDC"}],"standard_charges":[{"gross_charge":148.41,"discounted_cash":111.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NIFEDIPINE CAP 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69315021201","type":"CDM"},{"code":"69315021201","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CIPROFLOXACIN HCL OPHTH SOLN 0.3% (BASE EQUIVALENT)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx69315030802","type":"CDM"},{"code":"69315030802","type":"NDC"}],"standard_charges":[{"gross_charge":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HYDROCORTISONE PERIANAL CREAM 2.5%","drug_information":{"unit":28.0,"type":"GM"},"code_information":[{"code":"Rx69315031228","type":"CDM"},{"code":"69315031228","type":"NDC"}],"standard_charges":[{"gross_charge":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LORAZEPAM TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69315090401","type":"CDM"},{"code":"69315090401","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LORAZEPAM TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69315090501","type":"CDM"},{"code":"69315090501","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NOREPINEPHRINE-NACL IV SOLUTION 16 MG/250ML-0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx69374031525","type":"CDM"},{"code":"69374031525","type":"NDC"}],"standard_charges":[{"gross_charge":260.34,"discounted_cash":195.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ALBUTEROL SULFATE SOLN NEBU 0.5% (5 MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx69374033005","type":"CDM"},{"code":"J7611","type":"HCPCS"},{"code":"69374033005","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"METHACHOLINE 16 MG/ML INHALATION SOLUTION","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx69374053603","type":"CDM"},{"code":"J7674","type":"HCPCS"},{"code":"69374053603","type":"NDC"}],"standard_charges":[{"gross_charge":101.18,"discounted_cash":75.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"METHACHOLINE 0.0625 MG/ML INHALATION SOLUTION","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx69374053703","type":"CDM"},{"code":"J7674","type":"HCPCS"},{"code":"69374053703","type":"NDC"}],"standard_charges":[{"gross_charge":101.18,"discounted_cash":75.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"METHACHOLINE 0.25 MG/ML INHALATION SOLUTION","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx69374053803","type":"CDM"},{"code":"J7674","type":"HCPCS"},{"code":"69374053803","type":"NDC"}],"standard_charges":[{"gross_charge":101.18,"discounted_cash":75.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"METHACHOLINE 1 MG/ML INHALATION SOLUTION","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx69374053903","type":"CDM"},{"code":"J7674","type":"HCPCS"},{"code":"69374053903","type":"NDC"}],"standard_charges":[{"gross_charge":101.18,"discounted_cash":75.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"METHACHOLINE 4 MG/ML INHALATION SOLUTION","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx69374054003","type":"CDM"},{"code":"J7674","type":"HCPCS"},{"code":"69374054003","type":"NDC"}],"standard_charges":[{"gross_charge":101.18,"discounted_cash":75.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SODIUM CHLORIDE SOLN NEBU 0.9%","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx69374054103","type":"CDM"},{"code":"69374054103","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"METHACHOLINE CHLORIDE INHALATION SOLN KIT","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx69374054206","type":"CDM"},{"code":"J7999","type":"HCPCS"},{"code":"69374054206","type":"NDC"}],"standard_charges":[{"gross_charge":101.18,"discounted_cash":75.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"EPINEPHRINE HCL-NACL IV SOL PREF SYR 1000 MCG/10ML-0.9%,EPINEPHRINE SOLN PREFILLED SYRINGE 1 MG/10ML (0.1 MG/ML),EPINEPHRINE-NACL SOLN PREF SYR 1 MG/10ML-0.9% (100 MCG/ML),EPINEPHRINE IV SOLN PREFILLED SYRINGE 1 MG/10ML (0.1 MG/ML),EPINEPHRINE IV SOLN 1 MG/10ML (0.1 MG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx69374092510","type":"CDM"},{"code":"J0165","type":"HCPCS"},{"code":"69374092510","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LABETALOL HCL IV SOLN 5 MG/ML,LABETALOL HCL IV SOLN PREFILLED SYRINGE 20 MG/4ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 50 MG/10ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 25 MG/5ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 10 MG/2ML (5 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx69374094604","type":"CDM"},{"code":"J1920","type":"HCPCS"},{"code":"69374094604","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MORPHINE SULFATE INJ 1 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx69374097902","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"69374097902","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx69374098301","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"69374098301","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx69374098302","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"69374098302","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HYDROMORPHONE 1 MG/ML PCA/INFUSION,HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% IV SOLN 50 MG/50ML,HYDROMORPHONE HCL-NACL SOLN PREF SYR 30 MG/30ML-0.9%,HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% IV SOLN 30 MG/30ML,HYDROMORPHONE HCL-NACL SOLN PREF SYR 50 MG/50ML-0.9%,HYDROMORPHONE HCL-NACL SOLN PREF SYR 55 MG/55ML-0.9%,HYDROMORPHONE HCL-NACL SOLN PREF SYR 15 MG/15ML-0.9%,HYDROMORPHONE HCL-NACL SOLN PREF SYR 25 MG/25ML-0.9%,HYDROMORPHONE HCL-NACL INJ SOLN PREF SYR 30 MG/30ML-0.9%,HYDROMORPHONE HCL IV SOLN 1 MG/ML,HYDROMORPHONE HCL IV SOLN PREF SYR 50 MG/50ML,HYDROMORPHONE HCL-NACL INJ SOLN PREF SYR 25 MG/25ML-0.9%,HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% INJ 50 MG/50ML,HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% INJ 100 MG/100ML,HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% IV SOLN 100 MG/100ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx69374098330","type":"CDM"},{"code":"J7999","type":"HCPCS"},{"code":"69374098330","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL SOLN PREFILLED SYRINGE 10 MG/ML (1%)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx69374098505","type":"CDM"},{"code":"69374098505","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DOFETILIDE CAP 125 MCG (0.125 MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69452013117","type":"CDM"},{"code":"69452013117","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DOFETILIDE CAP 250 MCG (0.25 MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69452013217","type":"CDM"},{"code":"69452013217","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DOFETILIDE CAP 500 MCG (0.5 MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69452013317","type":"CDM"},{"code":"69452013317","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PHENYLEPHRINE HCL NASAL SOLN 1%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx69536010015","type":"CDM"},{"code":"69536010015","type":"NDC"}],"standard_charges":[{"gross_charge":4.98,"discounted_cash":3.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NALOXONE HCL NASAL SPRAY 4 MG/0.1ML","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69547062702","type":"CDM"},{"code":"69547062702","type":"NDC"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":17.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CARISOPRODOL TAB 350 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69584011110","type":"CDM"},{"code":"69584011110","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FOSNETUPITANT-PALONOSETRON FOR IV SOLN 235-0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69639010201","type":"CDM"},{"code":"J1454","type":"HCPCS"},{"code":"69639010201","type":"NDC"}],"standard_charges":[{"gross_charge":2491.4,"discounted_cash":1868.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SODIUM ACETATE INJ 2 MEQ/ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx69784023020","type":"CDM"},{"code":"69784023020","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SODIUM ACETATE INJ 2 MEQ/ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx69784023120","type":"CDM"},{"code":"69784023120","type":"NDC"}],"standard_charges":[{"gross_charge":112.88,"discounted_cash":84.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SODIUM ACETATE INJ 4 MEQ/ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx69784023210","type":"CDM"},{"code":"69784023210","type":"NDC"}],"standard_charges":[{"gross_charge":164.92,"discounted_cash":123.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TRANEXAMIC ACID TAB 650 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69918030130","type":"CDM"},{"code":"69918030130","type":"NDC"}],"standard_charges":[{"gross_charge":18.17,"discounted_cash":13.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DESMOPRESSIN ACETATE PRESERVATIVE FREE (PF) INJ 4 MCG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx69918089910","type":"CDM"},{"code":"J2597","type":"HCPCS"},{"code":"69918089910","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DESMOPRESSIN ACETATE INJ 4 MCG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx69918090110","type":"CDM"},{"code":"J2597","type":"HCPCS"},{"code":"69918090110","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"OXYMETAZOLINE HCL NASAL SOLN 0.05%","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx70000000101","type":"CDM"},{"code":"70000000101","type":"NDC"}],"standard_charges":[{"gross_charge":4.1,"discounted_cash":3.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ASPIRIN TAB DELAYED RELEASE 325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70000001401","type":"CDM"},{"code":"70000001401","type":"NDC"}],"standard_charges":[{"gross_charge":0.52,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HYDROGEN PEROXIDE SOLN 3%","drug_information":{"unit":236.0,"type":"ML"},"code_information":[{"code":"Rx70000002201","type":"CDM"},{"code":"70000002201","type":"NDC"}],"standard_charges":[{"gross_charge":1.44,"discounted_cash":1.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CAMPHOR-MENTHOL-METHYL SALICYLATE CREAM 4-10-30%","drug_information":{"unit":56.7,"type":"GM"},"code_information":[{"code":"Rx70000020802","type":"CDM"},{"code":"70000020802","type":"NDC"}],"standard_charges":[{"gross_charge":3.61,"discounted_cash":2.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ISOPROPYL ALCOHOL 70%","drug_information":{"unit":473.0,"type":"ML"},"code_information":[{"code":"Rx70000049701","type":"CDM"},{"code":"70000049701","type":"NDC"}],"standard_charges":[{"gross_charge":2.39,"discounted_cash":1.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DICLOFENAC SODIUM GEL 1% (1.16% DIETHYLAMINE EQUIV)","drug_information":{"unit":100.0,"type":"GM"},"code_information":[{"code":"Rx70000055502","type":"CDM"},{"code":"70000055502","type":"NDC"}],"standard_charges":[{"gross_charge":8.2,"discounted_cash":6.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NITROGLYCERIN TL SOLN 0.4 MG/SPRAY (400 MCG/SPRAY)","drug_information":{"unit":4.9,"type":"GM"},"code_information":[{"code":"Rx70003030065","type":"CDM"},{"code":"70003030065","type":"NDC"}],"standard_charges":[{"gross_charge":451.53,"discounted_cash":338.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FENTANYL 50 MCG/ML PCA/INFUSION,FENTANYL CITRATE IV SOLN 2500 MCG/50ML,FENTANYL CITRATE IV SOLN 5000 MCG/100ML,FENTANYL CITRATE INJ 1500 MCG/30ML,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 1500 MCG/30ML,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 2750 MCG/55ML,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 2500 MCG/50ML,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 1000 MCG/20ML,FENTANYL CITRATE IV SOLN 1500 MCG/30ML,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 1250 MCG/25ML,FENTANYL CITRATE-NACL SOLN PREF SYR 2500 MCG/50ML-0.9%,FENTANYL CITRATE-NACL 0.9% IV SOLN 2.5 MG/50ML,FENTANYL CITRATE-NACL 0.9% IV SOLN 5 MG/100ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx70004020016","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"70004020016","type":"NDC"}],"standard_charges":[{"gross_charge":246.06,"discounted_cash":184.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"KETAMINE HCL-NACL INJ SOLN PREF SY 50 MG/5ML-0.9% (10MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx70004043009","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"70004043009","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DILTIAZEM HCL 125 MG/125ML IN DEXTROSE 5% IV SOLN (1 MG/ML)","drug_information":{"unit":125.0,"type":"ML"},"code_information":[{"code":"Rx70004054035","type":"CDM"},{"code":"70004054035","type":"NDC"}],"standard_charges":[{"gross_charge":267.42,"discounted_cash":200.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PHENYLEPHRINE-NACL IV SOLUTION 25 MG/250ML-0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx70004080740","type":"CDM"},{"code":"J7999","type":"HCPCS"},{"code":"70004080740","type":"NDC"}],"standard_charges":[{"gross_charge":554.65,"discounted_cash":415.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DEXAMETHASONE SOD PHOSPHATE PRESERVATIVE FREE INJ 10 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx70069002125","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"70069002125","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NALOXONE HCL INJ 0.4 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx70069007110","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"70069007110","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"VERAPAMIL HCL IV SOLN 2.5 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx70069027125","type":"CDM"},{"code":"70069027125","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SUCCINYLCHOLINE CHLORIDE INJ 20 MG/ML,SUCCINYLCHOLINE CHLORIDE SOL PREF SYR 100 MG/5ML (20 MG/ML),SUCCINYLCHOLINE CHLORIDE SOL PREF SYR 200 MG/10ML (20 MG/ML),SUCCINYLCHOLINE CL INJ SOL PREF SYR 100 MG/5ML (20 MG/ML),SUCCINYLCHOLINE CL INJ SOL PREF SYR 140 MG/7ML (20 MG/ML),SUCCINYLCHOLINE CL INJ SOL PREF SYR 200 MG/10ML (20 MG/ML)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx70092108746","type":"CDM"},{"code":"J0330","type":"HCPCS"},{"code":"70092108746","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SUCCINYLCHOLINE CHLORIDE INJ 20 MG/ML,SUCCINYLCHOLINE CHLORIDE SOL PREF SYR 100 MG/5ML (20 MG/ML),SUCCINYLCHOLINE CHLORIDE SOL PREF SYR 200 MG/10ML (20 MG/ML),SUCCINYLCHOLINE CL INJ SOL PREF SYR 100 MG/5ML (20 MG/ML),SUCCINYLCHOLINE CL INJ SOL PREF SYR 140 MG/7ML (20 MG/ML),SUCCINYLCHOLINE CL INJ SOL PREF SYR 200 MG/10ML (20 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx70092108746","type":"CDM"},{"code":"J0330","type":"HCPCS"},{"code":"70092108746","type":"NDC"}],"standard_charges":[{"gross_charge":267.83,"discounted_cash":200.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LIDOCAINE-EPINEPHRINE-TETRACAINE GEL 4-0.05-0.5%,LIDOCAINE HCL-EPINEPHRINE BIT-TETRACAINE HCL GEL 4-0.18-0.5%,LIDOCAINE HCL-EPINEPHRINE BIT-TETRACAINE HCL GEL 4-0.09-0.5%,LIDOCAINE HCL-RACEPINEPHRINE-TETRACAINE HCL GEL 4-0.05-0.5%","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx70092113544","type":"CDM"},{"code":"70092113544","type":"NDC"}],"standard_charges":[{"gross_charge":35.75,"discounted_cash":26.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SODIUM CITRATE IV SOLN PREFILLED SYRINGE 4%,SODIUM CITRATE LOCK FLUSH IV SOLN PREF SYR 120 MG/3ML (4%),SODIUM CITRATE SOLN PREFILLED SYRINGE 4%,SODIUM CITRATE LOCK FLUSH IV SOLN 4%,ANTICOAGULANT SODIUM CITRATE SOLN 4%","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx70092114843","type":"CDM"},{"code":"70092114843","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"FENTANYL-BUPIVACAINE 2 MCG-0.1 %,FENTANYL 0.2 MG/100ML-BUPIV 0.1%-NACL 0.9% EPIDURAL INJ,FENTANYL 0.5 MG/250ML-BUPIV 0.1%-NACL 0.9% PF EPIDURAL INJ","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx70092116037","type":"CDM"},{"code":"70092116037","type":"NDC"}],"standard_charges":[{"gross_charge":113.61,"discounted_cash":85.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ROPIV-EPI-CLONID-KETOROLAC PREF SYR 123-0.25-0.04-15 MG/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx70092143350","type":"CDM"},{"code":"70092143350","type":"NDC"}],"standard_charges":[{"gross_charge":397.65,"discounted_cash":298.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NOREPINEPHRINE-NACL IV SOLUTION 16 MG/250ML-0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx70092146805","type":"CDM"},{"code":"70092146805","type":"NDC"}],"standard_charges":[{"gross_charge":268.83,"discounted_cash":201.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"EPHEDRINE SULF-NACL SOLN PREF SYR 50 MG/5ML-0.9% (10 MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx70092147744","type":"CDM"},{"code":"J7999","type":"HCPCS"},{"code":"70092147744","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PHENYLEPHRINE-NACL PREF SYR 1 MG/10ML-0.9% (100 MCG/ML),PHENYLEPHRINE HCL IV SOLN PREF SYR 1 MG/10ML (100 MCG/ML),PHENYLEPHRINE HCL IV SOLN 1 MG/10ML (100 MCG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx70092204646","type":"CDM"},{"code":"J7999","type":"HCPCS"},{"code":"70092204646","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ROCURONIUM BROMIDE IV SOLN 50 MG/5ML (10 MG/ML),ROCURONIUM BROMIDE IV SOLN PREF SYRINGE 50 MG/5ML (10 MG/ML),ROCURONIUM BROMIDE IV SOLN 100 MG/10ML (10 MG/ML),ROCURONIUM BROMIDE IV SOLN PREF SYR 100 MG/10ML (10 MG/ML),ROCURONIUM BROMIDE IV SOLN PREF SYRINGE 20 MG/2ML (10 MG/ML),ROCURONIUM BROMIDE IV SOLN PREF SYR 75 MG/7.5ML (10 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx70092245244","type":"CDM"},{"code":"70092245244","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"INDOCYANINE GREEN FOR INJ SOLN 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70100082502","type":"CDM"},{"code":"70100082502","type":"NDC"}],"standard_charges":[{"gross_charge":1197.55,"discounted_cash":898.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TRIAMCINOLONE ACETONIDE INJ SUSP 40 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx70121104901","type":"CDM"},{"code":"J3301","type":"HCPCS"},{"code":"70121104901","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TRIAMCINOLONE ACETONIDE INJ SUSP 40 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx70121116801","type":"CDM"},{"code":"J3301","type":"HCPCS"},{"code":"70121116801","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HEPATITIS B IMMUNE GLOBULIN (HUMAN) INJ SOLN 312 UNIT/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70257005151","type":"CDM"},{"code":"J1573","type":"HCPCS"},{"code":"70257005151","type":"NDC"}],"standard_charges":[{"gross_charge":2249.22,"discounted_cash":1686.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HEPATITIS B IMMUNE GLOBULIN (HUMAN) INJ SOLN 312 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx70257005251","type":"CDM"},{"code":"J1573","type":"HCPCS"},{"code":"70257005251","type":"NDC"}],"standard_charges":[{"gross_charge":759.6,"discounted_cash":569.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NITROFURANTOIN SUSP 25 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx70408023932","type":"CDM"},{"code":"70408023932","type":"NDC"}],"standard_charges":[{"gross_charge":245.28,"discounted_cash":183.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 5 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70436002282","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"70436002282","type":"NDC"}],"standard_charges":[{"gross_charge":164.04,"discounted_cash":123.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"EPTIFIBATIDE IV SOLN 75 MG/100ML (0.75 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx70436002780","type":"CDM"},{"code":"J1327","type":"HCPCS"},{"code":"70436002780","type":"NDC"}],"standard_charges":[{"gross_charge":414.14,"discounted_cash":310.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BUPROPION HCL TAB ER 12HR 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70436005801","type":"CDM"},{"code":"70436005801","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"INFLUENZA VAC TYPE A&B SURFACE ANT ADJ SUSP PREF SYR 0.5 ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx70461002504","type":"CDM"},{"code":"90653","type":"HCPCS"},{"code":"70461002504","type":"NDC"}],"standard_charges":[{"gross_charge":465.92,"discounted_cash":349.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"INFLUENZA VIRUS VAC TISS-CULT SUBUNIT SUSP PREF SYR 0.5 ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx70461065504","type":"CDM"},{"code":"90661","type":"HCPCS"},{"code":"70461065504","type":"NDC"}],"standard_charges":[{"gross_charge":186.62,"discounted_cash":139.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"VARICELLA-ZOSTER IMMUNE GLOB (HUMAN) IM INJ 125 UNIT/1.2ML","drug_information":{"unit":1.2,"type":"ML"},"code_information":[{"code":"Rx70504012602","type":"CDM"},{"code":"90396","type":"HCPCS"},{"code":"70504012602","type":"NDC"}],"standard_charges":[{"gross_charge":6583.8,"discounted_cash":4937.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM NA FOR INJ 3.375 GM (3-0.375 GM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70594007901","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"70594007901","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70594009601","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"70594009601","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70594009701","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"70594009701","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70594009702","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"70594009702","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"GLYCOPYRROLATE INJ 1 MG/5ML (0.2 MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx70700016722","type":"CDM"},{"code":"J1596","type":"HCPCS"},{"code":"70700016722","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PHYTONADIONE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70710101401","type":"CDM"},{"code":"70710101401","type":"NDC"}],"standard_charges":[{"gross_charge":115.57,"discounted_cash":86.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"COLCHICINE TAB 0.6 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70710135103","type":"CDM"},{"code":"70710135103","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SUCCINYLCHOLINE CHLORIDE INJ 20 MG/ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx70710137701","type":"CDM"},{"code":"J0330","type":"HCPCS"},{"code":"70710137701","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LIDOCAINE OINT 5%","drug_information":{"unit":35.44,"type":"GM"},"code_information":[{"code":"Rx70752011303","type":"CDM"},{"code":"70752011303","type":"NDC"}],"standard_charges":[{"gross_charge":35.86,"discounted_cash":26.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PHENYLEPHRINE HCL IV SOLN 10 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70756062285","type":"CDM"},{"code":"J2371","type":"HCPCS"},{"code":"70756062285","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"AZITHROMYCIN IV FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70860010010","type":"CDM"},{"code":"J0456","type":"HCPCS"},{"code":"70860010010","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PACLITAXEL IV CONC 300 MG/50ML (6 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx70860020050","type":"CDM"},{"code":"J9267","type":"HCPCS"},{"code":"70860020050","type":"NDC"}],"standard_charges":[{"gross_charge":262.69,"discounted_cash":197.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"THIOTHIXENE CAP 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70954001510","type":"CDM"},{"code":"70954001510","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DAPSONE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70954013520","type":"CDM"},{"code":"70954013520","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MITOMYCIN FOR INJ 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71288013951","type":"CDM"},{"code":"J9280","type":"HCPCS"},{"code":"71288013951","type":"NDC"}],"standard_charges":[{"gross_charge":2088.15,"discounted_cash":1566.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx71288040231","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"71288040231","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"GLYCOPYRROLATE INJ 0.2 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx71288041401","type":"CDM"},{"code":"J1596","type":"HCPCS"},{"code":"71288041401","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"GLYCOPYRROLATE INJ 0.2 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx71288041403","type":"CDM"},{"code":"J1596","type":"HCPCS"},{"code":"71288041403","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CISATRACURIUM BESYLATE IV SOLN 20 MG/10ML (2 MG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx71288071410","type":"CDM"},{"code":"71288071410","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CISATRACURIUM BESYLATE IV SOLN 20 MG/10ML (2 MG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx71288071411","type":"CDM"},{"code":"71288071411","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ROCURONIUM BROMIDE IV SOLN PREF SYRINGE 50 MG/5ML (10 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx71449000411","type":"CDM"},{"code":"J7999","type":"HCPCS"},{"code":"71449000411","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HYDROMORPHONE 1 MG/ML PCA/INFUSION,HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% IV SOLN 50 MG/50ML,HYDROMORPHONE HCL-NACL SOLN PREF SYR 30 MG/30ML-0.9%,HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% IV SOLN 30 MG/30ML,HYDROMORPHONE HCL-NACL SOLN PREF SYR 50 MG/50ML-0.9%,HYDROMORPHONE HCL-NACL SOLN PREF SYR 55 MG/55ML-0.9%,HYDROMORPHONE HCL-NACL SOLN PREF SYR 15 MG/15ML-0.9%,HYDROMORPHONE HCL-NACL SOLN PREF SYR 25 MG/25ML-0.9%,HYDROMORPHONE HCL-NACL INJ SOLN PREF SYR 30 MG/30ML-0.9%,HYDROMORPHONE HCL IV SOLN 1 MG/ML,HYDROMORPHONE HCL IV SOLN PREF SYR 50 MG/50ML,HYDROMORPHONE HCL-NACL INJ SOLN PREF SYR 25 MG/25ML-0.9%,HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% INJ 50 MG/50ML,HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% INJ 100 MG/100ML,HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% IV SOLN 100 MG/100ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx71449001832","type":"CDM"},{"code":"J7999","type":"HCPCS"},{"code":"71449001832","type":"NDC"}],"standard_charges":[{"gross_charge":131.06,"discounted_cash":98.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MORPHINE SULFATE IV SOLN 5 MG/ML,MORPHINE SULFATE-NACL SOLN PREF SYR 150 MG/30ML-0.9%","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx71449002232","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"71449002232","type":"NDC"}],"standard_charges":[{"gross_charge":100.27,"discounted_cash":75.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"KETAMINE HCL SOLN PREF SYR 50 MG/5ML (10 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx71449006811","type":"CDM"},{"code":"J7999","type":"HCPCS"},{"code":"71449006811","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ROPIVACAINE HCL 0.2% ON-Q SINGLE LUMEN PUMP","drug_information":{"unit":545.0,"type":"ML"},"code_information":[{"code":"Rx71449007951","type":"CDM"},{"code":"J7999","type":"HCPCS"},{"code":"71449007951","type":"NDC"}],"standard_charges":[{"gross_charge":2821.41,"discounted_cash":2116.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NEOSTIGMINE METHYLSULFATE SOLN PREF SYR 5 MG/5ML (1 MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx71449010311","type":"CDM"},{"code":"J2710","type":"HCPCS"},{"code":"71449010311","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SKIN PROTECTANTS MISC - CREAM","drug_information":{"unit":454.0,"type":"GM"},"code_information":[{"code":"Rx72140000021","type":"CDM"},{"code":"72140000021","type":"NDC"}],"standard_charges":[{"gross_charge":13.21,"discounted_cash":9.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SKIN PROTECTANTS MISC - CREAM","drug_information":{"unit":113.0,"type":"GM"},"code_information":[{"code":"Rx72140000022","type":"CDM"},{"code":"72140000022","type":"NDC"}],"standard_charges":[{"gross_charge":6.94,"discounted_cash":5.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DEXRAZOXANE HCL FOR INJ 500 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72266010101","type":"CDM"},{"code":"J1190","type":"HCPCS"},{"code":"72266010101","type":"NDC"}],"standard_charges":[{"gross_charge":1721.53,"discounted_cash":1291.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE INJ 30 MG/ML","drug_information":{"unit":0.333333333333333,"type":"ML"},"code_information":[{"code":"Rx72266011825","type":"CDM"},{"code":"J1885","type":"HCPCS"},{"code":"72266011825","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ONDANSETRON HCL INJ 40 MG/20ML (2 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx72266012401","type":"CDM"},{"code":"J2405","type":"HCPCS"},{"code":"72266012401","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ZIPRASIDONE MESYLATE FOR INJ 20 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72266016010","type":"CDM"},{"code":"J3486","type":"HCPCS"},{"code":"72266016010","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DIAZEPAM INJ 5 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx72572014002","type":"CDM"},{"code":"J3360","type":"HCPCS"},{"code":"72572014002","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HYDRALAZINE HCL INJ 20 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx72572026525","type":"CDM"},{"code":"J0360","type":"HCPCS"},{"code":"72572026525","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx72572037001","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"72572037001","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx72572037025","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"72572037025","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LORAZEPAM INJ 2 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx72572038025","type":"CDM"},{"code":"J2060","type":"HCPCS"},{"code":"72572038025","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MIDAZOLAM HCL INJ 2 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 10 MG/10ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 5 MG/5ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 2 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/5ML (BASE EQUIVALENT),MIDAZOLAM INJ SOLN PREFILLED SYRINGE 2 MG/2ML,MIDAZOLAM IV SOLN PREFILLED SYRINGE 2 MG/2ML,MIDAZOLAM INJ SOLN PREFILLED SYRINGE 3 MG/3ML,MIDAZOLAM INJ SOLN PREFILLED SYRINGE 5 MG/5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx72572043210","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"72572043210","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MORPHINE SULFATE IV SOLN 4 MG/ML","drug_information":{"unit":0.75,"type":"ML"},"code_information":[{"code":"Rx72572044025","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"72572044025","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 10 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72572080501","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"72572080501","type":"NDC"}],"standard_charges":[{"gross_charge":239.32,"discounted_cash":179.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE IM INJ 60 MG/2ML (30 MG/ML)","drug_information":{"unit":0.333333333333333,"type":"ML"},"code_information":[{"code":"Rx72611072525","type":"CDM"},{"code":"J1885","type":"HCPCS"},{"code":"72611072525","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 500 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72611076110","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"72611076110","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72611076510","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"72611076510","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ROCURONIUM BROMIDE IV SOLN PREF SYRINGE 50 MG/5ML (10 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx73702012915","type":"CDM"},{"code":"73702012915","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"INDOMETHACIN SUPPOS 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx73702014071","type":"CDM"},{"code":"73702014071","type":"NDC"}],"standard_charges":[{"gross_charge":1686.48,"discounted_cash":1264.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ZINC OXIDE CREAM 13%","drug_information":{"unit":57.0,"type":"GM"},"code_information":[{"code":"Rx74300000300","type":"CDM"},{"code":"74300000300","type":"NDC"}],"standard_charges":[{"gross_charge":5.34,"discounted_cash":4.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PHENAZOPYRIDINE HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx75826011410","type":"CDM"},{"code":"75826011410","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PHENAZOPYRIDINE HCL TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx75826011510","type":"CDM"},{"code":"75826011510","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PB-HYOSCY-ATROP-SCOPOL ELIX 16.2-0.1037-0.0194-0.0065 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx75826012804","type":"CDM"},{"code":"75826012804","type":"NDC"}],"standard_charges":[{"gross_charge":37.57,"discounted_cash":28.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PB-HYOSCY-ATROP-SCOPOL ELIX 16.2-0.1037-0.0194-0.0065 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx75826012816","type":"CDM"},{"code":"75826012816","type":"NDC"}],"standard_charges":[{"gross_charge":38.85,"discounted_cash":29.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NEOSTIGMINE METHYLSULFATE IV SOLN 10 MG/10 ML (1 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx76014000310","type":"CDM"},{"code":"J2710","type":"HCPCS"},{"code":"76014000310","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PHENYLEPHRINE HCL IV SOLN 10 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx76014000433","type":"CDM"},{"code":"J2371","type":"HCPCS"},{"code":"76014000433","type":"NDC"}],"standard_charges":[{"gross_charge":98.22,"discounted_cash":73.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"EPHEDRINE SULFATE IV SOLN 50 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx76014000525","type":"CDM"},{"code":"76014000525","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"EPHEDRINE SULFATE IV SOLN 50 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx76014000530","type":"CDM"},{"code":"76014000530","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MORPHINE SULFATE INJ 2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx76045000410","type":"CDM"},{"code":"J2272","type":"HCPCS"},{"code":"76045000410","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MORPHINE SULFATE INJ 4 MG/ML","drug_information":{"unit":0.75,"type":"ML"},"code_information":[{"code":"Rx76045000510","type":"CDM"},{"code":"J2272","type":"HCPCS"},{"code":"76045000510","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MORPHINE SULFATE INJ 4 MG/ML","drug_information":{"unit":0.75,"type":"ML"},"code_information":[{"code":"Rx76045000511","type":"CDM"},{"code":"J2272","type":"HCPCS"},{"code":"76045000511","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx76045000905","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"76045000905","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 2 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx76045001010","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"76045001010","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"METOCLOPRAMIDE HCL INJ 5 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx76045010120","type":"CDM"},{"code":"J2765","type":"HCPCS"},{"code":"76045010120","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NEOSTIGMINE METHYLSULFATE SOLN PREF SYR 3 MG/3ML (1 MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx76045038313","type":"CDM"},{"code":"J2710","type":"HCPCS"},{"code":"76045038313","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CARFILZOMIB FOR INJ 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx76075010101","type":"CDM"},{"code":"J9047","type":"HCPCS"},{"code":"76075010101","type":"NDC"}],"standard_charges":[{"gross_charge":25161.99,"discounted_cash":18871.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"IPRATROPIUM BROMIDE INHAL SOLN 0.02%","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx76204010001","type":"CDM"},{"code":"J7644","type":"HCPCS"},{"code":"76204010001","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"IPRATROPIUM BROMIDE INHAL SOLN 0.02%","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx76204010025","type":"CDM"},{"code":"J7644","type":"HCPCS"},{"code":"76204010025","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PHYTONADIONE INJ 1 MG/0.5ML (2 MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx76329124001","type":"CDM"},{"code":"J3430","type":"HCPCS"},{"code":"76329124001","type":"NDC"}],"standard_charges":[{"gross_charge":160.42,"discounted_cash":120.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MORPHINE SULFATE IV SOLN 1 MG/ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx76329191101","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"76329191101","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"DEXTROSE INJ 50%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx76329330101","type":"CDM"},{"code":"76329330101","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CALCIUM CHLORIDE INJ 10%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx76329330401","type":"CDM"},{"code":"76329330401","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ATROPINE SULFATE SOLN PREFILL SYR 0.5 MG/5ML (0.1 MG/ML),ATROPINE SULFATE SOLN PREFILL SYR 1 MG/10ML (0.1 MG/ML)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx76329333901","type":"CDM"},{"code":"J0461","type":"HCPCS"},{"code":"76329333901","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SODIUM BICARBONATE IV SOLN 8.4%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx76329335201","type":"CDM"},{"code":"76329335201","type":"NDC"}],"standard_charges":[{"gross_charge":119.47,"discounted_cash":89.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"NALOXONE HCL SOLN PREFILLED SYRINGE 2 MG/2ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx76329336901","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"76329336901","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"LIDOCAINE HCL (CARDIAC) IV SOLN PREF SYR 100 MG/5ML (2%),LIDOCAINE HCL(CARDIAC) IV PF SOLN PREF SYR 100 MG/5ML (2%),LIDOCAINE HCL (CARDIAC) IV SOLN 100 MG/5ML (2%),LIDOCAINE HCL (CARDIAC) IV PF SOLN 100 MG/5ML (2%),LIDOCAINE HCL LOCAL SOLN PREFILLED SYRINGE 100 MG/5ML (2%),LIDOCAINE HCL (CARDIAC) IV SOLN PREF SYR 60 MG/3ML (2%),LIDOCAINE HCL (CARDIAC) IV SOLN PREF SYR 200 MG/10ML (2%),LIDOCAINE HCL LOCAL IV SOLN PREF SYRINGE 100 MG/5ML (2%)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx76329339001","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"76329339001","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PROCAINAMIDE HCL INJ 100 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx76329339905","type":"CDM"},{"code":"J2690","type":"HCPCS"},{"code":"76329339905","type":"NDC"}],"standard_charges":[{"gross_charge":351.47,"discounted_cash":263.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SODIUM BICARBONATE TAB 650 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx77333083110","type":"CDM"},{"code":"77333083110","type":"NDC"}],"standard_charges":[{"gross_charge":0.61,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SODIUM CHLORIDE TAB 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx77333083525","type":"CDM"},{"code":"77333083525","type":"NDC"}],"standard_charges":[{"gross_charge":0.66,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PYRIDOXINE HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx77333094010","type":"CDM"},{"code":"77333094010","type":"NDC"}],"standard_charges":[{"gross_charge":0.62,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PYRIDOXINE HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx77333094025","type":"CDM"},{"code":"77333094025","type":"NDC"}],"standard_charges":[{"gross_charge":0.62,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PHENOL LIQUID 1.4%","drug_information":{"unit":177.0,"type":"ML"},"code_information":[{"code":"Rx78112001104","type":"CDM"},{"code":"78112001104","type":"NDC"}],"standard_charges":[{"gross_charge":6.16,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"PHENOL LIQUID 1.4%","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx78112069480","type":"CDM"},{"code":"78112069480","type":"NDC"}],"standard_charges":[{"gross_charge":2.94,"discounted_cash":2.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MOMETASONE FUROATE INHAL POWD 220 MCG/ACT (BREATH ACTIVATED)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx78206011402","type":"CDM"},{"code":"78206011402","type":"NDC"}],"standard_charges":[{"gross_charge":485.97,"discounted_cash":364.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MOMETASONE FUROATE INHAL POWD 110 MCG/ACT (BREATH ACTIVATED)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx78206011501","type":"CDM"},{"code":"78206011501","type":"NDC"}],"standard_charges":[{"gross_charge":383.43,"discounted_cash":287.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ACETYLCYSTEINE CAP 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx79854040975","type":"CDM"},{"code":"79854040975","type":"NDC"}],"standard_charges":[{"gross_charge":0.56,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"SODIUM PHOSPHATES - ENEMA","drug_information":{"unit":133.0,"type":"ML"},"code_information":[{"code":"Rx80196056775","type":"CDM"},{"code":"80196056775","type":"NDC"}],"standard_charges":[{"gross_charge":1.96,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"ORAL ELECTROLYTE SOLUTION","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx80681001400","type":"CDM"},{"code":"80681001400","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":3.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"MELATONIN TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx80681004100","type":"CDM"},{"code":"80681004100","type":"NDC"}],"standard_charges":[{"gross_charge":0.51,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"CHOLECALCIFEROL TAB 25 MCG (1000 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx80681016800","type":"CDM"},{"code":"80681016800","type":"NDC"}],"standard_charges":[{"gross_charge":0.51,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"TRANEXAMIC ACID-SODIUM CHLORIDE IV SOLN 1000 MG/100ML-0.7%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx80830232901","type":"CDM"},{"code":"J3290","type":"HCPCS"},{"code":"80830232901","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"BISACODYL SUPPOS 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx81421002105","type":"CDM"},{"code":"81421002105","type":"NDC"}],"standard_charges":[{"gross_charge":1.42,"discounted_cash":1.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"INSULIN GLARGINE-YFGN INJ 100 UNIT/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx83257001411","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"83257001411","type":"NDC"}],"standard_charges":[{"gross_charge":601.97,"discounted_cash":451.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION"}]},{"description":"K-WIRE STYLE 7 - 1.1MM X 102MM","code_information":[{"code":"Sx00-0186-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"725214","type":"LOCAL"},{"code":"736661","type":"LOCAL"}],"standard_charges":[{"gross_charge":23.62,"discounted_cash":17.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 725214 = Hospital System Supply Identifier | 736661 = Lawson ID"}]},{"description":"K-WIRE STYLE 1 - 1.6MM X 229MM","code_information":[{"code":"Sx00-0186-078","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"725212","type":"LOCAL"},{"code":"736659","type":"LOCAL"}],"standard_charges":[{"gross_charge":23.62,"discounted_cash":17.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 725212 = Hospital System Supply Identifier | 736659 = Lawson ID"}]},{"description":"PLATE L1 ORTHOG BSSO LADR 39MM","code_information":[{"code":"Sx00-020-09-0","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"779930","type":"LOCAL"},{"code":"773375","type":"LOCAL"}],"standard_charges":[{"gross_charge":807.79,"discounted_cash":605.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 779930 = Hospital System Supply Identifier | 773375 = Lawson ID"}]},{"description":"PIN KNOWLES 5/32 X 3-1/2IN","code_information":[{"code":"Sx00-0281-001","type":"CDM"},{"code":"272","type":"RC"},{"code":"35992","type":"LOCAL"},{"code":"245952","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.37,"discounted_cash":192.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 35992 = Hospital System Supply Identifier | 245952 = Lawson ID"}]},{"description":"PIN KNOWLES 5/32 X 3-3/4IN","code_information":[{"code":"Sx00-0281-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"36003","type":"LOCAL"},{"code":"245971","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.37,"discounted_cash":192.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 36003 = Hospital System Supply Identifier | 245971 = Lawson ID"}]},{"description":"PIN KNOWLES 5/32 X 4-1/2IN","code_information":[{"code":"Sx00-0281-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"36002","type":"LOCAL"},{"code":"245970","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.37,"discounted_cash":192.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 36002 = Hospital System Supply Identifier | 245970 = Lawson ID"}]},{"description":"PIN KNOWLES 5/32 X 6IN","code_information":[{"code":"Sx00-0281-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"36001","type":"LOCAL"},{"code":"245961","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.37,"discounted_cash":192.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 36001 = Hospital System Supply Identifier | 245961 = Lawson ID"}]},{"description":"PIN KNOWLES 5/32 X 5-3/4IN","code_information":[{"code":"Sx00-0281-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"36000","type":"LOCAL"},{"code":"245960","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.37,"discounted_cash":192.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 36000 = Hospital System Supply Identifier | 245960 = Lawson ID"}]},{"description":"PIN KNOWLES 5/32 X 5-1/2IN","code_information":[{"code":"Sx00-0281-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"35998","type":"LOCAL"},{"code":"245958","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.37,"discounted_cash":192.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 35998 = Hospital System Supply Identifier | 245958 = Lawson ID"}]},{"description":"PIN KNOWLES 5/32 X 5IN","code_information":[{"code":"Sx00-0281-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"35997","type":"LOCAL"},{"code":"245957","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.37,"discounted_cash":192.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 35997 = Hospital System Supply Identifier | 245957 = Lawson ID"}]},{"description":"PIN KNOWLES 5/32 X 5-1/4IN","code_information":[{"code":"Sx00-0281-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"35999","type":"LOCAL"},{"code":"245959","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.37,"discounted_cash":192.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 35999 = Hospital System Supply Identifier | 245959 = Lawson ID"}]},{"description":"PIN KNOWLES 5/32 X 4-1/4IN","code_information":[{"code":"Sx00-0281-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"35995","type":"LOCAL"},{"code":"245955","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.37,"discounted_cash":192.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 35995 = Hospital System Supply Identifier | 245955 = Lawson ID"}]},{"description":"PIN KNOWLES 5/32 X 4IN","code_information":[{"code":"Sx00-0281-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"35994","type":"LOCAL"},{"code":"245954","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.37,"discounted_cash":192.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 35994 = Hospital System Supply Identifier | 245954 = Lawson ID"}]},{"description":"PIN KNOWLES 5/32 X 3-1/4IN","code_information":[{"code":"Sx00-0281-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"35993","type":"LOCAL"},{"code":"245953","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.37,"discounted_cash":192.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 35993 = Hospital System Supply Identifier | 245953 = Lawson ID"}]},{"description":"PIN KNOWLES 5/32 X 3IN","code_information":[{"code":"Sx00-0281-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"35991","type":"LOCAL"},{"code":"245951","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.37,"discounted_cash":192.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 35991 = Hospital System Supply Identifier | 245951 = Lawson ID"}]},{"description":"PIN KNOWLES 5/32 X 2-3/4IN","code_information":[{"code":"Sx00-0281-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"35990","type":"LOCAL"},{"code":"245950","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.37,"discounted_cash":192.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 35990 = Hospital System Supply Identifier | 245950 = Lawson ID"}]},{"description":"PIN KNOWLES 5/32 X 2-1/2IN","code_information":[{"code":"Sx00-0281-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"35989","type":"LOCAL"},{"code":"245949","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.37,"discounted_cash":192.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 35989 = Hospital System Supply Identifier | 245949 = Lawson ID"}]},{"description":"PIN KNOWLES 5/32 X 4-3/4IN","code_information":[{"code":"Sx00-0281-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"35996","type":"LOCAL"},{"code":"245956","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.37,"discounted_cash":192.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 35996 = Hospital System Supply Identifier | 245956 = Lawson ID"}]},{"description":"PIN KNOWLES 3/16 X 4-3/4IN","code_information":[{"code":"Sx00-0281-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408066","type":"LOCAL"},{"code":"245943","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.37,"discounted_cash":192.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408066 = Hospital System Supply Identifier | 245943 = Lawson ID"}]},{"description":"PIN KNOWLES 3/16 X 6IN","code_information":[{"code":"Sx00-0281-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408071","type":"LOCAL"},{"code":"245948","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.37,"discounted_cash":192.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408071 = Hospital System Supply Identifier | 245948 = Lawson ID"}]},{"description":"PIN KNOWLES 3/16 X 5-3/4IN","code_information":[{"code":"Sx00-0281-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408070","type":"LOCAL"},{"code":"245947","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.37,"discounted_cash":192.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408070 = Hospital System Supply Identifier | 245947 = Lawson ID"}]},{"description":"PIN KNOWLES 3/16 X 5-1/4IN","code_information":[{"code":"Sx00-0281-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408069","type":"LOCAL"},{"code":"245946","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.37,"discounted_cash":192.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408069 = Hospital System Supply Identifier | 245946 = Lawson ID"}]},{"description":"PIN KNOWLES 3/16 X 5-1/2IN","code_information":[{"code":"Sx00-0281-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408068","type":"LOCAL"},{"code":"245945","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.37,"discounted_cash":192.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408068 = Hospital System Supply Identifier | 245945 = Lawson ID"}]},{"description":"PIN KNOWLES 3/16 X 5IN","code_information":[{"code":"Sx00-0281-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408067","type":"LOCAL"},{"code":"245944","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.37,"discounted_cash":192.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408067 = Hospital System Supply Identifier | 245944 = Lawson ID"}]},{"description":"PIN KNOWLES 3/16 X 4-1/4IN","code_information":[{"code":"Sx00-0281-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408065","type":"LOCAL"},{"code":"245942","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.37,"discounted_cash":192.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408065 = Hospital System Supply Identifier | 245942 = Lawson ID"}]},{"description":"PIN KNOWLES 3/16 X 3 1/2IN","code_information":[{"code":"Sx00-0281-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408061","type":"LOCAL"},{"code":"245927","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.37,"discounted_cash":192.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408061 = Hospital System Supply Identifier | 245927 = Lawson ID"}]},{"description":"PIN KNOWLES 3/16 X 2-1/2IN","code_information":[{"code":"Sx00-0281-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408063","type":"LOCAL"},{"code":"245940","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.37,"discounted_cash":192.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408063 = Hospital System Supply Identifier | 245940 = Lawson ID"}]},{"description":"PIN KNOWLES 3/16 X 2-3/4IN","code_information":[{"code":"Sx00-0281-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408064","type":"LOCAL"},{"code":"245941","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.37,"discounted_cash":192.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408064 = Hospital System Supply Identifier | 245941 = Lawson ID"}]},{"description":"PIN KNOWLES 3/16 X 4IN","code_information":[{"code":"Sx00-0281-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408058","type":"LOCAL"},{"code":"245922","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.37,"discounted_cash":192.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408058 = Hospital System Supply Identifier | 245922 = Lawson ID"}]},{"description":"PIN KNOWLES 5/32 X 4 1/2IN","code_information":[{"code":"Sx00-0281-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408057","type":"LOCAL"},{"code":"245920","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.37,"discounted_cash":192.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408057 = Hospital System Supply Identifier | 245920 = Lawson ID"}]},{"description":"PIN KNOWLES 3/16 X 3 3/4IN","code_information":[{"code":"Sx00-0281-002","type":"CDM"},{"code":"272","type":"RC"},{"code":"408072","type":"LOCAL"},{"code":"245969","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.37,"discounted_cash":192.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408072 = Hospital System Supply Identifier | 245969 = Lawson ID"}]},{"description":"PIN KNOWLES 3/16 X 3 1/4IN","code_information":[{"code":"Sx00-0281-002","type":"CDM"},{"code":"272","type":"RC"},{"code":"408060","type":"LOCAL"},{"code":"245926","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.37,"discounted_cash":192.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408060 = Hospital System Supply Identifier | 245926 = Lawson ID"}]},{"description":"PIN KNOWLES 3/16 X 3IN","code_information":[{"code":"Sx00-0281-002","type":"CDM"},{"code":"272","type":"RC"},{"code":"408059","type":"LOCAL"},{"code":"245923","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.37,"discounted_cash":192.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408059 = Hospital System Supply Identifier | 245923 = Lawson ID"}]},{"description":"DISC - PIN STNMN 2.4MMX60CM","code_information":[{"code":"Sx00-0409-021","type":"CDM"},{"code":"272","type":"RC"},{"code":"410428","type":"LOCAL"},{"code":"417181","type":"LOCAL"}],"standard_charges":[{"gross_charge":263.7,"discounted_cash":197.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410428 = Hospital System Supply Identifier | 417181 = Lawson ID"}]},{"description":"PIN STEINMANN 3.2X60","code_information":[{"code":"Sx00-0409-022","type":"CDM"},{"code":"272","type":"RC"},{"code":"411088","type":"LOCAL"},{"code":"437117","type":"LOCAL"}],"standard_charges":[{"gross_charge":304.72,"discounted_cash":228.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 411088 = Hospital System Supply Identifier | 437117 = Lawson ID"}]},{"description":"PIN STNMN 4.0MMX60CM","code_information":[{"code":"Sx00-0409-023","type":"CDM"},{"code":"272","type":"RC"},{"code":"410429","type":"LOCAL"},{"code":"417182","type":"LOCAL"}],"standard_charges":[{"gross_charge":304.72,"discounted_cash":228.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410429 = Hospital System Supply Identifier | 417182 = Lawson ID"}]},{"description":"GUIDEWIRE ORTHOPEDIC 60CM 3.2MM 6MM NSTRL BULLET TIP ZIMALOY INTRAMEDULLARY NAIL","code_information":[{"code":"Sx00-0409-034","type":"CDM"},{"code":"272","type":"RC"},{"code":"410441","type":"LOCAL"},{"code":"418220","type":"LOCAL"}],"standard_charges":[{"gross_charge":527.4,"discounted_cash":395.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410441 = Hospital System Supply Identifier | 418220 = Lawson ID"}]},{"description":"GUIDEWIRE ORTHOPEDIC 60CM 2MM NSTRL SMOOTH ZIMALOY INTRAMEDULLARY NAIL","code_information":[{"code":"Sx00-0409-042","type":"CDM"},{"code":"272","type":"RC"},{"code":"409623","type":"LOCAL"},{"code":"402333","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.9,"discounted_cash":285.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 409623 = Hospital System Supply Identifier | 402333 = Lawson ID"}]},{"description":"GUIDEWIRE ORTHOPEDIC 60CM 3.2MM NSTRL SMOOTH ZIMALOY INTRAMEDULLARY NAIL","code_information":[{"code":"Sx00-0409-043","type":"CDM"},{"code":"272","type":"RC"},{"code":"409624","type":"LOCAL"},{"code":"402334","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.9,"discounted_cash":285.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 409624 = Hospital System Supply Identifier | 402334 = Lawson ID"}]},{"description":"DISC - COLLAR CERV SERP MED XLNG 3.5","code_information":[{"code":"Sx00-0737-005","type":"CDM"},{"code":"274","type":"RC"},{"code":"L0120","type":"HCPCS"},{"code":"35006","type":"LOCAL"},{"code":"106778","type":"LOCAL"}],"standard_charges":[{"gross_charge":33.32,"discounted_cash":24.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 35006 = Hospital System Supply Identifier | 106778 = Lawson ID"}]},{"description":"DUP USE S13371 - PIN RUSH MEDUL 1/4 801-01-03","code_information":[{"code":"Sx00-0801-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1173319","type":"LOCAL"},{"code":"245931","type":"LOCAL"}],"standard_charges":[{"gross_charge":31.5,"discounted_cash":23.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1173319 = Hospital System Supply Identifier | 245931 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY 1/4 SZI","code_information":[{"code":"Sx00-0801-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408056","type":"LOCAL"},{"code":"245915","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408056 = Hospital System Supply Identifier | 245915 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY 1/4 SZH","code_information":[{"code":"Sx00-0801-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408055","type":"LOCAL"},{"code":"245914","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408055 = Hospital System Supply Identifier | 245914 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY 1/4 SZG","code_information":[{"code":"Sx00-0801-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408054","type":"LOCAL"},{"code":"245913","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408054 = Hospital System Supply Identifier | 245913 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY 1/4 SZF","code_information":[{"code":"Sx00-0801-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408053","type":"LOCAL"},{"code":"245912","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408053 = Hospital System Supply Identifier | 245912 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY A 28CMX6.4MM","code_information":[{"code":"Sx00-0801-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"53562","type":"LOCAL"},{"code":"116024","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 53562 = Hospital System Supply Identifier | 116024 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY 1/4 SZD","code_information":[{"code":"Sx00-0801-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408051","type":"LOCAL"},{"code":"245910","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408051 = Hospital System Supply Identifier | 245910 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY 1/4 SZC","code_information":[{"code":"Sx00-0801-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408050","type":"LOCAL"},{"code":"245909","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408050 = Hospital System Supply Identifier | 245909 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY 1/4 SZA-1","code_information":[{"code":"Sx00-0801-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"35272","type":"LOCAL"},{"code":"142730","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 35272 = Hospital System Supply Identifier | 142730 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY 1/4 SZE","code_information":[{"code":"Sx00-0801-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408052","type":"LOCAL"},{"code":"245911","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408052 = Hospital System Supply Identifier | 245911 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY 1/4 SZA-2","code_information":[{"code":"Sx00-0801-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"35037","type":"LOCAL"},{"code":"116023","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 35037 = Hospital System Supply Identifier | 116023 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY L 41.3CMX4.8MM","code_information":[{"code":"Sx00-0802-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408422","type":"LOCAL"},{"code":"328029","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408422 = Hospital System Supply Identifier | 328029 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/16 802-01-10","code_information":[{"code":"Sx00-0802-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407863","type":"LOCAL"},{"code":"206202","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407863 = Hospital System Supply Identifier | 206202 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/16 802-01-09","code_information":[{"code":"Sx00-0802-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407862","type":"LOCAL"},{"code":"206201","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407862 = Hospital System Supply Identifier | 206201 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/16 802-01-03","code_information":[{"code":"Sx00-0802-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407861","type":"LOCAL"},{"code":"206200","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407861 = Hospital System Supply Identifier | 206200 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/16 802-01-08","code_information":[{"code":"Sx00-0802-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407484","type":"LOCAL"},{"code":"147124","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407484 = Hospital System Supply Identifier | 147124 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY D 26CMX4.8MM","code_information":[{"code":"Sx00-0802-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"166633","type":"LOCAL"},{"code":"147122","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 166633 = Hospital System Supply Identifier | 147122 = Lawson ID"}]},{"description":"PIN RUSH MEDUL 3/16 802-01-06","code_information":[{"code":"Sx00-0802-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"55025","type":"LOCAL"},{"code":"142731","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 55025 = Hospital System Supply Identifier | 142731 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/16 802-01-04","code_information":[{"code":"Sx00-0802-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"53560","type":"LOCAL"},{"code":"116020","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 53560 = Hospital System Supply Identifier | 116020 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY A 20.3CMX4.8MM","code_information":[{"code":"Sx00-0802-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"53559","type":"LOCAL"},{"code":"116019","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 53559 = Hospital System Supply Identifier | 116019 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/16 802-01-07","code_information":[{"code":"Sx00-0802-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"166634","type":"LOCAL"},{"code":"147123","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 166634 = Hospital System Supply Identifier | 147123 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 1/8 803-01-04","code_information":[{"code":"Sx00-0803-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"168150","type":"LOCAL"},{"code":"206182","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 168150 = Hospital System Supply Identifier | 206182 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 1/8 803-01-14","code_information":[{"code":"Sx00-0803-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"168155","type":"LOCAL"},{"code":"206187","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 168155 = Hospital System Supply Identifier | 206187 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 1/8 803-01-13","code_information":[{"code":"Sx00-0803-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"168154","type":"LOCAL"},{"code":"206186","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 168154 = Hospital System Supply Identifier | 206186 = Lawson ID"}]},{"description":"PIN RUSH MEDUL 1/8 803-01-11","code_information":[{"code":"Sx00-0803-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"168153","type":"LOCAL"},{"code":"206185","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 168153 = Hospital System Supply Identifier | 206185 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 1/8 803-01-10","code_information":[{"code":"Sx00-0803-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"168152","type":"LOCAL"},{"code":"206184","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 168152 = Hospital System Supply Identifier | 206184 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 1/8 803-01-03","code_information":[{"code":"Sx00-0803-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"168149","type":"LOCAL"},{"code":"206181","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 168149 = Hospital System Supply Identifier | 206181 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 1/8 803-01-07","code_information":[{"code":"Sx00-0803-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"168151","type":"LOCAL"},{"code":"206183","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 168151 = Hospital System Supply Identifier | 206183 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 1/8 803-01-08","code_information":[{"code":"Sx00-0803-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"166637","type":"LOCAL"},{"code":"147128","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 166637 = Hospital System Supply Identifier | 147128 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 1/8 803-01-06","code_information":[{"code":"Sx00-0803-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"166636","type":"LOCAL"},{"code":"147127","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 166636 = Hospital System Supply Identifier | 147127 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 1/8 803-01-05","code_information":[{"code":"Sx00-0803-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407485","type":"LOCAL"},{"code":"147126","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407485 = Hospital System Supply Identifier | 147126 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 1/8 803-01-02","code_information":[{"code":"Sx00-0803-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"166635","type":"LOCAL"},{"code":"147125","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 166635 = Hospital System Supply Identifier | 147125 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 1/8 803-01-12","code_information":[{"code":"Sx00-0803-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"53561","type":"LOCAL"},{"code":"116021","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 53561 = Hospital System Supply Identifier | 116021 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 1/8 803-01-09","code_information":[{"code":"Sx00-0803-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"166638","type":"LOCAL"},{"code":"147129","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 166638 = Hospital System Supply Identifier | 147129 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/32 804-01-14","code_information":[{"code":"Sx00-0804-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407860","type":"LOCAL"},{"code":"206199","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407860 = Hospital System Supply Identifier | 206199 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/32 804-01-13","code_information":[{"code":"Sx00-0804-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407859","type":"LOCAL"},{"code":"206198","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407859 = Hospital System Supply Identifier | 206198 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/32 804-01-12","code_information":[{"code":"Sx00-0804-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407858","type":"LOCAL"},{"code":"206197","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407858 = Hospital System Supply Identifier | 206197 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/32 804-01-11","code_information":[{"code":"Sx00-0804-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407857","type":"LOCAL"},{"code":"206196","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407857 = Hospital System Supply Identifier | 206196 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/32 804-01-10","code_information":[{"code":"Sx00-0804-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407856","type":"LOCAL"},{"code":"206195","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407856 = Hospital System Supply Identifier | 206195 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/32 804-01-09","code_information":[{"code":"Sx00-0804-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407855","type":"LOCAL"},{"code":"206194","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407855 = Hospital System Supply Identifier | 206194 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/32 804-01-08","code_information":[{"code":"Sx00-0804-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407854","type":"LOCAL"},{"code":"206193","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407854 = Hospital System Supply Identifier | 206193 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/32 804-01-06","code_information":[{"code":"Sx00-0804-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407852","type":"LOCAL"},{"code":"206191","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407852 = Hospital System Supply Identifier | 206191 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/32 804-01-05","code_information":[{"code":"Sx00-0804-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407851","type":"LOCAL"},{"code":"206190","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407851 = Hospital System Supply Identifier | 206190 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/32 804-01-04","code_information":[{"code":"Sx00-0804-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407850","type":"LOCAL"},{"code":"206189","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407850 = Hospital System Supply Identifier | 206189 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/32 804-01-03","code_information":[{"code":"Sx00-0804-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407849","type":"LOCAL"},{"code":"206188","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407849 = Hospital System Supply Identifier | 206188 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/32 804-01-02","code_information":[{"code":"Sx00-0804-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407486","type":"LOCAL"},{"code":"147130","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407486 = Hospital System Supply Identifier | 147130 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/32 804-01-07","code_information":[{"code":"Sx00-0804-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407853","type":"LOCAL"},{"code":"206192","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407853 = Hospital System Supply Identifier | 206192 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY U 20.3CMX2.4MM","code_information":[{"code":"Sx00-0806-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408758","type":"LOCAL"},{"code":"339790","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408758 = Hospital System Supply Identifier | 339790 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY Y 25.4CMX2.4MM","code_information":[{"code":"Sx00-0806-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408762","type":"LOCAL"},{"code":"339794","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408762 = Hospital System Supply Identifier | 339794 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY X 24.1CMX2.4MM","code_information":[{"code":"Sx00-0806-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408761","type":"LOCAL"},{"code":"339793","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408761 = Hospital System Supply Identifier | 339793 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY W 22.9CMX2.4MM","code_information":[{"code":"Sx00-0806-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408760","type":"LOCAL"},{"code":"339792","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408760 = Hospital System Supply Identifier | 339792 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY V 21.6CMX2.4MM","code_information":[{"code":"Sx00-0806-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408759","type":"LOCAL"},{"code":"339791","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408759 = Hospital System Supply Identifier | 339791 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY T 19.1CMX2.4MM","code_information":[{"code":"Sx00-0806-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408757","type":"LOCAL"},{"code":"339789","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408757 = Hospital System Supply Identifier | 339789 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY N 11.4CMX2.4MM","code_information":[{"code":"Sx00-0806-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408751","type":"LOCAL"},{"code":"339783","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408751 = Hospital System Supply Identifier | 339783 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY R 16.5CMX2.4MM","code_information":[{"code":"Sx00-0806-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408755","type":"LOCAL"},{"code":"339787","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408755 = Hospital System Supply Identifier | 339787 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY O 12.7CMX2.4MM","code_information":[{"code":"Sx00-0806-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408752","type":"LOCAL"},{"code":"339784","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408752 = Hospital System Supply Identifier | 339784 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY S 17.8CMX2.4MM","code_information":[{"code":"Sx00-0806-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408756","type":"LOCAL"},{"code":"339788","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408756 = Hospital System Supply Identifier | 339788 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY Q 15.2CMX2.4MM","code_information":[{"code":"Sx00-0806-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408754","type":"LOCAL"},{"code":"339786","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408754 = Hospital System Supply Identifier | 339786 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY P 14.0CMX2.4MM","code_information":[{"code":"Sx00-0806-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408753","type":"LOCAL"},{"code":"339785","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408753 = Hospital System Supply Identifier | 339785 = Lawson ID"}]},{"description":"PLT ANTLAT DST TIB 3.5MM 2H LT","code_information":[{"code":"Sx00-0903-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053825","type":"LOCAL"},{"code":"876275","type":"LOCAL"}],"standard_charges":[{"gross_charge":6468.57,"discounted_cash":4851.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053825 = Hospital System Supply Identifier | 876275 = Lawson ID"}]},{"description":"PLT ANTLAT DST TIB 3.5MM 3H LT","code_information":[{"code":"Sx00-0903-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053826","type":"LOCAL"},{"code":"876276","type":"LOCAL"}],"standard_charges":[{"gross_charge":6468.57,"discounted_cash":4851.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053826 = Hospital System Supply Identifier | 876276 = Lawson ID"}]},{"description":"PLT ANTLAT DST TIB 3.5MM 4H LT","code_information":[{"code":"Sx00-0903-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053827","type":"LOCAL"},{"code":"876277","type":"LOCAL"}],"standard_charges":[{"gross_charge":6468.57,"discounted_cash":4851.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053827 = Hospital System Supply Identifier | 876277 = Lawson ID"}]},{"description":"PLT ANTLAT DST TIB 3.5MM 3H RT","code_information":[{"code":"Sx00-0903-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053829","type":"LOCAL"},{"code":"876279","type":"LOCAL"}],"standard_charges":[{"gross_charge":6468.57,"discounted_cash":4851.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053829 = Hospital System Supply Identifier | 876279 = Lawson ID"}]},{"description":"PLT ANTLAT DST TIB 3.5MM 4H RT","code_information":[{"code":"Sx00-0903-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053830","type":"LOCAL"},{"code":"876280","type":"LOCAL"}],"standard_charges":[{"gross_charge":6468.57,"discounted_cash":4851.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053830 = Hospital System Supply Identifier | 876280 = Lawson ID"}]},{"description":"PLT ANTLAT DST TIB 3.5MM 2H RT","code_information":[{"code":"Sx00-0903-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053828","type":"LOCAL"},{"code":"876278","type":"LOCAL"}],"standard_charges":[{"gross_charge":6468.57,"discounted_cash":4851.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053828 = Hospital System Supply Identifier | 876278 = Lawson ID"}]},{"description":"SCREW SLF-TP 3.5X12MM","code_information":[{"code":"Sx00-0903-251","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"918408","type":"LOCAL"},{"code":"711671","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 918408 = Hospital System Supply Identifier | 711671 = Lawson ID"}]},{"description":"SCREW SLF-TP 3.5X14MM","code_information":[{"code":"Sx00-0903-251","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"832048","type":"LOCAL"},{"code":"711672","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 832048 = Hospital System Supply Identifier | 711672 = Lawson ID"}]},{"description":"SCREW SLF-TP 3.5X16MM","code_information":[{"code":"Sx00-0903-251","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"832049","type":"LOCAL"},{"code":"711673","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 832049 = Hospital System Supply Identifier | 711673 = Lawson ID"}]},{"description":"SCREW S/T CORT 3.5MM HEX 10MM","code_information":[{"code":"Sx00-0903-251","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053831","type":"LOCAL"},{"code":"876281","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053831 = Hospital System Supply Identifier | 876281 = Lawson ID"}]},{"description":"SCREW BONE 3.5X18 CORT NON LOK","code_information":[{"code":"Sx00-0903-251","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"821235","type":"LOCAL"},{"code":"S121105","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 821235 = Hospital System Supply Identifier | S121105 = Lawson ID"}]},{"description":"SCREW S/T CORT 3.5MM HEX 28MM","code_information":[{"code":"Sx00-0903-252","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053832","type":"LOCAL"},{"code":"876282","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053832 = Hospital System Supply Identifier | 876282 = Lawson ID"}]},{"description":"SCREW BONE 3.5X26CORT NON LOCK","code_information":[{"code":"Sx00-0903-252","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"944916","type":"LOCAL"},{"code":"829511","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 944916 = Hospital System Supply Identifier | 829511 = Lawson ID"}]},{"description":"SCREW BONE 3.5X20CORT NON LOCK","code_information":[{"code":"Sx00-0903-252","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"932148","type":"LOCAL"},{"code":"816523","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 932148 = Hospital System Supply Identifier | 816523 = Lawson ID"}]},{"description":"SCREW BONE 3.5X24CORT NON LOCK","code_information":[{"code":"Sx00-0903-252","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"932147","type":"LOCAL"},{"code":"816522","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 932147 = Hospital System Supply Identifier | 816522 = Lawson ID"}]},{"description":"SCREW BONE 3.5X22CORT NON LOCK","code_information":[{"code":"Sx00-0903-252","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"932149","type":"LOCAL"},{"code":"816524","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 932149 = Hospital System Supply Identifier | 816524 = Lawson ID"}]},{"description":"SCREW BONE 3.5X36CORT NON LOCK","code_information":[{"code":"Sx00-0903-253","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"932146","type":"LOCAL"},{"code":"816521","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 932146 = Hospital System Supply Identifier | 816521 = Lawson ID"}]},{"description":"SCREW BONE 3.5X32CORT NON LOCK","code_information":[{"code":"Sx00-0903-253","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"932150","type":"LOCAL"},{"code":"816525","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 932150 = Hospital System Supply Identifier | 816525 = Lawson ID"}]},{"description":"SCREW S/T CORT 3.5MM HEX 30MM","code_information":[{"code":"Sx00-0903-253","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053833","type":"LOCAL"},{"code":"876283","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053833 = Hospital System Supply Identifier | 876283 = Lawson ID"}]},{"description":"SCREW S/T CORT 3.5MM HEX 34MM","code_information":[{"code":"Sx00-0903-253","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053834","type":"LOCAL"},{"code":"876284","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053834 = Hospital System Supply Identifier | 876284 = Lawson ID"}]},{"description":"SCREW S/T CORT 3.5MMS HEX 35MM","code_information":[{"code":"Sx00-0903-253","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053835","type":"LOCAL"},{"code":"876285","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053835 = Hospital System Supply Identifier | 876285 = Lawson ID"}]},{"description":"SCREW S/T CORT 3.5MM HEX 38MM","code_information":[{"code":"Sx00-0903-253","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053836","type":"LOCAL"},{"code":"876286","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053836 = Hospital System Supply Identifier | 876286 = Lawson ID"}]},{"description":"SCREW BONE 3.5X46 CORT NON-LOK","code_information":[{"code":"Sx00-0903-254","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"821257","type":"LOCAL"},{"code":"S298652","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 821257 = Hospital System Supply Identifier | S298652 = Lawson ID"}]},{"description":"SCREW S/T CORT 3.5MM HEX 48MM","code_information":[{"code":"Sx00-0903-254","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053841","type":"LOCAL"},{"code":"876291","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053841 = Hospital System Supply Identifier | 876291 = Lawson ID"}]},{"description":"SCREW S/T CORT 3.5MM HEX, 45MM","code_information":[{"code":"Sx00-0903-254","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053840","type":"LOCAL"},{"code":"876290","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053840 = Hospital System Supply Identifier | 876290 = Lawson ID"}]},{"description":"SCREW S/T CORT 3.5MM HEX 40MM","code_information":[{"code":"Sx00-0903-254","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053837","type":"LOCAL"},{"code":"876287","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053837 = Hospital System Supply Identifier | 876287 = Lawson ID"}]},{"description":"SCREW S/T CORT 3.5MM HEX 42MM","code_information":[{"code":"Sx00-0903-254","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053838","type":"LOCAL"},{"code":"876288","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053838 = Hospital System Supply Identifier | 876288 = Lawson ID"}]},{"description":"SCREW S/T CORT 3.5MM HEX 44MM","code_information":[{"code":"Sx00-0903-254","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053839","type":"LOCAL"},{"code":"876289","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053839 = Hospital System Supply Identifier | 876289 = Lawson ID"}]},{"description":"SCREW BONE 3.5X50 CORT NON-LOK","code_information":[{"code":"Sx00-0903-255","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"821258","type":"LOCAL"},{"code":"S48755","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 821258 = Hospital System Supply Identifier | S48755 = Lawson ID"}]},{"description":"SCREW BONE 3.5X55 CORT NON-LOK","code_information":[{"code":"Sx00-0903-255","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"821259","type":"LOCAL"},{"code":"S48756","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 821259 = Hospital System Supply Identifier | S48756 = Lawson ID"}]},{"description":"SCREW S/T CORT 3.5MM HEX 58MM","code_information":[{"code":"Sx00-0903-255","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053845","type":"LOCAL"},{"code":"876295","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053845 = Hospital System Supply Identifier | 876295 = Lawson ID"}]},{"description":"SCREW S/T CORT 3.5MM HEX 56MM","code_information":[{"code":"Sx00-0903-255","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053844","type":"LOCAL"},{"code":"876294","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053844 = Hospital System Supply Identifier | 876294 = Lawson ID"}]},{"description":"SCREW S/T CORT 3.5MM HEX 54MM","code_information":[{"code":"Sx00-0903-255","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053843","type":"LOCAL"},{"code":"876293","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053843 = Hospital System Supply Identifier | 876293 = Lawson ID"}]},{"description":"SCREW S/T CORT 3.5MM HEX 52MM","code_information":[{"code":"Sx00-0903-255","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053842","type":"LOCAL"},{"code":"876292","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053842 = Hospital System Supply Identifier | 876292 = Lawson ID"}]},{"description":"SCREW S/T CORT 3.5MM HEX 60MM","code_information":[{"code":"Sx00-0903-256","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053846","type":"LOCAL"},{"code":"876296","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053846 = Hospital System Supply Identifier | 876296 = Lawson ID"}]},{"description":"SCREW S/T CORT 3.5MM HEX 65MM","code_information":[{"code":"Sx00-0903-256","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053847","type":"LOCAL"},{"code":"876297","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053847 = Hospital System Supply Identifier | 876297 = Lawson ID"}]},{"description":"SCREW S/T CORT 3.5MM HEX 70MM","code_information":[{"code":"Sx00-0903-257","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053848","type":"LOCAL"},{"code":"876298","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053848 = Hospital System Supply Identifier | 876298 = Lawson ID"}]},{"description":"SCREW LOK CORT 3.5MM HEX 12MM","code_information":[{"code":"Sx00-0903-261","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053849","type":"LOCAL"},{"code":"876299","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053849 = Hospital System Supply Identifier | 876299 = Lawson ID"}]},{"description":"SCREW BONE T15 103.5BLU NSTRL","code_information":[{"code":"Sx00-0903-261","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"943269","type":"LOCAL"},{"code":"827838","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 943269 = Hospital System Supply Identifier | 827838 = Lawson ID"}]},{"description":"SCREW BONE 143.5NSTRL T15 HEXA","code_information":[{"code":"Sx00-0903-261","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"943270","type":"LOCAL"},{"code":"827839","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 943270 = Hospital System Supply Identifier | 827839 = Lawson ID"}]},{"description":"SCREW BONE 3.5X18CORT LOCKING","code_information":[{"code":"Sx00-0903-261","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"932142","type":"LOCAL"},{"code":"816517","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 932142 = Hospital System Supply Identifier | 816517 = Lawson ID"}]},{"description":"SCREW BONE 3.5X16CORT LOCKING","code_information":[{"code":"Sx00-0903-261","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"932144","type":"LOCAL"},{"code":"816519","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 932144 = Hospital System Supply Identifier | 816519 = Lawson ID"}]},{"description":"SCREW BONE 3.5X20CORT LOCKING","code_information":[{"code":"Sx00-0903-262","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"932143","type":"LOCAL"},{"code":"816518","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 932143 = Hospital System Supply Identifier | 816518 = Lawson ID"}]},{"description":"SCREW BONE 3.5X22CORT LOCKING","code_information":[{"code":"Sx00-0903-262","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"932145","type":"LOCAL"},{"code":"816520","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 932145 = Hospital System Supply Identifier | 816520 = Lawson ID"}]},{"description":"SCREW BONE 3.5X26CORT LOCKING","code_information":[{"code":"Sx00-0903-262","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"944914","type":"LOCAL"},{"code":"829509","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 944914 = Hospital System Supply Identifier | 829509 = Lawson ID"}]},{"description":"SCREW BONE 3.5X28CORT LOCKING","code_information":[{"code":"Sx00-0903-262","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"946351","type":"LOCAL"},{"code":"830987","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 946351 = Hospital System Supply Identifier | 830987 = Lawson ID"}]},{"description":"SCREW LOK CORT 3.5MM HEX 24MM","code_information":[{"code":"Sx00-0903-262","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053850","type":"LOCAL"},{"code":"876300","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053850 = Hospital System Supply Identifier | 876300 = Lawson ID"}]},{"description":"SCREW LOK CORT 3.5MM HEX 38MM","code_information":[{"code":"Sx00-0903-263","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053853","type":"LOCAL"},{"code":"876303","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053853 = Hospital System Supply Identifier | 876303 = Lawson ID"}]},{"description":"SCREW LOK CORT 3.5MM HEX 35MM","code_information":[{"code":"Sx00-0903-263","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053852","type":"LOCAL"},{"code":"876302","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053852 = Hospital System Supply Identifier | 876302 = Lawson ID"}]},{"description":"SCREW LOK CORT 3.5MM HEX 34MM","code_information":[{"code":"Sx00-0903-263","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053851","type":"LOCAL"},{"code":"876301","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053851 = Hospital System Supply Identifier | 876301 = Lawson ID"}]},{"description":"SCREW BONE 3.5X36CORT LOCKING","code_information":[{"code":"Sx00-0903-263","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"944989","type":"LOCAL"},{"code":"829586","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 944989 = Hospital System Supply Identifier | 829586 = Lawson ID"}]},{"description":"SCREW BONE 3.5X30CORT LOCKING","code_information":[{"code":"Sx00-0903-263","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"944915","type":"LOCAL"},{"code":"829510","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 944915 = Hospital System Supply Identifier | 829510 = Lawson ID"}]},{"description":"SCREW BONE 3.5X32CORT LOCKING","code_information":[{"code":"Sx00-0903-263","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"946352","type":"LOCAL"},{"code":"830988","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 946352 = Hospital System Supply Identifier | 830988 = Lawson ID"}]},{"description":"SCREW LOK CORT 3.5MM HEX 48MM","code_information":[{"code":"Sx00-0903-264","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053857","type":"LOCAL"},{"code":"876307","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053857 = Hospital System Supply Identifier | 876307 = Lawson ID"}]},{"description":"SCREW BONE 3.5X40CORT LOCKING","code_information":[{"code":"Sx00-0903-264","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"944990","type":"LOCAL"},{"code":"829587","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 944990 = Hospital System Supply Identifier | 829587 = Lawson ID"}]},{"description":"SCREW BONE 3.5X44CORT LOCKING","code_information":[{"code":"Sx00-0903-264","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"944991","type":"LOCAL"},{"code":"829588","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 944991 = Hospital System Supply Identifier | 829588 = Lawson ID"}]},{"description":"SCREW LOK CORT 3.5MM HEX 42MM","code_information":[{"code":"Sx00-0903-264","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053854","type":"LOCAL"},{"code":"876304","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053854 = Hospital System Supply Identifier | 876304 = Lawson ID"}]},{"description":"SCREW LOK CORT 3.5MM HEX 45MM","code_information":[{"code":"Sx00-0903-264","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053855","type":"LOCAL"},{"code":"876305","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053855 = Hospital System Supply Identifier | 876305 = Lawson ID"}]},{"description":"SCREW LOK CORT 3.5MM HEX 46MM","code_information":[{"code":"Sx00-0903-264","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053856","type":"LOCAL"},{"code":"876306","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053856 = Hospital System Supply Identifier | 876306 = Lawson ID"}]},{"description":"SCREW LOK CORT 3.5MM HEX 56MM","code_information":[{"code":"Sx00-0903-265","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053861","type":"LOCAL"},{"code":"876311","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053861 = Hospital System Supply Identifier | 876311 = Lawson ID"}]},{"description":"SCREW LOK CORT 3.5MM HEX 50MM","code_information":[{"code":"Sx00-0903-265","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053860","type":"LOCAL"},{"code":"876310","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053860 = Hospital System Supply Identifier | 876310 = Lawson ID"}]},{"description":"SCREW BONE 3.5X50CORT LOCKING","code_information":[{"code":"Sx00-0903-265","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"944992","type":"LOCAL"},{"code":"829589","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 944992 = Hospital System Supply Identifier | 829589 = Lawson ID"}]},{"description":"SCREW LOK CORT 3.5MM HEX 52MM","code_information":[{"code":"Sx00-0903-265","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053858","type":"LOCAL"},{"code":"876308","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053858 = Hospital System Supply Identifier | 876308 = Lawson ID"}]},{"description":"SCREW LOK CORT 3.5MM HEX 54MM","code_information":[{"code":"Sx00-0903-265","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053859","type":"LOCAL"},{"code":"876309","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053859 = Hospital System Supply Identifier | 876309 = Lawson ID"}]},{"description":"SCREW LOK CORT 3.5MM HEX 65MM","code_information":[{"code":"Sx00-0903-266","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053862","type":"LOCAL"},{"code":"876312","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053862 = Hospital System Supply Identifier | 876312 = Lawson ID"}]},{"description":"SCREW BONE 3.5X60CORT LOCKING","code_information":[{"code":"Sx00-0903-266","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"944993","type":"LOCAL"},{"code":"829590","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 944993 = Hospital System Supply Identifier | 829590 = Lawson ID"}]},{"description":"SCREW LOK CORT 3.5MM HEX 70MM","code_information":[{"code":"Sx00-0903-267","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053863","type":"LOCAL"},{"code":"876313","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053863 = Hospital System Supply Identifier | 876313 = Lawson ID"}]},{"description":"PLT NRW MED DST TIB 3.5MM 6H L","code_information":[{"code":"Sx00-0903-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053867","type":"LOCAL"},{"code":"876317","type":"LOCAL"}],"standard_charges":[{"gross_charge":9742.78,"discounted_cash":7307.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053867 = Hospital System Supply Identifier | 876317 = Lawson ID"}]},{"description":"PLT NRW MED DST TIB 3.5MM 5H L","code_information":[{"code":"Sx00-0903-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053866","type":"LOCAL"},{"code":"876316","type":"LOCAL"}],"standard_charges":[{"gross_charge":7054.7,"discounted_cash":5291.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053866 = Hospital System Supply Identifier | 876316 = Lawson ID"}]},{"description":"PLT NRW MED DST TIB 3.5MM 8H L","code_information":[{"code":"Sx00-0903-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053868","type":"LOCAL"},{"code":"876318","type":"LOCAL"}],"standard_charges":[{"gross_charge":9742.78,"discounted_cash":7307.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053868 = Hospital System Supply Identifier | 876318 = Lawson ID"}]},{"description":"PLT NRW MED DST TIB 3.5MM 2H L","code_information":[{"code":"Sx00-0903-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053864","type":"LOCAL"},{"code":"876314","type":"LOCAL"}],"standard_charges":[{"gross_charge":7054.7,"discounted_cash":5291.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053864 = Hospital System Supply Identifier | 876314 = Lawson ID"}]},{"description":"PLATE BONE NARROW 3.5LFT MEDIA","code_information":[{"code":"Sx00-0903-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"932151","type":"LOCAL"},{"code":"816526","type":"LOCAL"}],"standard_charges":[{"gross_charge":7054.7,"discounted_cash":5291.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 932151 = Hospital System Supply Identifier | 816526 = Lawson ID"}]},{"description":"PLT NRW MED DST TIB 3.5MM 3H L","code_information":[{"code":"Sx00-0903-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053865","type":"LOCAL"},{"code":"876315","type":"LOCAL"}],"standard_charges":[{"gross_charge":7054.7,"discounted_cash":5291.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053865 = Hospital System Supply Identifier | 876315 = Lawson ID"}]},{"description":"PLATE BONE NARROW 3.5RT MEDIAL","code_information":[{"code":"Sx00-0903-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"932141","type":"LOCAL"},{"code":"816516","type":"LOCAL"}],"standard_charges":[{"gross_charge":7054.7,"discounted_cash":5291.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 932141 = Hospital System Supply Identifier | 816516 = Lawson ID"}]},{"description":"PLATE BONE NARROW 136NSTRL 8H","code_information":[{"code":"Sx00-0903-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"943268","type":"LOCAL"},{"code":"827837","type":"LOCAL"}],"standard_charges":[{"gross_charge":9742.78,"discounted_cash":7307.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 943268 = Hospital System Supply Identifier | 827837 = Lawson ID"}]},{"description":"PLT NRW MED DST TIB 3.5MM 2H R","code_information":[{"code":"Sx00-0903-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053869","type":"LOCAL"},{"code":"876319","type":"LOCAL"}],"standard_charges":[{"gross_charge":7054.7,"discounted_cash":5291.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053869 = Hospital System Supply Identifier | 876319 = Lawson ID"}]},{"description":"PLT NRW MED DST TIB 3.5MM 3H R","code_information":[{"code":"Sx00-0903-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053870","type":"LOCAL"},{"code":"876320","type":"LOCAL"}],"standard_charges":[{"gross_charge":7054.7,"discounted_cash":5291.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053870 = Hospital System Supply Identifier | 876320 = Lawson ID"}]},{"description":"PLT NRW MED DST TIB 3.5MM 5H R","code_information":[{"code":"Sx00-0903-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053871","type":"LOCAL"},{"code":"876321","type":"LOCAL"}],"standard_charges":[{"gross_charge":7054.7,"discounted_cash":5291.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053871 = Hospital System Supply Identifier | 876321 = Lawson ID"}]},{"description":"PLT NRW MED DST TIB 3.5MM 6H R","code_information":[{"code":"Sx00-0903-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053872","type":"LOCAL"},{"code":"876322","type":"LOCAL"}],"standard_charges":[{"gross_charge":9742.78,"discounted_cash":7307.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053872 = Hospital System Supply Identifier | 876322 = Lawson ID"}]},{"description":"PLT WDE MED DST TIB 3.5MM 8H L","code_information":[{"code":"Sx00-0903-330","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053877","type":"LOCAL"},{"code":"876327","type":"LOCAL"}],"standard_charges":[{"gross_charge":9742.78,"discounted_cash":7307.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053877 = Hospital System Supply Identifier | 876327 = Lawson ID"}]},{"description":"PLT WDE MED DST TIB 3.5MM 6H L","code_information":[{"code":"Sx00-0903-330","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053876","type":"LOCAL"},{"code":"876326","type":"LOCAL"}],"standard_charges":[{"gross_charge":9742.78,"discounted_cash":7307.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053876 = Hospital System Supply Identifier | 876326 = Lawson ID"}]},{"description":"PLT WDE MED DST TIB 3.5MM 5H L","code_information":[{"code":"Sx00-0903-330","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053875","type":"LOCAL"},{"code":"876325","type":"LOCAL"}],"standard_charges":[{"gross_charge":6468.57,"discounted_cash":4851.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053875 = Hospital System Supply Identifier | 876325 = Lawson ID"}]},{"description":"PLT WDE MED DST TIB 3.5MM 3H L","code_information":[{"code":"Sx00-0903-330","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053874","type":"LOCAL"},{"code":"876324","type":"LOCAL"}],"standard_charges":[{"gross_charge":6468.57,"discounted_cash":4851.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053874 = Hospital System Supply Identifier | 876324 = Lawson ID"}]},{"description":"PLATE LT 4H 3.5WIDE MEDIAL DIS","code_information":[{"code":"Sx00-0903-330","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"946353","type":"LOCAL"},{"code":"830989","type":"LOCAL"}],"standard_charges":[{"gross_charge":6468.57,"discounted_cash":4851.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 946353 = Hospital System Supply Identifier | 830989 = Lawson ID"}]},{"description":"PLT WDE MED DST TIB 3.5MM 2H L","code_information":[{"code":"Sx00-0903-330","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053873","type":"LOCAL"},{"code":"876323","type":"LOCAL"}],"standard_charges":[{"gross_charge":6468.57,"discounted_cash":4851.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053873 = Hospital System Supply Identifier | 876323 = Lawson ID"}]},{"description":"PLT WDE MED DST TIB 3.5MM 2H R","code_information":[{"code":"Sx00-0903-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053878","type":"LOCAL"},{"code":"876328","type":"LOCAL"}],"standard_charges":[{"gross_charge":6468.57,"discounted_cash":4851.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053878 = Hospital System Supply Identifier | 876328 = Lawson ID"}]},{"description":"PLT WDE MED DST TIB 3.5MM 3H R","code_information":[{"code":"Sx00-0903-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053879","type":"LOCAL"},{"code":"876329","type":"LOCAL"}],"standard_charges":[{"gross_charge":6468.57,"discounted_cash":4851.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053879 = Hospital System Supply Identifier | 876329 = Lawson ID"}]},{"description":"PLT WDE MED DST TIB 3.5MM 4H R","code_information":[{"code":"Sx00-0903-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053880","type":"LOCAL"},{"code":"876330","type":"LOCAL"}],"standard_charges":[{"gross_charge":6468.57,"discounted_cash":4851.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053880 = Hospital System Supply Identifier | 876330 = Lawson ID"}]},{"description":"PLT WDE MED DST TIB 3.5MM 5H R","code_information":[{"code":"Sx00-0903-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053881","type":"LOCAL"},{"code":"876331","type":"LOCAL"}],"standard_charges":[{"gross_charge":6468.57,"discounted_cash":4851.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053881 = Hospital System Supply Identifier | 876331 = Lawson ID"}]},{"description":"PLT WDE MED DST TIB 3.5MM 6H R","code_information":[{"code":"Sx00-0903-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053882","type":"LOCAL"},{"code":"876332","type":"LOCAL"}],"standard_charges":[{"gross_charge":9742.78,"discounted_cash":7307.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053882 = Hospital System Supply Identifier | 876332 = Lawson ID"}]},{"description":"PLT WDE MED DST TIB 3.5MM 8H R","code_information":[{"code":"Sx00-0903-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053883","type":"LOCAL"},{"code":"876333","type":"LOCAL"}],"standard_charges":[{"gross_charge":9742.78,"discounted_cash":7307.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053883 = Hospital System Supply Identifier | 876333 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X48MM 10MM","code_information":[{"code":"Sx00-0903-384","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053888","type":"LOCAL"},{"code":"876338","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053888 = Hospital System Supply Identifier | 876338 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X46MM 10MM","code_information":[{"code":"Sx00-0903-384","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053887","type":"LOCAL"},{"code":"876337","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053887 = Hospital System Supply Identifier | 876337 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X40MM 10MM","code_information":[{"code":"Sx00-0903-384","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053884","type":"LOCAL"},{"code":"876334","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053884 = Hospital System Supply Identifier | 876334 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X42MM 10MM","code_information":[{"code":"Sx00-0903-384","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053885","type":"LOCAL"},{"code":"876335","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053885 = Hospital System Supply Identifier | 876335 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X44MM 10MM","code_information":[{"code":"Sx00-0903-384","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053886","type":"LOCAL"},{"code":"876336","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053886 = Hospital System Supply Identifier | 876336 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X50MM 10MM","code_information":[{"code":"Sx00-0903-385","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053889","type":"LOCAL"},{"code":"876339","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053889 = Hospital System Supply Identifier | 876339 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X52MM 10MM","code_information":[{"code":"Sx00-0903-385","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053890","type":"LOCAL"},{"code":"876340","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053890 = Hospital System Supply Identifier | 876340 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X54MM 10MM","code_information":[{"code":"Sx00-0903-385","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053891","type":"LOCAL"},{"code":"876341","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053891 = Hospital System Supply Identifier | 876341 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X56MM 10MM","code_information":[{"code":"Sx00-0903-385","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053892","type":"LOCAL"},{"code":"876342","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053892 = Hospital System Supply Identifier | 876342 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X58MM 10MM","code_information":[{"code":"Sx00-0903-385","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053893","type":"LOCAL"},{"code":"876343","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053893 = Hospital System Supply Identifier | 876343 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X68MM 10MM","code_information":[{"code":"Sx00-0903-386","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053898","type":"LOCAL"},{"code":"876348","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053898 = Hospital System Supply Identifier | 876348 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X66MM 10MM","code_information":[{"code":"Sx00-0903-386","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053897","type":"LOCAL"},{"code":"876347","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053897 = Hospital System Supply Identifier | 876347 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X64MM 10MM","code_information":[{"code":"Sx00-0903-386","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053896","type":"LOCAL"},{"code":"876346","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053896 = Hospital System Supply Identifier | 876346 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X60MM 10MM","code_information":[{"code":"Sx00-0903-386","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053894","type":"LOCAL"},{"code":"876344","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053894 = Hospital System Supply Identifier | 876344 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X62MM 10MM","code_information":[{"code":"Sx00-0903-386","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053895","type":"LOCAL"},{"code":"876345","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053895 = Hospital System Supply Identifier | 876345 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X70MM 10MM","code_information":[{"code":"Sx00-0903-387","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053899","type":"LOCAL"},{"code":"876349","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053899 = Hospital System Supply Identifier | 876349 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X40MM 15MM","code_information":[{"code":"Sx00-0903-394","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053900","type":"LOCAL"},{"code":"876350","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053900 = Hospital System Supply Identifier | 876350 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X42MM 15MM","code_information":[{"code":"Sx00-0903-394","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053901","type":"LOCAL"},{"code":"876351","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053901 = Hospital System Supply Identifier | 876351 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X44MM 15MM","code_information":[{"code":"Sx00-0903-394","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053902","type":"LOCAL"},{"code":"876352","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053902 = Hospital System Supply Identifier | 876352 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X46MM 15MM","code_information":[{"code":"Sx00-0903-394","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053903","type":"LOCAL"},{"code":"876353","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053903 = Hospital System Supply Identifier | 876353 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X48MM 15MM","code_information":[{"code":"Sx00-0903-394","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053904","type":"LOCAL"},{"code":"876354","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053904 = Hospital System Supply Identifier | 876354 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X58MM 15MM","code_information":[{"code":"Sx00-0903-395","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053909","type":"LOCAL"},{"code":"876359","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053909 = Hospital System Supply Identifier | 876359 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X56MM 15MM","code_information":[{"code":"Sx00-0903-395","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053908","type":"LOCAL"},{"code":"876358","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053908 = Hospital System Supply Identifier | 876358 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X50MM 15MM","code_information":[{"code":"Sx00-0903-395","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053905","type":"LOCAL"},{"code":"876355","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053905 = Hospital System Supply Identifier | 876355 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X52MM 15MM","code_information":[{"code":"Sx00-0903-395","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053906","type":"LOCAL"},{"code":"876356","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053906 = Hospital System Supply Identifier | 876356 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X54MM 15MM","code_information":[{"code":"Sx00-0903-395","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053907","type":"LOCAL"},{"code":"876357","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053907 = Hospital System Supply Identifier | 876357 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X60MM 15MM","code_information":[{"code":"Sx00-0903-396","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053910","type":"LOCAL"},{"code":"876360","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053910 = Hospital System Supply Identifier | 876360 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X62MM 15MM","code_information":[{"code":"Sx00-0903-396","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053911","type":"LOCAL"},{"code":"876361","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053911 = Hospital System Supply Identifier | 876361 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X64MM 15MM","code_information":[{"code":"Sx00-0903-396","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053912","type":"LOCAL"},{"code":"876362","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053912 = Hospital System Supply Identifier | 876362 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X66MM 15MM","code_information":[{"code":"Sx00-0903-396","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053913","type":"LOCAL"},{"code":"876363","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053913 = Hospital System Supply Identifier | 876363 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X68MM 15MM","code_information":[{"code":"Sx00-0903-396","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053914","type":"LOCAL"},{"code":"876364","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053914 = Hospital System Supply Identifier | 876364 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X70MM 15MM","code_information":[{"code":"Sx00-0903-397","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053915","type":"LOCAL"},{"code":"876365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053915 = Hospital System Supply Identifier | 876365 = Lawson ID"}]},{"description":"PLATE BONE COMPRESSION NARROW 3 HOLE MEDIAL PEDILOC 0009036103 3.5MM","code_information":[{"code":"Sx00-0903-610","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356466","type":"LOCAL"},{"code":"1082536","type":"LOCAL"}],"standard_charges":[{"gross_charge":7054.7,"discounted_cash":5291.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356466 = Hospital System Supply Identifier | 1082536 = Lawson ID"}]},{"description":"PLATE BONE COMPRESSION NARROW 3 HOLE MEDIAL PEDILOC 0009036203 3.5MM","code_information":[{"code":"Sx00-0903-620","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356350","type":"LOCAL"},{"code":"1082496","type":"LOCAL"}],"standard_charges":[{"gross_charge":7054.7,"discounted_cash":5291.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356350 = Hospital System Supply Identifier | 1082496 = Lawson ID"}]},{"description":"PLATE INF 90D 3HL","code_information":[{"code":"Sx00-0907-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053916","type":"LOCAL"},{"code":"876366","type":"LOCAL"}],"standard_charges":[{"gross_charge":6028.0,"discounted_cash":4521.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053916 = Hospital System Supply Identifier | 876366 = Lawson ID"}]},{"description":"PLATE INF 110D 3HL","code_information":[{"code":"Sx00-0907-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053917","type":"LOCAL"},{"code":"876367","type":"LOCAL"}],"standard_charges":[{"gross_charge":6028.0,"discounted_cash":4521.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053917 = Hospital System Supply Identifier | 876367 = Lawson ID"}]},{"description":"PLATE INF 130D 3HL","code_information":[{"code":"Sx00-0907-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053918","type":"LOCAL"},{"code":"876368","type":"LOCAL"}],"standard_charges":[{"gross_charge":6028.0,"discounted_cash":4521.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053918 = Hospital System Supply Identifier | 876368 = Lawson ID"}]},{"description":"PLATE 90DX3.5MM 6MM OFF 3HL","code_information":[{"code":"Sx00-0907-110","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053919","type":"LOCAL"},{"code":"876369","type":"LOCAL"}],"standard_charges":[{"gross_charge":5958.26,"discounted_cash":4468.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053919 = Hospital System Supply Identifier | 876369 = Lawson ID"}]},{"description":"PLATE 100DX3.5MM 6MM OFF 3HL","code_information":[{"code":"Sx00-0907-112","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053920","type":"LOCAL"},{"code":"876370","type":"LOCAL"}],"standard_charges":[{"gross_charge":6681.81,"discounted_cash":5011.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053920 = Hospital System Supply Identifier | 876370 = Lawson ID"}]},{"description":"PLATE BONE 3.5110 DEG 6OFFSET","code_information":[{"code":"Sx00-0907-114","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"944994","type":"LOCAL"},{"code":"829591","type":"LOCAL"}],"standard_charges":[{"gross_charge":6681.81,"discounted_cash":5011.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 944994 = Hospital System Supply Identifier | 829591 = Lawson ID"}]},{"description":"PLATE 120DX3.5MM 6MM OFF 3HL","code_information":[{"code":"Sx00-0907-116","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053921","type":"LOCAL"},{"code":"876371","type":"LOCAL"}],"standard_charges":[{"gross_charge":6681.81,"discounted_cash":5011.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053921 = Hospital System Supply Identifier | 876371 = Lawson ID"}]},{"description":"PLATE 90DX3.5MM 12MM OFF 3HL","code_information":[{"code":"Sx00-0907-120","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053922","type":"LOCAL"},{"code":"876372","type":"LOCAL"}],"standard_charges":[{"gross_charge":6148.14,"discounted_cash":4611.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053922 = Hospital System Supply Identifier | 876372 = Lawson ID"}]},{"description":"PLATE 100DX3.5MM 12MM OFF 3HL","code_information":[{"code":"Sx00-0907-122","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053923","type":"LOCAL"},{"code":"876373","type":"LOCAL"}],"standard_charges":[{"gross_charge":6681.81,"discounted_cash":5011.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053923 = Hospital System Supply Identifier | 876373 = Lawson ID"}]},{"description":"PLATE BONE 3.5110 DEG 12OFFSET","code_information":[{"code":"Sx00-0907-124","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"944995","type":"LOCAL"},{"code":"829592","type":"LOCAL"}],"standard_charges":[{"gross_charge":6681.81,"discounted_cash":5011.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 944995 = Hospital System Supply Identifier | 829592 = Lawson ID"}]},{"description":"PLATE 120DX3.5MM 12MM OFF 3HL","code_information":[{"code":"Sx00-0907-126","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053924","type":"LOCAL"},{"code":"876374","type":"LOCAL"}],"standard_charges":[{"gross_charge":6681.81,"discounted_cash":5011.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053924 = Hospital System Supply Identifier | 876374 = Lawson ID"}]},{"description":"PLATE 90DX4.5MM 6MM OFF 3HL","code_information":[{"code":"Sx00-0907-130","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053925","type":"LOCAL"},{"code":"876375","type":"LOCAL"}],"standard_charges":[{"gross_charge":6096.36,"discounted_cash":4572.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053925 = Hospital System Supply Identifier | 876375 = Lawson ID"}]},{"description":"PLATE 90DX4.5MM 6MM OFF 4HL","code_information":[{"code":"Sx00-0907-130","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053926","type":"LOCAL"},{"code":"876376","type":"LOCAL"}],"standard_charges":[{"gross_charge":6096.36,"discounted_cash":4572.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053926 = Hospital System Supply Identifier | 876376 = Lawson ID"}]},{"description":"PLATE 100DX4.5MM 6MM OFF 4HL","code_information":[{"code":"Sx00-0907-132","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053927","type":"LOCAL"},{"code":"876377","type":"LOCAL"}],"standard_charges":[{"gross_charge":6409.49,"discounted_cash":4807.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053927 = Hospital System Supply Identifier | 876377 = Lawson ID"}]},{"description":"PLATE 110DX4.5MM 6MM OFF 4HL","code_information":[{"code":"Sx00-0907-134","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053928","type":"LOCAL"},{"code":"876378","type":"LOCAL"}],"standard_charges":[{"gross_charge":6409.49,"discounted_cash":4807.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053928 = Hospital System Supply Identifier | 876378 = Lawson ID"}]},{"description":"PLATE 120DX4.5MM 6MM OFF 4HL","code_information":[{"code":"Sx00-0907-136","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053929","type":"LOCAL"},{"code":"876379","type":"LOCAL"}],"standard_charges":[{"gross_charge":6409.49,"discounted_cash":4807.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053929 = Hospital System Supply Identifier | 876379 = Lawson ID"}]},{"description":"PLATE 90DX4.5MM 14MM OFF 3HL","code_information":[{"code":"Sx00-0907-140","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053930","type":"LOCAL"},{"code":"876380","type":"LOCAL"}],"standard_charges":[{"gross_charge":6243.23,"discounted_cash":4682.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053930 = Hospital System Supply Identifier | 876380 = Lawson ID"}]},{"description":"PLATE 90DX4.5MM 14MM OFF 4HL","code_information":[{"code":"Sx00-0907-140","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053931","type":"LOCAL"},{"code":"876381","type":"LOCAL"}],"standard_charges":[{"gross_charge":6243.23,"discounted_cash":4682.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053931 = Hospital System Supply Identifier | 876381 = Lawson ID"}]},{"description":"PLATE 100DX4.5MM 14MM OFF 4HL","code_information":[{"code":"Sx00-0907-142","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053932","type":"LOCAL"},{"code":"876382","type":"LOCAL"}],"standard_charges":[{"gross_charge":6409.49,"discounted_cash":4807.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053932 = Hospital System Supply Identifier | 876382 = Lawson ID"}]},{"description":"PLATE 110DX4.5MM 14MM OFF 4HL","code_information":[{"code":"Sx00-0907-144","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053933","type":"LOCAL"},{"code":"876383","type":"LOCAL"}],"standard_charges":[{"gross_charge":6409.49,"discounted_cash":4807.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053933 = Hospital System Supply Identifier | 876383 = Lawson ID"}]},{"description":"PLATE 120DX4.5MM 14MM OFF 4HL","code_information":[{"code":"Sx00-0907-146","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053934","type":"LOCAL"},{"code":"876384","type":"LOCAL"}],"standard_charges":[{"gross_charge":6409.49,"discounted_cash":4807.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053934 = Hospital System Supply Identifier | 876384 = Lawson ID"}]},{"description":"PLATE BONE 130 DEG 784H SS","code_information":[{"code":"Sx00-0907-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"945776","type":"LOCAL"},{"code":"830396","type":"LOCAL"}],"standard_charges":[{"gross_charge":6681.81,"discounted_cash":5011.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 945776 = Hospital System Supply Identifier | 830396 = Lawson ID"}]},{"description":"PLATE 130DX3.5MM 3HL","code_information":[{"code":"Sx00-0907-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053935","type":"LOCAL"},{"code":"876385","type":"LOCAL"}],"standard_charges":[{"gross_charge":6495.48,"discounted_cash":4871.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053935 = Hospital System Supply Identifier | 876385 = Lawson ID"}]},{"description":"PLATE 130DX3.5MM 8HL","code_information":[{"code":"Sx00-0907-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053936","type":"LOCAL"},{"code":"876386","type":"LOCAL"}],"standard_charges":[{"gross_charge":9792.09,"discounted_cash":7344.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053936 = Hospital System Supply Identifier | 876386 = Lawson ID"}]},{"description":"PLATE BONE 3.5 130-DEG 6-HOLE","code_information":[{"code":"Sx00-0907-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"818909","type":"LOCAL"},{"code":"S48754","type":"LOCAL"}],"standard_charges":[{"gross_charge":6842.97,"discounted_cash":5132.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 818909 = Hospital System Supply Identifier | S48754 = Lawson ID"}]},{"description":"PLATE 130DX3.5MM 10HL","code_information":[{"code":"Sx00-0907-211","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053937","type":"LOCAL"},{"code":"876387","type":"LOCAL"}],"standard_charges":[{"gross_charge":9792.09,"discounted_cash":7344.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053937 = Hospital System Supply Identifier | 876387 = Lawson ID"}]},{"description":"PLATE BONE 130 D FEM PROX 8H L","code_information":[{"code":"Sx00-0907-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"939584","type":"LOCAL"},{"code":"824109","type":"LOCAL"}],"standard_charges":[{"gross_charge":9792.09,"discounted_cash":7344.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 939584 = Hospital System Supply Identifier | 824109 = Lawson ID"}]},{"description":"PLATE 130DX4.5MM 3HL","code_information":[{"code":"Sx00-0907-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053938","type":"LOCAL"},{"code":"876388","type":"LOCAL"}],"standard_charges":[{"gross_charge":6096.36,"discounted_cash":4572.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053938 = Hospital System Supply Identifier | 876388 = Lawson ID"}]},{"description":"PLATE 130DX4.5MM 6HL","code_information":[{"code":"Sx00-0907-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053939","type":"LOCAL"},{"code":"876389","type":"LOCAL"}],"standard_charges":[{"gross_charge":6409.49,"discounted_cash":4807.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053939 = Hospital System Supply Identifier | 876389 = Lawson ID"}]},{"description":"PLATE BONE FX 4.5 130-DEG 4-HO","code_information":[{"code":"Sx00-0907-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"819260","type":"LOCAL"},{"code":"S298651","type":"LOCAL"}],"standard_charges":[{"gross_charge":6243.23,"discounted_cash":4682.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 819260 = Hospital System Supply Identifier | S298651 = Lawson ID"}]},{"description":"PLATE 103DX4.5MM 10HL","code_information":[{"code":"Sx00-0907-221","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053940","type":"LOCAL"},{"code":"876390","type":"LOCAL"}],"standard_charges":[{"gross_charge":9792.09,"discounted_cash":7344.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053940 = Hospital System Supply Identifier | 876390 = Lawson ID"}]},{"description":"PLATE 150DX3.5MM 3HL","code_information":[{"code":"Sx00-0907-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053941","type":"LOCAL"},{"code":"876391","type":"LOCAL"}],"standard_charges":[{"gross_charge":6495.48,"discounted_cash":4871.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053941 = Hospital System Supply Identifier | 876391 = Lawson ID"}]},{"description":"PLATE 150DX3.5MM 5HL","code_information":[{"code":"Sx00-0907-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053942","type":"LOCAL"},{"code":"876392","type":"LOCAL"}],"standard_charges":[{"gross_charge":6681.81,"discounted_cash":5011.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053942 = Hospital System Supply Identifier | 876392 = Lawson ID"}]},{"description":"PLATE 150DX4.5 3HL","code_information":[{"code":"Sx00-0907-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053943","type":"LOCAL"},{"code":"876393","type":"LOCAL"}],"standard_charges":[{"gross_charge":5926.62,"discounted_cash":4444.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053943 = Hospital System Supply Identifier | 876393 = Lawson ID"}]},{"description":"PLATE 150DX4.5 5HL","code_information":[{"code":"Sx00-0907-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053944","type":"LOCAL"},{"code":"876394","type":"LOCAL"}],"standard_charges":[{"gross_charge":6096.36,"discounted_cash":4572.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053944 = Hospital System Supply Identifier | 876394 = Lawson ID"}]},{"description":"SCREW BONE 3.5X36CANN LOCKING","code_information":[{"code":"Sx00-0907-373","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"945774","type":"LOCAL"},{"code":"830394","type":"LOCAL"}],"standard_charges":[{"gross_charge":1634.68,"discounted_cash":1226.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 945774 = Hospital System Supply Identifier | 830394 = Lawson ID"}]},{"description":"SCREW LOK CORT CANN 3.5X30MM","code_information":[{"code":"Sx00-0907-373","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053945","type":"LOCAL"},{"code":"876395","type":"LOCAL"}],"standard_charges":[{"gross_charge":1634.68,"discounted_cash":1226.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053945 = Hospital System Supply Identifier | 876395 = Lawson ID"}]},{"description":"SCREW LOK CORT CANN 3.5X32MM","code_information":[{"code":"Sx00-0907-373","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053946","type":"LOCAL"},{"code":"876396","type":"LOCAL"}],"standard_charges":[{"gross_charge":1634.68,"discounted_cash":1226.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053946 = Hospital System Supply Identifier | 876396 = Lawson ID"}]},{"description":"SCREW LOK CORT CANN 3.5X34MM","code_information":[{"code":"Sx00-0907-373","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053947","type":"LOCAL"},{"code":"876397","type":"LOCAL"}],"standard_charges":[{"gross_charge":1634.68,"discounted_cash":1226.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053947 = Hospital System Supply Identifier | 876397 = Lawson ID"}]},{"description":"SCREW LOK CORT CANN 3.5X38MM","code_information":[{"code":"Sx00-0907-373","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053948","type":"LOCAL"},{"code":"876398","type":"LOCAL"}],"standard_charges":[{"gross_charge":1634.68,"discounted_cash":1226.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053948 = Hospital System Supply Identifier | 876398 = Lawson ID"}]},{"description":"SCREW LOK CORT CANN 3.5X45MM","code_information":[{"code":"Sx00-0907-374","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053949","type":"LOCAL"},{"code":"876399","type":"LOCAL"}],"standard_charges":[{"gross_charge":1634.68,"discounted_cash":1226.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053949 = Hospital System Supply Identifier | 876399 = Lawson ID"}]},{"description":"SCREW BONE 3.5X40CANN LOCKING","code_information":[{"code":"Sx00-0907-374","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"945775","type":"LOCAL"},{"code":"830395","type":"LOCAL"}],"standard_charges":[{"gross_charge":1634.68,"discounted_cash":1226.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 945775 = Hospital System Supply Identifier | 830395 = Lawson ID"}]},{"description":"SCREW LOK CORT CANN 3.5X50MM","code_information":[{"code":"Sx00-0907-375","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053950","type":"LOCAL"},{"code":"876400","type":"LOCAL"}],"standard_charges":[{"gross_charge":1634.68,"discounted_cash":1226.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053950 = Hospital System Supply Identifier | 876400 = Lawson ID"}]},{"description":"SCREW LOK CORT CANN 3.5X55MM","code_information":[{"code":"Sx00-0907-375","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053951","type":"LOCAL"},{"code":"876401","type":"LOCAL"}],"standard_charges":[{"gross_charge":1634.68,"discounted_cash":1226.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053951 = Hospital System Supply Identifier | 876401 = Lawson ID"}]},{"description":"SCREW LOK CORT CANN 3.5X60MM","code_information":[{"code":"Sx00-0907-376","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053952","type":"LOCAL"},{"code":"876402","type":"LOCAL"}],"standard_charges":[{"gross_charge":1634.68,"discounted_cash":1226.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053952 = Hospital System Supply Identifier | 876402 = Lawson ID"}]},{"description":"SCREW LOK CORT CANN 3.5X65MM","code_information":[{"code":"Sx00-0907-376","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053953","type":"LOCAL"},{"code":"876403","type":"LOCAL"}],"standard_charges":[{"gross_charge":1634.68,"discounted_cash":1226.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053953 = Hospital System Supply Identifier | 876403 = Lawson ID"}]},{"description":"SCREW LOK CORT CANN 3.5X70MM","code_information":[{"code":"Sx00-0907-377","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053954","type":"LOCAL"},{"code":"876404","type":"LOCAL"}],"standard_charges":[{"gross_charge":1634.68,"discounted_cash":1226.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053954 = Hospital System Supply Identifier | 876404 = Lawson ID"}]},{"description":"PLATE BONE 3 HOLE HIP 140 DEGREE 0009074103 3.5MM","code_information":[{"code":"Sx00-0907-410","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356942","type":"LOCAL"},{"code":"1082505","type":"LOCAL"}],"standard_charges":[{"gross_charge":6601.14,"discounted_cash":4950.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356942 = Hospital System Supply Identifier | 1082505 = Lawson ID"}]},{"description":"PLATE 140DX3.5MM","code_information":[{"code":"Sx00-0907-410","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053955","type":"LOCAL"},{"code":"876405","type":"LOCAL"}],"standard_charges":[{"gross_charge":6974.08,"discounted_cash":5230.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053955 = Hospital System Supply Identifier | 876405 = Lawson ID"}]},{"description":"PLATE BONE 3 HOLE HIP 140 DEGREE 0009074203 4.5MM","code_information":[{"code":"Sx00-0907-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356944","type":"LOCAL"},{"code":"1082555","type":"LOCAL"}],"standard_charges":[{"gross_charge":6601.14,"discounted_cash":4950.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356944 = Hospital System Supply Identifier | 1082555 = Lawson ID"}]},{"description":"PLATE 140DX4.5MM","code_information":[{"code":"Sx00-0907-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053956","type":"LOCAL"},{"code":"876406","type":"LOCAL"}],"standard_charges":[{"gross_charge":6541.08,"discounted_cash":4905.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053956 = Hospital System Supply Identifier | 876406 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X18MM","code_information":[{"code":"Sx00-0907-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053961","type":"LOCAL"},{"code":"876411","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053961 = Hospital System Supply Identifier | 876411 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X16MM","code_information":[{"code":"Sx00-0907-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053960","type":"LOCAL"},{"code":"876410","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053960 = Hospital System Supply Identifier | 876410 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X10MM","code_information":[{"code":"Sx00-0907-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053957","type":"LOCAL"},{"code":"876407","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053957 = Hospital System Supply Identifier | 876407 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X12MM","code_information":[{"code":"Sx00-0907-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053958","type":"LOCAL"},{"code":"876408","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053958 = Hospital System Supply Identifier | 876408 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X14MM","code_information":[{"code":"Sx00-0907-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053959","type":"LOCAL"},{"code":"876409","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053959 = Hospital System Supply Identifier | 876409 = Lawson ID"}]},{"description":"SCREW BONE 24X4.5 SLF-TP CORT","code_information":[{"code":"Sx00-0907-452","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"971157","type":"LOCAL"},{"code":"841869","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 971157 = Hospital System Supply Identifier | 841869 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X26MM","code_information":[{"code":"Sx00-0907-452","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053962","type":"LOCAL"},{"code":"876412","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053962 = Hospital System Supply Identifier | 876412 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X28MM","code_information":[{"code":"Sx00-0907-452","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053963","type":"LOCAL"},{"code":"876413","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053963 = Hospital System Supply Identifier | 876413 = Lawson ID"}]},{"description":"SCREW BONE 4.5X22 CORT NON-LOK","code_information":[{"code":"Sx00-0907-452","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"821596","type":"LOCAL"},{"code":"S298653","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 821596 = Hospital System Supply Identifier | S298653 = Lawson ID"}]},{"description":"SCREW BONE 4.5X20 CORT NON-LOK","code_information":[{"code":"Sx00-0907-452","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"821595","type":"LOCAL"},{"code":"S298654","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 821595 = Hospital System Supply Identifier | S298654 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X34MM","code_information":[{"code":"Sx00-0907-453","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053966","type":"LOCAL"},{"code":"876416","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053966 = Hospital System Supply Identifier | 876416 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X32MM","code_information":[{"code":"Sx00-0907-453","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053965","type":"LOCAL"},{"code":"876415","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053965 = Hospital System Supply Identifier | 876415 = Lawson ID"}]},{"description":"SCREW BONE 364.5LONG BONE CORT","code_information":[{"code":"Sx00-0907-453","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"939588","type":"LOCAL"},{"code":"824113","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 939588 = Hospital System Supply Identifier | 824113 = Lawson ID"}]},{"description":"SCREW BONE 384.5LONG BONE CORT","code_information":[{"code":"Sx00-0907-453","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"939587","type":"LOCAL"},{"code":"824112","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 939587 = Hospital System Supply Identifier | 824112 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X30MM","code_information":[{"code":"Sx00-0907-453","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053964","type":"LOCAL"},{"code":"876414","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053964 = Hospital System Supply Identifier | 876414 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X48MM","code_information":[{"code":"Sx00-0907-454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053971","type":"LOCAL"},{"code":"876421","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053971 = Hospital System Supply Identifier | 876421 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X40MM","code_information":[{"code":"Sx00-0907-454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053967","type":"LOCAL"},{"code":"876417","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053967 = Hospital System Supply Identifier | 876417 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X42MM","code_information":[{"code":"Sx00-0907-454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053968","type":"LOCAL"},{"code":"876418","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053968 = Hospital System Supply Identifier | 876418 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X44MM","code_information":[{"code":"Sx00-0907-454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053969","type":"LOCAL"},{"code":"876419","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053969 = Hospital System Supply Identifier | 876419 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X46MM","code_information":[{"code":"Sx00-0907-454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053970","type":"LOCAL"},{"code":"876420","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053970 = Hospital System Supply Identifier | 876420 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X55MM","code_information":[{"code":"Sx00-0907-455","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053973","type":"LOCAL"},{"code":"876423","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053973 = Hospital System Supply Identifier | 876423 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X50MM","code_information":[{"code":"Sx00-0907-455","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053972","type":"LOCAL"},{"code":"876422","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053972 = Hospital System Supply Identifier | 876422 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X60MM","code_information":[{"code":"Sx00-0907-456","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053974","type":"LOCAL"},{"code":"876424","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053974 = Hospital System Supply Identifier | 876424 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X65MM","code_information":[{"code":"Sx00-0907-456","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053975","type":"LOCAL"},{"code":"876425","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053975 = Hospital System Supply Identifier | 876425 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X70MM","code_information":[{"code":"Sx00-0907-457","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053976","type":"LOCAL"},{"code":"876426","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053976 = Hospital System Supply Identifier | 876426 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X75MM","code_information":[{"code":"Sx00-0907-457","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053977","type":"LOCAL"},{"code":"876427","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053977 = Hospital System Supply Identifier | 876427 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X80MM","code_information":[{"code":"Sx00-0907-458","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053978","type":"LOCAL"},{"code":"876428","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053978 = Hospital System Supply Identifier | 876428 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X10","code_information":[{"code":"Sx00-0907-461","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053979","type":"LOCAL"},{"code":"876429","type":"LOCAL"}],"standard_charges":[{"gross_charge":811.47,"discounted_cash":608.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053979 = Hospital System Supply Identifier | 876429 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X12","code_information":[{"code":"Sx00-0907-461","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053980","type":"LOCAL"},{"code":"876430","type":"LOCAL"}],"standard_charges":[{"gross_charge":811.47,"discounted_cash":608.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053980 = Hospital System Supply Identifier | 876430 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X14","code_information":[{"code":"Sx00-0907-461","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053981","type":"LOCAL"},{"code":"876431","type":"LOCAL"}],"standard_charges":[{"gross_charge":811.47,"discounted_cash":608.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053981 = Hospital System Supply Identifier | 876431 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X16","code_information":[{"code":"Sx00-0907-461","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053982","type":"LOCAL"},{"code":"876432","type":"LOCAL"}],"standard_charges":[{"gross_charge":811.47,"discounted_cash":608.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053982 = Hospital System Supply Identifier | 876432 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X18","code_information":[{"code":"Sx00-0907-461","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053983","type":"LOCAL"},{"code":"876433","type":"LOCAL"}],"standard_charges":[{"gross_charge":811.47,"discounted_cash":608.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053983 = Hospital System Supply Identifier | 876433 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X28","code_information":[{"code":"Sx00-0907-462","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053986","type":"LOCAL"},{"code":"876436","type":"LOCAL"}],"standard_charges":[{"gross_charge":811.47,"discounted_cash":608.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053986 = Hospital System Supply Identifier | 876436 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X26","code_information":[{"code":"Sx00-0907-462","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053985","type":"LOCAL"},{"code":"876435","type":"LOCAL"}],"standard_charges":[{"gross_charge":811.47,"discounted_cash":608.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053985 = Hospital System Supply Identifier | 876435 = Lawson ID"}]},{"description":"SCREW BONE 24X4.5 CORT","code_information":[{"code":"Sx00-0907-462","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"971156","type":"LOCAL"},{"code":"841868","type":"LOCAL"}],"standard_charges":[{"gross_charge":811.47,"discounted_cash":608.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 971156 = Hospital System Supply Identifier | 841868 = Lawson ID"}]},{"description":"SCREW BONE 20X4.5 CORT","code_information":[{"code":"Sx00-0907-462","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"971155","type":"LOCAL"},{"code":"841867","type":"LOCAL"}],"standard_charges":[{"gross_charge":811.47,"discounted_cash":608.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 971155 = Hospital System Supply Identifier | 841867 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X22","code_information":[{"code":"Sx00-0907-462","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053984","type":"LOCAL"},{"code":"876434","type":"LOCAL"}],"standard_charges":[{"gross_charge":811.47,"discounted_cash":608.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053984 = Hospital System Supply Identifier | 876434 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X30","code_information":[{"code":"Sx00-0907-463","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053987","type":"LOCAL"},{"code":"876437","type":"LOCAL"}],"standard_charges":[{"gross_charge":811.47,"discounted_cash":608.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053987 = Hospital System Supply Identifier | 876437 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X32","code_information":[{"code":"Sx00-0907-463","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053988","type":"LOCAL"},{"code":"876438","type":"LOCAL"}],"standard_charges":[{"gross_charge":811.47,"discounted_cash":608.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053988 = Hospital System Supply Identifier | 876438 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X34","code_information":[{"code":"Sx00-0907-463","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053989","type":"LOCAL"},{"code":"876439","type":"LOCAL"}],"standard_charges":[{"gross_charge":811.47,"discounted_cash":608.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053989 = Hospital System Supply Identifier | 876439 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X36","code_information":[{"code":"Sx00-0907-463","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053990","type":"LOCAL"},{"code":"876440","type":"LOCAL"}],"standard_charges":[{"gross_charge":811.47,"discounted_cash":608.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053990 = Hospital System Supply Identifier | 876440 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X38","code_information":[{"code":"Sx00-0907-463","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053991","type":"LOCAL"},{"code":"876441","type":"LOCAL"}],"standard_charges":[{"gross_charge":811.47,"discounted_cash":608.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053991 = Hospital System Supply Identifier | 876441 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X45","code_information":[{"code":"Sx00-0907-464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053994","type":"LOCAL"},{"code":"876444","type":"LOCAL"}],"standard_charges":[{"gross_charge":811.47,"discounted_cash":608.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053994 = Hospital System Supply Identifier | 876444 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X48","code_information":[{"code":"Sx00-0907-464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053995","type":"LOCAL"},{"code":"876445","type":"LOCAL"}],"standard_charges":[{"gross_charge":811.47,"discounted_cash":608.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053995 = Hospital System Supply Identifier | 876445 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X44","code_information":[{"code":"Sx00-0907-464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053993","type":"LOCAL"},{"code":"876443","type":"LOCAL"}],"standard_charges":[{"gross_charge":811.47,"discounted_cash":608.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053993 = Hospital System Supply Identifier | 876443 = Lawson ID"}]},{"description":"SCREW BONE 42X4.5 CORT","code_information":[{"code":"Sx00-0907-464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"971158","type":"LOCAL"},{"code":"841870","type":"LOCAL"}],"standard_charges":[{"gross_charge":811.47,"discounted_cash":608.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 971158 = Hospital System Supply Identifier | 841870 = Lawson ID"}]},{"description":"SCREW BONE 46X4.5 CORT","code_information":[{"code":"Sx00-0907-464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"971159","type":"LOCAL"},{"code":"841871","type":"LOCAL"}],"standard_charges":[{"gross_charge":811.47,"discounted_cash":608.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 971159 = Hospital System Supply Identifier | 841871 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X40","code_information":[{"code":"Sx00-0907-464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053992","type":"LOCAL"},{"code":"876442","type":"LOCAL"}],"standard_charges":[{"gross_charge":811.47,"discounted_cash":608.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053992 = Hospital System Supply Identifier | 876442 = Lawson ID"}]},{"description":"SCREW BONE 50X4.5 CORT","code_information":[{"code":"Sx00-0907-465","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"971160","type":"LOCAL"},{"code":"841872","type":"LOCAL"}],"standard_charges":[{"gross_charge":811.47,"discounted_cash":608.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 971160 = Hospital System Supply Identifier | 841872 = Lawson ID"}]},{"description":"SCREW BONE 55X4.5 CORT","code_information":[{"code":"Sx00-0907-465","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"971161","type":"LOCAL"},{"code":"841873","type":"LOCAL"}],"standard_charges":[{"gross_charge":811.47,"discounted_cash":608.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 971161 = Hospital System Supply Identifier | 841873 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X60","code_information":[{"code":"Sx00-0907-466","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053996","type":"LOCAL"},{"code":"876446","type":"LOCAL"}],"standard_charges":[{"gross_charge":811.47,"discounted_cash":608.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053996 = Hospital System Supply Identifier | 876446 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X65","code_information":[{"code":"Sx00-0907-466","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053997","type":"LOCAL"},{"code":"876447","type":"LOCAL"}],"standard_charges":[{"gross_charge":811.47,"discounted_cash":608.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053997 = Hospital System Supply Identifier | 876447 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X70","code_information":[{"code":"Sx00-0907-467","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053998","type":"LOCAL"},{"code":"876448","type":"LOCAL"}],"standard_charges":[{"gross_charge":811.47,"discounted_cash":608.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053998 = Hospital System Supply Identifier | 876448 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X75","code_information":[{"code":"Sx00-0907-467","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053999","type":"LOCAL"},{"code":"876449","type":"LOCAL"}],"standard_charges":[{"gross_charge":811.47,"discounted_cash":608.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1053999 = Hospital System Supply Identifier | 876449 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X80","code_information":[{"code":"Sx00-0907-468","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054000","type":"LOCAL"},{"code":"876450","type":"LOCAL"}],"standard_charges":[{"gross_charge":811.47,"discounted_cash":608.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054000 = Hospital System Supply Identifier | 876450 = Lawson ID"}]},{"description":"SCREW CANN CORT LOK 4.5X30MM","code_information":[{"code":"Sx00-0907-473","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054001","type":"LOCAL"},{"code":"876451","type":"LOCAL"}],"standard_charges":[{"gross_charge":1525.26,"discounted_cash":1143.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054001 = Hospital System Supply Identifier | 876451 = Lawson ID"}]},{"description":"SCREW CANN CORT LOK 4.5X32MM","code_information":[{"code":"Sx00-0907-473","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054002","type":"LOCAL"},{"code":"876452","type":"LOCAL"}],"standard_charges":[{"gross_charge":1525.26,"discounted_cash":1143.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054002 = Hospital System Supply Identifier | 876452 = Lawson ID"}]},{"description":"SCREW CANN CORT LOK 4.5X34MM","code_information":[{"code":"Sx00-0907-473","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054003","type":"LOCAL"},{"code":"876453","type":"LOCAL"}],"standard_charges":[{"gross_charge":1525.26,"discounted_cash":1143.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054003 = Hospital System Supply Identifier | 876453 = Lawson ID"}]},{"description":"SCREW CANN CORT LOK 4.5X36MM","code_information":[{"code":"Sx00-0907-473","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054004","type":"LOCAL"},{"code":"876454","type":"LOCAL"}],"standard_charges":[{"gross_charge":1525.26,"discounted_cash":1143.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054004 = Hospital System Supply Identifier | 876454 = Lawson ID"}]},{"description":"SCREW CANN CORT LOK 4.5X38MM","code_information":[{"code":"Sx00-0907-473","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054005","type":"LOCAL"},{"code":"876455","type":"LOCAL"}],"standard_charges":[{"gross_charge":1525.26,"discounted_cash":1143.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054005 = Hospital System Supply Identifier | 876455 = Lawson ID"}]},{"description":"SCREW CANN CORT LOK 4.5X40MM","code_information":[{"code":"Sx00-0907-474","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054006","type":"LOCAL"},{"code":"876456","type":"LOCAL"}],"standard_charges":[{"gross_charge":1525.26,"discounted_cash":1143.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054006 = Hospital System Supply Identifier | 876456 = Lawson ID"}]},{"description":"SCREW CANN CORT LOK 4.5X45MM","code_information":[{"code":"Sx00-0907-474","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054007","type":"LOCAL"},{"code":"876457","type":"LOCAL"}],"standard_charges":[{"gross_charge":1525.26,"discounted_cash":1143.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054007 = Hospital System Supply Identifier | 876457 = Lawson ID"}]},{"description":"SCREW CANN CORT LOK 4.5X55MM","code_information":[{"code":"Sx00-0907-475","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054009","type":"LOCAL"},{"code":"876459","type":"LOCAL"}],"standard_charges":[{"gross_charge":1525.26,"discounted_cash":1143.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054009 = Hospital System Supply Identifier | 876459 = Lawson ID"}]},{"description":"SCREW CANN CORT LOK 4.5X50MM","code_information":[{"code":"Sx00-0907-475","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054008","type":"LOCAL"},{"code":"876458","type":"LOCAL"}],"standard_charges":[{"gross_charge":1525.26,"discounted_cash":1143.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054008 = Hospital System Supply Identifier | 876458 = Lawson ID"}]},{"description":"SCREW BONE 654.5PROX FEM T20 H","code_information":[{"code":"Sx00-0907-476","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"939586","type":"LOCAL"},{"code":"824111","type":"LOCAL"}],"standard_charges":[{"gross_charge":1525.26,"discounted_cash":1143.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 939586 = Hospital System Supply Identifier | 824111 = Lawson ID"}]},{"description":"SCREW CANN CORT LOK 4.5X60MM","code_information":[{"code":"Sx00-0907-476","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054010","type":"LOCAL"},{"code":"876460","type":"LOCAL"}],"standard_charges":[{"gross_charge":1525.26,"discounted_cash":1143.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054010 = Hospital System Supply Identifier | 876460 = Lawson ID"}]},{"description":"SCREW CANN CORT LOK 4.5X70MM","code_information":[{"code":"Sx00-0907-477","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054011","type":"LOCAL"},{"code":"876461","type":"LOCAL"}],"standard_charges":[{"gross_charge":1525.26,"discounted_cash":1143.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054011 = Hospital System Supply Identifier | 876461 = Lawson ID"}]},{"description":"SCREW CANN CORT LOK 4.5X75MM","code_information":[{"code":"Sx00-0907-477","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054012","type":"LOCAL"},{"code":"876462","type":"LOCAL"}],"standard_charges":[{"gross_charge":1525.26,"discounted_cash":1143.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054012 = Hospital System Supply Identifier | 876462 = Lawson ID"}]},{"description":"SCREW BONE 804.5HEXALOBE FEM P","code_information":[{"code":"Sx00-0907-478","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"939585","type":"LOCAL"},{"code":"824110","type":"LOCAL"}],"standard_charges":[{"gross_charge":1525.26,"discounted_cash":1143.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 939585 = Hospital System Supply Identifier | 824110 = Lawson ID"}]},{"description":"DISC - GWIRE RM MDLLRY4.7X68","code_information":[{"code":"Sx00-0928-039","type":"CDM"},{"code":"272","type":"RC"},{"code":"408388","type":"LOCAL"},{"code":"310986","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408388 = Hospital System Supply Identifier | 310986 = Lawson ID"}]},{"description":"MESH L1 STD ORTHOG STRIP 117MM","code_information":[{"code":"Sx00-100-63-0","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"779931","type":"LOCAL"},{"code":"773376","type":"LOCAL"}],"standard_charges":[{"gross_charge":1133.21,"discounted_cash":849.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 779931 = Hospital System Supply Identifier | 773376 = Lawson ID"}]},{"description":"NAIL FLEX TI 1.5MM","code_information":[{"code":"Sx00-1000-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054013","type":"LOCAL"},{"code":"876463","type":"LOCAL"}],"standard_charges":[{"gross_charge":1453.3,"discounted_cash":1089.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054013 = Hospital System Supply Identifier | 876463 = Lawson ID"}]},{"description":"NAIL FLEX TI 2.0MM","code_information":[{"code":"Sx00-1000-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054014","type":"LOCAL"},{"code":"876464","type":"LOCAL"}],"standard_charges":[{"gross_charge":1453.3,"discounted_cash":1089.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054014 = Hospital System Supply Identifier | 876464 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY 2.5TI FLEX","code_information":[{"code":"Sx00-1000-025","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"932137","type":"LOCAL"},{"code":"816512","type":"LOCAL"}],"standard_charges":[{"gross_charge":1453.3,"discounted_cash":1089.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 932137 = Hospital System Supply Identifier | 816512 = Lawson ID"}]},{"description":"NAIL FLEX TI 3.0MM","code_information":[{"code":"Sx00-1000-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054015","type":"LOCAL"},{"code":"876465","type":"LOCAL"}],"standard_charges":[{"gross_charge":1453.3,"discounted_cash":1089.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054015 = Hospital System Supply Identifier | 876465 = Lawson ID"}]},{"description":"NAIL FLEX TI 3.5MM","code_information":[{"code":"Sx00-1000-035","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054016","type":"LOCAL"},{"code":"876466","type":"LOCAL"}],"standard_charges":[{"gross_charge":1453.3,"discounted_cash":1089.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054016 = Hospital System Supply Identifier | 876466 = Lawson ID"}]},{"description":"NAIL FLEX TI 4.0MM","code_information":[{"code":"Sx00-1000-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054017","type":"LOCAL"},{"code":"876467","type":"LOCAL"}],"standard_charges":[{"gross_charge":1453.3,"discounted_cash":1089.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054017 = Hospital System Supply Identifier | 876467 = Lawson ID"}]},{"description":"NAIL FLEX TI 4.5MM","code_information":[{"code":"Sx00-1000-045","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054018","type":"LOCAL"},{"code":"876468","type":"LOCAL"}],"standard_charges":[{"gross_charge":1453.3,"discounted_cash":1089.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054018 = Hospital System Supply Identifier | 876468 = Lawson ID"}]},{"description":"CAP NAIL PEDFLEX 2MM","code_information":[{"code":"Sx00-1000-120","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"881051","type":"LOCAL"},{"code":"401794","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.41,"discounted_cash":445.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 881051 = Hospital System Supply Identifier | 401794 = Lawson ID"}]},{"description":"CAP NAIL PEDFLEX 2.5MM","code_information":[{"code":"Sx00-1000-125","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"881052","type":"LOCAL"},{"code":"401795","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.41,"discounted_cash":445.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 881052 = Hospital System Supply Identifier | 401795 = Lawson ID"}]},{"description":"CAP NAIL PEDFLEX 3MM","code_information":[{"code":"Sx00-1000-130","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"881053","type":"LOCAL"},{"code":"401796","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.41,"discounted_cash":445.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 881053 = Hospital System Supply Identifier | 401796 = Lawson ID"}]},{"description":"CAP NAIL PEDFLEX 3.5MM","code_information":[{"code":"Sx00-1000-135","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050783","type":"LOCAL"},{"code":"401797","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.41,"discounted_cash":445.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050783 = Hospital System Supply Identifier | 401797 = Lawson ID"}]},{"description":"CAP NAIL PEDFLEX 4MM","code_information":[{"code":"Sx00-1000-140","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050784","type":"LOCAL"},{"code":"401798","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.41,"discounted_cash":445.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050784 = Hospital System Supply Identifier | 401798 = Lawson ID"}]},{"description":"CAP NAIL PEDFLEX 4.5MM","code_information":[{"code":"Sx00-1000-145","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050785","type":"LOCAL"},{"code":"401799","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.41,"discounted_cash":445.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050785 = Hospital System Supply Identifier | 401799 = Lawson ID"}]},{"description":"NAIL PEDFLEX SS 1.5MM","code_information":[{"code":"Sx00-1000-315","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"817980","type":"LOCAL"},{"code":"S281845","type":"LOCAL"}],"standard_charges":[{"gross_charge":919.75,"discounted_cash":689.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 817980 = Hospital System Supply Identifier | S281845 = Lawson ID"}]},{"description":"NAIL PEDFLEX SS 2MM","code_information":[{"code":"Sx00-1000-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050786","type":"LOCAL"},{"code":"401801","type":"LOCAL"}],"standard_charges":[{"gross_charge":919.75,"discounted_cash":689.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050786 = Hospital System Supply Identifier | 401801 = Lawson ID"}]},{"description":"NAIL PEDFLEX SS 2.5MM","code_information":[{"code":"Sx00-1000-325","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"817981","type":"LOCAL"},{"code":"S281846","type":"LOCAL"}],"standard_charges":[{"gross_charge":919.75,"discounted_cash":689.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 817981 = Hospital System Supply Identifier | S281846 = Lawson ID"}]},{"description":"NAIL PEDFLEX SS 3MM","code_information":[{"code":"Sx00-1000-330","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050787","type":"LOCAL"},{"code":"401803","type":"LOCAL"}],"standard_charges":[{"gross_charge":919.75,"discounted_cash":689.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050787 = Hospital System Supply Identifier | 401803 = Lawson ID"}]},{"description":"NAIL PEDFLEX SS 3.5MM","code_information":[{"code":"Sx00-1000-335","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050788","type":"LOCAL"},{"code":"401804","type":"LOCAL"}],"standard_charges":[{"gross_charge":919.75,"discounted_cash":689.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050788 = Hospital System Supply Identifier | 401804 = Lawson ID"}]},{"description":"NAIL PEDFLEX SS 4MM","code_information":[{"code":"Sx00-1000-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050789","type":"LOCAL"},{"code":"401805","type":"LOCAL"}],"standard_charges":[{"gross_charge":919.75,"discounted_cash":689.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050789 = Hospital System Supply Identifier | 401805 = Lawson ID"}]},{"description":"NAIL PEDFLEX TI 1.5MM","code_information":[{"code":"Sx00-1000-515","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"881047","type":"LOCAL"},{"code":"401787","type":"LOCAL"}],"standard_charges":[{"gross_charge":1453.3,"discounted_cash":1089.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 881047 = Hospital System Supply Identifier | 401787 = Lawson ID"}]},{"description":"NAIL PEDFLEX TI 2MM","code_information":[{"code":"Sx00-1000-520","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"881048","type":"LOCAL"},{"code":"401788","type":"LOCAL"}],"standard_charges":[{"gross_charge":1453.3,"discounted_cash":1089.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 881048 = Hospital System Supply Identifier | 401788 = Lawson ID"}]},{"description":"NAIL PEDFLEX TI 2.5MM","code_information":[{"code":"Sx00-1000-525","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"881049","type":"LOCAL"},{"code":"401789","type":"LOCAL"}],"standard_charges":[{"gross_charge":1453.3,"discounted_cash":1089.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 881049 = Hospital System Supply Identifier | 401789 = Lawson ID"}]},{"description":"NAIL PEDFLEX TI 3MM","code_information":[{"code":"Sx00-1000-530","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"881050","type":"LOCAL"},{"code":"401790","type":"LOCAL"}],"standard_charges":[{"gross_charge":1453.3,"discounted_cash":1089.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 881050 = Hospital System Supply Identifier | 401790 = Lawson ID"}]},{"description":"NAIL PEDFLEX TI 3.5MM","code_information":[{"code":"Sx00-1000-535","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050780","type":"LOCAL"},{"code":"401791","type":"LOCAL"}],"standard_charges":[{"gross_charge":1453.3,"discounted_cash":1089.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050780 = Hospital System Supply Identifier | 401791 = Lawson ID"}]},{"description":"NAIL PEDFLEX TI 4MM","code_information":[{"code":"Sx00-1000-540","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050781","type":"LOCAL"},{"code":"401792","type":"LOCAL"}],"standard_charges":[{"gross_charge":1453.3,"discounted_cash":1089.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050781 = Hospital System Supply Identifier | 401792 = Lawson ID"}]},{"description":"NAIL PEDFLEX TI 4.5MM","code_information":[{"code":"Sx00-1000-545","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050782","type":"LOCAL"},{"code":"401793","type":"LOCAL"}],"standard_charges":[{"gross_charge":1453.3,"discounted_cash":1089.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050782 = Hospital System Supply Identifier | 401793 = Lawson ID"}]},{"description":"NAIL FLEX SS RND TIP 1.5X300MM","code_information":[{"code":"Sx00-1000-615","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"886407","type":"LOCAL"},{"code":"454543","type":"LOCAL"}],"standard_charges":[{"gross_charge":1453.3,"discounted_cash":1089.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 886407 = Hospital System Supply Identifier | 454543 = Lawson ID"}]},{"description":"NAIL PEDIFLEX RND TIP SS 2.0MM","code_information":[{"code":"Sx00-1000-620","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"886242","type":"LOCAL"},{"code":"449446","type":"LOCAL"}],"standard_charges":[{"gross_charge":1453.3,"discounted_cash":1089.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 886242 = Hospital System Supply Identifier | 449446 = Lawson ID"}]},{"description":"NAIL PEDFLEX SS 2.5X300MM","code_information":[{"code":"Sx00-1000-625","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"886717","type":"LOCAL"},{"code":"455417","type":"LOCAL"}],"standard_charges":[{"gross_charge":1453.3,"discounted_cash":1089.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 886717 = Hospital System Supply Identifier | 455417 = Lawson ID"}]},{"description":"NAIL PEDFLEX SS 3.0X400MM","code_information":[{"code":"Sx00-1000-630","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1051021","type":"LOCAL"},{"code":"455418","type":"LOCAL"}],"standard_charges":[{"gross_charge":1453.3,"discounted_cash":1089.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1051021 = Hospital System Supply Identifier | 455418 = Lawson ID"}]},{"description":"NAIL PEDFLEX SS 3.5X400MM","code_information":[{"code":"Sx00-1000-635","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1051022","type":"LOCAL"},{"code":"455419","type":"LOCAL"}],"standard_charges":[{"gross_charge":1453.3,"discounted_cash":1089.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1051022 = Hospital System Supply Identifier | 455419 = Lawson ID"}]},{"description":"NAIL PEDFLEX SS 4.0X450MM","code_information":[{"code":"Sx00-1000-640","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1051023","type":"LOCAL"},{"code":"455420","type":"LOCAL"}],"standard_charges":[{"gross_charge":1453.3,"discounted_cash":1089.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1051023 = Hospital System Supply Identifier | 455420 = Lawson ID"}]},{"description":"NAIL PEDFLX RND TIP SS 1.5X300","code_information":[{"code":"Sx00-1001-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054019","type":"LOCAL"},{"code":"876469","type":"LOCAL"}],"standard_charges":[{"gross_charge":919.75,"discounted_cash":689.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054019 = Hospital System Supply Identifier | 876469 = Lawson ID"}]},{"description":"NAIL PEDFLX RND TIP SS 2.0X300","code_information":[{"code":"Sx00-1001-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054020","type":"LOCAL"},{"code":"876470","type":"LOCAL"}],"standard_charges":[{"gross_charge":919.75,"discounted_cash":689.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054020 = Hospital System Supply Identifier | 876470 = Lawson ID"}]},{"description":"NAIL PEDFLX RND TIP SS 2.5X300","code_information":[{"code":"Sx00-1001-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054021","type":"LOCAL"},{"code":"876471","type":"LOCAL"}],"standard_charges":[{"gross_charge":919.75,"discounted_cash":689.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054021 = Hospital System Supply Identifier | 876471 = Lawson ID"}]},{"description":"NAIL TI 3.0MMX400FLEX","code_information":[{"code":"Sx00-1001-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"942921","type":"LOCAL"},{"code":"827479","type":"LOCAL"}],"standard_charges":[{"gross_charge":919.75,"discounted_cash":689.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 942921 = Hospital System Supply Identifier | 827479 = Lawson ID"}]},{"description":"NAIL PEDFLX RND TIP SS 3.5X400","code_information":[{"code":"Sx00-1001-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054022","type":"LOCAL"},{"code":"876472","type":"LOCAL"}],"standard_charges":[{"gross_charge":919.75,"discounted_cash":689.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054022 = Hospital System Supply Identifier | 876472 = Lawson ID"}]},{"description":"NAIL PEDFLX RND TIP SS 4.0X450","code_information":[{"code":"Sx00-1001-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054023","type":"LOCAL"},{"code":"876473","type":"LOCAL"}],"standard_charges":[{"gross_charge":919.75,"discounted_cash":689.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054023 = Hospital System Supply Identifier | 876473 = Lawson ID"}]},{"description":"NAIL TI FLEX 1.5MMX300MM","code_information":[{"code":"Sx00-1001-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"943005","type":"LOCAL"},{"code":"827565","type":"LOCAL"}],"standard_charges":[{"gross_charge":919.75,"discounted_cash":689.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 943005 = Hospital System Supply Identifier | 827565 = Lawson ID"}]},{"description":"NAIL TI FLEX 2.5MMX300MM","code_information":[{"code":"Sx00-1001-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"942911","type":"LOCAL"},{"code":"827469","type":"LOCAL"}],"standard_charges":[{"gross_charge":919.75,"discounted_cash":689.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 942911 = Hospital System Supply Identifier | 827469 = Lawson ID"}]},{"description":"NAIL TI FLEX 2.0MMX300MM","code_information":[{"code":"Sx00-1001-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"942912","type":"LOCAL"},{"code":"827470","type":"LOCAL"}],"standard_charges":[{"gross_charge":919.75,"discounted_cash":689.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 942912 = Hospital System Supply Identifier | 827470 = Lawson ID"}]},{"description":"NAIL TI FLEX 3.0MMX400ROUND TI","code_information":[{"code":"Sx00-1001-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"944793","type":"LOCAL"},{"code":"829382","type":"LOCAL"}],"standard_charges":[{"gross_charge":919.75,"discounted_cash":689.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 944793 = Hospital System Supply Identifier | 829382 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY 4003.5ELAS","code_information":[{"code":"Sx00-1001-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"944599","type":"LOCAL"},{"code":"829177","type":"LOCAL"}],"standard_charges":[{"gross_charge":919.75,"discounted_cash":689.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 944599 = Hospital System Supply Identifier | 829177 = Lawson ID"}]},{"description":"NAIL PEDFLX RND TIP TI 4.0X450","code_information":[{"code":"Sx00-1001-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054024","type":"LOCAL"},{"code":"876474","type":"LOCAL"}],"standard_charges":[{"gross_charge":919.75,"discounted_cash":689.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054024 = Hospital System Supply Identifier | 876474 = Lawson ID"}]},{"description":"NAIL PEDFLX RND TIP TI 4.5X450","code_information":[{"code":"Sx00-1001-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054025","type":"LOCAL"},{"code":"876475","type":"LOCAL"}],"standard_charges":[{"gross_charge":919.75,"discounted_cash":689.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054025 = Hospital System Supply Identifier | 876475 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED STAINLESS-STEEL LONG-BONE","code_information":[{"code":"Sx00-1001-053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356498","type":"LOCAL"},{"code":"1083545","type":"LOCAL"}],"standard_charges":[{"gross_charge":2338.02,"discounted_cash":1753.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356498 = Hospital System Supply Identifier | 1083545 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED STAINLESS-STEEL LONG-BONE","code_information":[{"code":"Sx00-1001-053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356384","type":"LOCAL"},{"code":"1083589","type":"LOCAL"}],"standard_charges":[{"gross_charge":2338.02,"discounted_cash":1753.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356384 = Hospital System Supply Identifier | 1083589 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED STAINLESS-STEEL LONG-BONE","code_information":[{"code":"Sx00-1001-053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356827","type":"LOCAL"},{"code":"1083729","type":"LOCAL"}],"standard_charges":[{"gross_charge":2338.02,"discounted_cash":1753.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356827 = Hospital System Supply Identifier | 1083729 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED STAINLESS-STEEL LONG-BONE","code_information":[{"code":"Sx00-1001-053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356434","type":"LOCAL"},{"code":"1083742","type":"LOCAL"}],"standard_charges":[{"gross_charge":2338.02,"discounted_cash":1753.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356434 = Hospital System Supply Identifier | 1083742 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED STAINLESS-STEEL LONG-BONE","code_information":[{"code":"Sx00-1001-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356352","type":"LOCAL"},{"code":"1083620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2338.02,"discounted_cash":1753.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356352 = Hospital System Supply Identifier | 1083620 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED STAINLESS-STEEL LONG-BONE","code_information":[{"code":"Sx00-1001-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356394","type":"LOCAL"},{"code":"1083558","type":"LOCAL"}],"standard_charges":[{"gross_charge":2338.02,"discounted_cash":1753.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356394 = Hospital System Supply Identifier | 1083558 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED STAINLESS-STEEL LONG-BONE","code_information":[{"code":"Sx00-1001-061","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356949","type":"LOCAL"},{"code":"1083628","type":"LOCAL"}],"standard_charges":[{"gross_charge":684.86,"discounted_cash":513.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356949 = Hospital System Supply Identifier | 1083628 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED STAINLESS-STEEL LONG-BONE","code_information":[{"code":"Sx00-1001-061","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356625","type":"LOCAL"},{"code":"1083599","type":"LOCAL"}],"standard_charges":[{"gross_charge":684.86,"discounted_cash":513.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356625 = Hospital System Supply Identifier | 1083599 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED STAINLESS-STEEL LONG-BONE","code_information":[{"code":"Sx00-1001-061","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356970","type":"LOCAL"},{"code":"1083593","type":"LOCAL"}],"standard_charges":[{"gross_charge":684.86,"discounted_cash":513.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356970 = Hospital System Supply Identifier | 1083593 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED TITANIUM LONG-BONE","code_information":[{"code":"Sx00-1001-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357118","type":"LOCAL"},{"code":"1083559","type":"LOCAL"}],"standard_charges":[{"gross_charge":724.48,"discounted_cash":543.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357118 = Hospital System Supply Identifier | 1083559 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED TITANIUM LONG-BONE","code_information":[{"code":"Sx00-1001-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356385","type":"LOCAL"},{"code":"1083659","type":"LOCAL"}],"standard_charges":[{"gross_charge":724.48,"discounted_cash":543.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356385 = Hospital System Supply Identifier | 1083659 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED TITANIUM LONG-BONE","code_information":[{"code":"Sx00-1001-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356751","type":"LOCAL"},{"code":"1083689","type":"LOCAL"}],"standard_charges":[{"gross_charge":724.48,"discounted_cash":543.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356751 = Hospital System Supply Identifier | 1083689 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED TITANIUM LONG-BONE","code_information":[{"code":"Sx00-1001-073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357128","type":"LOCAL"},{"code":"1083616","type":"LOCAL"}],"standard_charges":[{"gross_charge":2457.99,"discounted_cash":1843.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357128 = Hospital System Supply Identifier | 1083616 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED TITANIUM LONG-BONE","code_information":[{"code":"Sx00-1001-073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356837","type":"LOCAL"},{"code":"1083710","type":"LOCAL"}],"standard_charges":[{"gross_charge":2457.99,"discounted_cash":1843.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356837 = Hospital System Supply Identifier | 1083710 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED TITANIUM LONG-BONE","code_information":[{"code":"Sx00-1001-073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356951","type":"LOCAL"},{"code":"1083716","type":"LOCAL"}],"standard_charges":[{"gross_charge":2457.99,"discounted_cash":1843.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356951 = Hospital System Supply Identifier | 1083716 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED TITANIUM LONG-BONE","code_information":[{"code":"Sx00-1001-073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356433","type":"LOCAL"},{"code":"1083733","type":"LOCAL"}],"standard_charges":[{"gross_charge":2457.99,"discounted_cash":1843.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356433 = Hospital System Supply Identifier | 1083733 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED TITANIUM LONG-BONE","code_information":[{"code":"Sx00-1001-074","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356460","type":"LOCAL"},{"code":"1083736","type":"LOCAL"}],"standard_charges":[{"gross_charge":2457.99,"discounted_cash":1843.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356460 = Hospital System Supply Identifier | 1083736 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED TITANIUM LONG-BONE","code_information":[{"code":"Sx00-1001-074","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357071","type":"LOCAL"},{"code":"1083723","type":"LOCAL"}],"standard_charges":[{"gross_charge":2457.99,"discounted_cash":1843.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357071 = Hospital System Supply Identifier | 1083723 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED TITANIUM LONG-BONE","code_information":[{"code":"Sx00-1001-074","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356369","type":"LOCAL"},{"code":"1083707","type":"LOCAL"}],"standard_charges":[{"gross_charge":2457.99,"discounted_cash":1843.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356369 = Hospital System Supply Identifier | 1083707 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED TITANIUM LONG-BONE","code_information":[{"code":"Sx00-1001-074","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356363","type":"LOCAL"},{"code":"1083635","type":"LOCAL"}],"standard_charges":[{"gross_charge":2457.99,"discounted_cash":1843.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356363 = Hospital System Supply Identifier | 1083635 = Lawson ID"}]},{"description":"GUIDE WIRE 1.6MMX150SMOOTH","code_information":[{"code":"Sx00-1005-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"942666","type":"LOCAL"},{"code":"827218","type":"LOCAL"}],"standard_charges":[{"gross_charge":111.51,"discounted_cash":83.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 942666 = Hospital System Supply Identifier | 827218 = Lawson ID"}]},{"description":"PLATE TUBULAR 1/4 2.7MM 4HL","code_information":[{"code":"Sx00-1005-200","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054027","type":"LOCAL"},{"code":"876477","type":"LOCAL"}],"standard_charges":[{"gross_charge":741.34,"discounted_cash":556.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054027 = Hospital System Supply Identifier | 876477 = Lawson ID"}]},{"description":"PLATE TUBULAR 1/4 2.7MM 6HL","code_information":[{"code":"Sx00-1005-200","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054028","type":"LOCAL"},{"code":"876478","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.08,"discounted_cash":583.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054028 = Hospital System Supply Identifier | 876478 = Lawson ID"}]},{"description":"PLATE TUBULAR 1/4 2.7MM 7HL","code_information":[{"code":"Sx00-1005-200","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054029","type":"LOCAL"},{"code":"876479","type":"LOCAL"}],"standard_charges":[{"gross_charge":814.81,"discounted_cash":611.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054029 = Hospital System Supply Identifier | 876479 = Lawson ID"}]},{"description":"PLATE TUBULAR 1/4 2.7MM 8HL","code_information":[{"code":"Sx00-1005-200","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054030","type":"LOCAL"},{"code":"876480","type":"LOCAL"}],"standard_charges":[{"gross_charge":814.81,"discounted_cash":611.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054030 = Hospital System Supply Identifier | 876480 = Lawson ID"}]},{"description":"PLATE TUBULAR 1/4 2.7MM 10HL","code_information":[{"code":"Sx00-1005-201","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054031","type":"LOCAL"},{"code":"876481","type":"LOCAL"}],"standard_charges":[{"gross_charge":879.42,"discounted_cash":659.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054031 = Hospital System Supply Identifier | 876481 = Lawson ID"}]},{"description":"PLATE LOK COMP 2.7MM 8HL","code_information":[{"code":"Sx00-1005-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054036","type":"LOCAL"},{"code":"876486","type":"LOCAL"}],"standard_charges":[{"gross_charge":2045.17,"discounted_cash":1533.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054036 = Hospital System Supply Identifier | 876486 = Lawson ID"}]},{"description":"PLATE LOK COMP 2.7MM 7HL","code_information":[{"code":"Sx00-1005-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054035","type":"LOCAL"},{"code":"876485","type":"LOCAL"}],"standard_charges":[{"gross_charge":2045.17,"discounted_cash":1533.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054035 = Hospital System Supply Identifier | 876485 = Lawson ID"}]},{"description":"PLATE LOK COMP 2.7MM 6HL","code_information":[{"code":"Sx00-1005-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054034","type":"LOCAL"},{"code":"876484","type":"LOCAL"}],"standard_charges":[{"gross_charge":2008.83,"discounted_cash":1506.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054034 = Hospital System Supply Identifier | 876484 = Lawson ID"}]},{"description":"PLATE LOK COMP 2.7MM 5HL","code_information":[{"code":"Sx00-1005-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054033","type":"LOCAL"},{"code":"876483","type":"LOCAL"}],"standard_charges":[{"gross_charge":1972.48,"discounted_cash":1479.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054033 = Hospital System Supply Identifier | 876483 = Lawson ID"}]},{"description":"PLATE LOK COMP 2.7MM 4HL","code_information":[{"code":"Sx00-1005-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054032","type":"LOCAL"},{"code":"876482","type":"LOCAL"}],"standard_charges":[{"gross_charge":1936.14,"discounted_cash":1452.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054032 = Hospital System Supply Identifier | 876482 = Lawson ID"}]},{"description":"IMPLANT-PLATE-BONE COMPRESSION LOCKING 12-HOLE","code_information":[{"code":"Sx00-1005-211","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357185","type":"LOCAL"},{"code":"1083724","type":"LOCAL"}],"standard_charges":[{"gross_charge":2329.65,"discounted_cash":1747.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357185 = Hospital System Supply Identifier | 1083724 = Lawson ID"}]},{"description":"PLATE LOK COMP 2.7MM 10HL","code_information":[{"code":"Sx00-1005-211","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054037","type":"LOCAL"},{"code":"876487","type":"LOCAL"}],"standard_charges":[{"gross_charge":2116.1,"discounted_cash":1587.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054037 = Hospital System Supply Identifier | 876487 = Lawson ID"}]},{"description":"PLATE RECONSTRUCTION 2.7MM 4HL","code_information":[{"code":"Sx00-1005-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054038","type":"LOCAL"},{"code":"876488","type":"LOCAL"}],"standard_charges":[{"gross_charge":1432.42,"discounted_cash":1074.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054038 = Hospital System Supply Identifier | 876488 = Lawson ID"}]},{"description":"PLATE RECONSTRUCTION 2.7MM 8HL","code_information":[{"code":"Sx00-1005-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054039","type":"LOCAL"},{"code":"876489","type":"LOCAL"}],"standard_charges":[{"gross_charge":1485.47,"discounted_cash":1114.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054039 = Hospital System Supply Identifier | 876489 = Lawson ID"}]},{"description":"PLATE RECONSTRUCTION 2.7MM 12H","code_information":[{"code":"Sx00-1005-221","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054040","type":"LOCAL"},{"code":"876490","type":"LOCAL"}],"standard_charges":[{"gross_charge":2128.5,"discounted_cash":1596.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054040 = Hospital System Supply Identifier | 876490 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X8MM","code_information":[{"code":"Sx00-1005-250","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054041","type":"LOCAL"},{"code":"876491","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.32,"discounted_cash":132.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054041 = Hospital System Supply Identifier | 876491 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X18MM","code_information":[{"code":"Sx00-1005-251","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054046","type":"LOCAL"},{"code":"876496","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.32,"discounted_cash":132.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054046 = Hospital System Supply Identifier | 876496 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X16MM","code_information":[{"code":"Sx00-1005-251","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054045","type":"LOCAL"},{"code":"876495","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.32,"discounted_cash":132.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054045 = Hospital System Supply Identifier | 876495 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X12MM","code_information":[{"code":"Sx00-1005-251","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054043","type":"LOCAL"},{"code":"876493","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.32,"discounted_cash":132.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054043 = Hospital System Supply Identifier | 876493 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X10MM","code_information":[{"code":"Sx00-1005-251","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054042","type":"LOCAL"},{"code":"876492","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.32,"discounted_cash":132.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054042 = Hospital System Supply Identifier | 876492 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X14MM","code_information":[{"code":"Sx00-1005-251","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054044","type":"LOCAL"},{"code":"876494","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.32,"discounted_cash":132.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054044 = Hospital System Supply Identifier | 876494 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X20MM","code_information":[{"code":"Sx00-1005-252","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054047","type":"LOCAL"},{"code":"876497","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.32,"discounted_cash":132.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054047 = Hospital System Supply Identifier | 876497 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X22MM","code_information":[{"code":"Sx00-1005-252","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054048","type":"LOCAL"},{"code":"876498","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.32,"discounted_cash":132.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054048 = Hospital System Supply Identifier | 876498 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X24MM","code_information":[{"code":"Sx00-1005-252","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054049","type":"LOCAL"},{"code":"876499","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.32,"discounted_cash":132.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054049 = Hospital System Supply Identifier | 876499 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X26MM","code_information":[{"code":"Sx00-1005-252","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054050","type":"LOCAL"},{"code":"876500","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.32,"discounted_cash":132.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054050 = Hospital System Supply Identifier | 876500 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X28MM","code_information":[{"code":"Sx00-1005-252","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054051","type":"LOCAL"},{"code":"876501","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.32,"discounted_cash":132.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054051 = Hospital System Supply Identifier | 876501 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X38MM","code_information":[{"code":"Sx00-1005-253","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054056","type":"LOCAL"},{"code":"876506","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.32,"discounted_cash":132.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054056 = Hospital System Supply Identifier | 876506 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X36MM","code_information":[{"code":"Sx00-1005-253","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054055","type":"LOCAL"},{"code":"876505","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.32,"discounted_cash":132.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054055 = Hospital System Supply Identifier | 876505 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X32MM","code_information":[{"code":"Sx00-1005-253","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054053","type":"LOCAL"},{"code":"876503","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.32,"discounted_cash":132.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054053 = Hospital System Supply Identifier | 876503 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X30MM","code_information":[{"code":"Sx00-1005-253","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054052","type":"LOCAL"},{"code":"876502","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.32,"discounted_cash":132.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054052 = Hospital System Supply Identifier | 876502 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X34MM","code_information":[{"code":"Sx00-1005-253","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054054","type":"LOCAL"},{"code":"876504","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.32,"discounted_cash":132.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054054 = Hospital System Supply Identifier | 876504 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X40MM","code_information":[{"code":"Sx00-1005-254","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054057","type":"LOCAL"},{"code":"876507","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.32,"discounted_cash":132.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054057 = Hospital System Supply Identifier | 876507 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X45MM","code_information":[{"code":"Sx00-1005-254","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054058","type":"LOCAL"},{"code":"876508","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.32,"discounted_cash":132.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054058 = Hospital System Supply Identifier | 876508 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X50MM","code_information":[{"code":"Sx00-1005-255","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054059","type":"LOCAL"},{"code":"876509","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.32,"discounted_cash":132.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054059 = Hospital System Supply Identifier | 876509 = Lawson ID"}]},{"description":"SCREW LOK T10 2.7X8MM","code_information":[{"code":"Sx00-1005-260","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054060","type":"LOCAL"},{"code":"876510","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054060 = Hospital System Supply Identifier | 876510 = Lawson ID"}]},{"description":"SCREW LOK T10 2.7X16MM","code_information":[{"code":"Sx00-1005-261","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054064","type":"LOCAL"},{"code":"876514","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054064 = Hospital System Supply Identifier | 876514 = Lawson ID"}]},{"description":"SCREW LOK T10 2.7X18MM","code_information":[{"code":"Sx00-1005-261","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054065","type":"LOCAL"},{"code":"876515","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054065 = Hospital System Supply Identifier | 876515 = Lawson ID"}]},{"description":"SCREW LOK T10 2.7X14MM","code_information":[{"code":"Sx00-1005-261","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054063","type":"LOCAL"},{"code":"876513","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054063 = Hospital System Supply Identifier | 876513 = Lawson ID"}]},{"description":"SCREW LOK T10 2.7X12MM","code_information":[{"code":"Sx00-1005-261","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054062","type":"LOCAL"},{"code":"876512","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054062 = Hospital System Supply Identifier | 876512 = Lawson ID"}]},{"description":"SCREW LOK T10 2.7X10MM","code_information":[{"code":"Sx00-1005-261","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054061","type":"LOCAL"},{"code":"876511","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054061 = Hospital System Supply Identifier | 876511 = Lawson ID"}]},{"description":"SCREW LOK T10 2.7X20MM","code_information":[{"code":"Sx00-1005-262","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054066","type":"LOCAL"},{"code":"876516","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054066 = Hospital System Supply Identifier | 876516 = Lawson ID"}]},{"description":"SCREW LOK T10 2.7X22MM","code_information":[{"code":"Sx00-1005-262","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054067","type":"LOCAL"},{"code":"876517","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054067 = Hospital System Supply Identifier | 876517 = Lawson ID"}]},{"description":"SCREW LOK T10 2.7X24MM","code_information":[{"code":"Sx00-1005-262","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054068","type":"LOCAL"},{"code":"876518","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054068 = Hospital System Supply Identifier | 876518 = Lawson ID"}]},{"description":"SCREW LOK T10 2.7X26MM","code_information":[{"code":"Sx00-1005-262","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054069","type":"LOCAL"},{"code":"876519","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054069 = Hospital System Supply Identifier | 876519 = Lawson ID"}]},{"description":"SCREW LOK T10 2.7X28MM","code_information":[{"code":"Sx00-1005-262","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054070","type":"LOCAL"},{"code":"876520","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054070 = Hospital System Supply Identifier | 876520 = Lawson ID"}]},{"description":"SCREW LOK T10 2.7X30MM","code_information":[{"code":"Sx00-1005-263","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054071","type":"LOCAL"},{"code":"876521","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054071 = Hospital System Supply Identifier | 876521 = Lawson ID"}]},{"description":"PLATE TUBULAR 1/3 2.7MM 9HL","code_information":[{"code":"Sx00-1005-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054076","type":"LOCAL"},{"code":"876526","type":"LOCAL"}],"standard_charges":[{"gross_charge":969.89,"discounted_cash":727.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054076 = Hospital System Supply Identifier | 876526 = Lawson ID"}]},{"description":"PLATE TUBULAR 1/3 2.7MM 8HL","code_information":[{"code":"Sx00-1005-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054075","type":"LOCAL"},{"code":"876525","type":"LOCAL"}],"standard_charges":[{"gross_charge":925.01,"discounted_cash":693.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054075 = Hospital System Supply Identifier | 876525 = Lawson ID"}]},{"description":"PLATE TUBULAR 1/3 2.7MM 7HL","code_information":[{"code":"Sx00-1005-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054074","type":"LOCAL"},{"code":"876524","type":"LOCAL"}],"standard_charges":[{"gross_charge":925.01,"discounted_cash":693.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054074 = Hospital System Supply Identifier | 876524 = Lawson ID"}]},{"description":"PLATE TUBULAR 1/3 2.7MM 6HL","code_information":[{"code":"Sx00-1005-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054073","type":"LOCAL"},{"code":"876523","type":"LOCAL"}],"standard_charges":[{"gross_charge":888.28,"discounted_cash":666.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054073 = Hospital System Supply Identifier | 876523 = Lawson ID"}]},{"description":"PLATE TUBULAR 1/3 2.7MM 4HL","code_information":[{"code":"Sx00-1005-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054072","type":"LOCAL"},{"code":"876522","type":"LOCAL"}],"standard_charges":[{"gross_charge":851.54,"discounted_cash":638.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054072 = Hospital System Supply Identifier | 876522 = Lawson ID"}]},{"description":"PLATE BONE 1/3 TUBULAR NSTRL 5","code_information":[{"code":"Sx00-1005-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"942929","type":"LOCAL"},{"code":"827489","type":"LOCAL"}],"standard_charges":[{"gross_charge":888.28,"discounted_cash":666.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 942929 = Hospital System Supply Identifier | 827489 = Lawson ID"}]},{"description":"PLATE TUBULAR 1/3 2.7MM 10HL","code_information":[{"code":"Sx00-1005-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054077","type":"LOCAL"},{"code":"876527","type":"LOCAL"}],"standard_charges":[{"gross_charge":1050.87,"discounted_cash":788.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054077 = Hospital System Supply Identifier | 876527 = Lawson ID"}]},{"description":"PLATE TUBULAR 1/3 2.7MM 12HL","code_information":[{"code":"Sx00-1005-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054078","type":"LOCAL"},{"code":"876528","type":"LOCAL"}],"standard_charges":[{"gross_charge":1058.0,"discounted_cash":793.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054078 = Hospital System Supply Identifier | 876528 = Lawson ID"}]},{"description":"PLATE COMP LOK 3.5MM 4HL","code_information":[{"code":"Sx00-1005-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054079","type":"LOCAL"},{"code":"876529","type":"LOCAL"}],"standard_charges":[{"gross_charge":1360.98,"discounted_cash":1020.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054079 = Hospital System Supply Identifier | 876529 = Lawson ID"}]},{"description":"PLATE COMP LOK 3.5MM 5HL","code_information":[{"code":"Sx00-1005-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054080","type":"LOCAL"},{"code":"876530","type":"LOCAL"}],"standard_charges":[{"gross_charge":1412.53,"discounted_cash":1059.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054080 = Hospital System Supply Identifier | 876530 = Lawson ID"}]},{"description":"PLATE COMP LOK 3.5MM 6HL","code_information":[{"code":"Sx00-1005-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054081","type":"LOCAL"},{"code":"876531","type":"LOCAL"}],"standard_charges":[{"gross_charge":1465.58,"discounted_cash":1099.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054081 = Hospital System Supply Identifier | 876531 = Lawson ID"}]},{"description":"PLATE COMP LOK 3.5MM 7HL","code_information":[{"code":"Sx00-1005-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054082","type":"LOCAL"},{"code":"876532","type":"LOCAL"}],"standard_charges":[{"gross_charge":1521.95,"discounted_cash":1141.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054082 = Hospital System Supply Identifier | 876532 = Lawson ID"}]},{"description":"PLATE COMP LOK 3.5MM 8HL","code_information":[{"code":"Sx00-1005-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054083","type":"LOCAL"},{"code":"876533","type":"LOCAL"}],"standard_charges":[{"gross_charge":1521.95,"discounted_cash":1141.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054083 = Hospital System Supply Identifier | 876533 = Lawson ID"}]},{"description":"PLATE COMP LOK 3.5MM 18HL","code_information":[{"code":"Sx00-1005-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054087","type":"LOCAL"},{"code":"876537","type":"LOCAL"}],"standard_charges":[{"gross_charge":1834.5,"discounted_cash":1375.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054087 = Hospital System Supply Identifier | 876537 = Lawson ID"}]},{"description":"PLATE COMP LOK 3.5MM 16HL","code_information":[{"code":"Sx00-1005-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054086","type":"LOCAL"},{"code":"876536","type":"LOCAL"}],"standard_charges":[{"gross_charge":1730.14,"discounted_cash":1297.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054086 = Hospital System Supply Identifier | 876536 = Lawson ID"}]},{"description":"PLATE COMP LOK 3.5MM 10HL","code_information":[{"code":"Sx00-1005-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054084","type":"LOCAL"},{"code":"876534","type":"LOCAL"}],"standard_charges":[{"gross_charge":1575.0,"discounted_cash":1181.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054084 = Hospital System Supply Identifier | 876534 = Lawson ID"}]},{"description":"PLATE COMP LOK 3.5MM 12HL","code_information":[{"code":"Sx00-1005-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054085","type":"LOCAL"},{"code":"876535","type":"LOCAL"}],"standard_charges":[{"gross_charge":1730.14,"discounted_cash":1297.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054085 = Hospital System Supply Identifier | 876535 = Lawson ID"}]},{"description":"PLATE COMP LOK 3.5MM 20HL","code_information":[{"code":"Sx00-1005-312","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054088","type":"LOCAL"},{"code":"876538","type":"LOCAL"}],"standard_charges":[{"gross_charge":1834.5,"discounted_cash":1375.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054088 = Hospital System Supply Identifier | 876538 = Lawson ID"}]},{"description":"PLATE RECON 3.5MM 4 HOLE","code_information":[{"code":"Sx00-1005-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054089","type":"LOCAL"},{"code":"876539","type":"LOCAL"}],"standard_charges":[{"gross_charge":2078.21,"discounted_cash":1558.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054089 = Hospital System Supply Identifier | 876539 = Lawson ID"}]},{"description":"PLATE RECON 3.5MM 6 HOLE","code_information":[{"code":"Sx00-1005-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054090","type":"LOCAL"},{"code":"876540","type":"LOCAL"}],"standard_charges":[{"gross_charge":2324.29,"discounted_cash":1743.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054090 = Hospital System Supply Identifier | 876540 = Lawson ID"}]},{"description":"PLATE RECON 3.5MM 8 HOLE","code_information":[{"code":"Sx00-1005-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054091","type":"LOCAL"},{"code":"876541","type":"LOCAL"}],"standard_charges":[{"gross_charge":2548.16,"discounted_cash":1911.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054091 = Hospital System Supply Identifier | 876541 = Lawson ID"}]},{"description":"PLATE RECON 3.5MM 16 HOLE","code_information":[{"code":"Sx00-1005-321","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054092","type":"LOCAL"},{"code":"876542","type":"LOCAL"}],"standard_charges":[{"gross_charge":2776.05,"discounted_cash":2082.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054092 = Hospital System Supply Identifier | 876542 = Lawson ID"}]},{"description":"PLATE T LOK 3.5 2 HL HD 5HL","code_information":[{"code":"Sx00-1005-330","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054094","type":"LOCAL"},{"code":"876544","type":"LOCAL"}],"standard_charges":[{"gross_charge":1664.53,"discounted_cash":1248.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054094 = Hospital System Supply Identifier | 876544 = Lawson ID"}]},{"description":"PLATE T LOK 3.5 2 HL HD 3HL","code_information":[{"code":"Sx00-1005-330","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054093","type":"LOCAL"},{"code":"876543","type":"LOCAL"}],"standard_charges":[{"gross_charge":1555.11,"discounted_cash":1166.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054093 = Hospital System Supply Identifier | 876543 = Lawson ID"}]},{"description":"PLATE T LOK 3.5 3 HL HD 7HL","code_information":[{"code":"Sx00-1005-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054097","type":"LOCAL"},{"code":"876547","type":"LOCAL"}],"standard_charges":[{"gross_charge":2131.08,"discounted_cash":1598.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054097 = Hospital System Supply Identifier | 876547 = Lawson ID"}]},{"description":"PLATE T LOK 3.5 3 HL HD 3HL","code_information":[{"code":"Sx00-1005-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054095","type":"LOCAL"},{"code":"876545","type":"LOCAL"}],"standard_charges":[{"gross_charge":1555.11,"discounted_cash":1166.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054095 = Hospital System Supply Identifier | 876545 = Lawson ID"}]},{"description":"PLATE T LOK 3.5 3 HL HD 5HL","code_information":[{"code":"Sx00-1005-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054096","type":"LOCAL"},{"code":"876546","type":"LOCAL"}],"standard_charges":[{"gross_charge":1664.53,"discounted_cash":1248.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054096 = Hospital System Supply Identifier | 876546 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 10","code_information":[{"code":"Sx00-1005-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054098","type":"LOCAL"},{"code":"876548","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054098 = Hospital System Supply Identifier | 876548 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 12","code_information":[{"code":"Sx00-1005-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054099","type":"LOCAL"},{"code":"876549","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054099 = Hospital System Supply Identifier | 876549 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 14","code_information":[{"code":"Sx00-1005-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054100","type":"LOCAL"},{"code":"876550","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054100 = Hospital System Supply Identifier | 876550 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 16","code_information":[{"code":"Sx00-1005-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054101","type":"LOCAL"},{"code":"876551","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054101 = Hospital System Supply Identifier | 876551 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 18","code_information":[{"code":"Sx00-1005-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054102","type":"LOCAL"},{"code":"876552","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054102 = Hospital System Supply Identifier | 876552 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 24","code_information":[{"code":"Sx00-1005-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054105","type":"LOCAL"},{"code":"876555","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054105 = Hospital System Supply Identifier | 876555 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 20","code_information":[{"code":"Sx00-1005-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054103","type":"LOCAL"},{"code":"876553","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054103 = Hospital System Supply Identifier | 876553 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 22","code_information":[{"code":"Sx00-1005-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054104","type":"LOCAL"},{"code":"876554","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054104 = Hospital System Supply Identifier | 876554 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 26","code_information":[{"code":"Sx00-1005-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054106","type":"LOCAL"},{"code":"876556","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054106 = Hospital System Supply Identifier | 876556 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 28","code_information":[{"code":"Sx00-1005-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054107","type":"LOCAL"},{"code":"876557","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054107 = Hospital System Supply Identifier | 876557 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 35","code_information":[{"code":"Sx00-1005-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054111","type":"LOCAL"},{"code":"876561","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054111 = Hospital System Supply Identifier | 876561 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 34","code_information":[{"code":"Sx00-1005-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054110","type":"LOCAL"},{"code":"876560","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054110 = Hospital System Supply Identifier | 876560 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 36","code_information":[{"code":"Sx00-1005-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054112","type":"LOCAL"},{"code":"876562","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054112 = Hospital System Supply Identifier | 876562 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 30","code_information":[{"code":"Sx00-1005-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054108","type":"LOCAL"},{"code":"876558","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054108 = Hospital System Supply Identifier | 876558 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 32","code_information":[{"code":"Sx00-1005-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054109","type":"LOCAL"},{"code":"876559","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054109 = Hospital System Supply Identifier | 876559 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 38","code_information":[{"code":"Sx00-1005-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054113","type":"LOCAL"},{"code":"876563","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054113 = Hospital System Supply Identifier | 876563 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 42","code_information":[{"code":"Sx00-1005-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054115","type":"LOCAL"},{"code":"876565","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054115 = Hospital System Supply Identifier | 876565 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 48","code_information":[{"code":"Sx00-1005-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054119","type":"LOCAL"},{"code":"876569","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054119 = Hospital System Supply Identifier | 876569 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 46","code_information":[{"code":"Sx00-1005-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054118","type":"LOCAL"},{"code":"876568","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054118 = Hospital System Supply Identifier | 876568 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 40","code_information":[{"code":"Sx00-1005-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054114","type":"LOCAL"},{"code":"876564","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054114 = Hospital System Supply Identifier | 876564 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 44","code_information":[{"code":"Sx00-1005-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054116","type":"LOCAL"},{"code":"876566","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054116 = Hospital System Supply Identifier | 876566 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 45","code_information":[{"code":"Sx00-1005-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054117","type":"LOCAL"},{"code":"876567","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054117 = Hospital System Supply Identifier | 876567 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 50","code_information":[{"code":"Sx00-1005-405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054120","type":"LOCAL"},{"code":"876570","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054120 = Hospital System Supply Identifier | 876570 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 55","code_information":[{"code":"Sx00-1005-405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054121","type":"LOCAL"},{"code":"876571","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054121 = Hospital System Supply Identifier | 876571 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 60","code_information":[{"code":"Sx00-1005-406","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054122","type":"LOCAL"},{"code":"876572","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054122 = Hospital System Supply Identifier | 876572 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 16","code_information":[{"code":"Sx00-1005-421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054123","type":"LOCAL"},{"code":"876573","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054123 = Hospital System Supply Identifier | 876573 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 18","code_information":[{"code":"Sx00-1005-421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054124","type":"LOCAL"},{"code":"876574","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054124 = Hospital System Supply Identifier | 876574 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 28","code_information":[{"code":"Sx00-1005-422","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054129","type":"LOCAL"},{"code":"876579","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054129 = Hospital System Supply Identifier | 876579 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 24","code_information":[{"code":"Sx00-1005-422","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054127","type":"LOCAL"},{"code":"876577","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054127 = Hospital System Supply Identifier | 876577 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 26","code_information":[{"code":"Sx00-1005-422","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054128","type":"LOCAL"},{"code":"876578","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054128 = Hospital System Supply Identifier | 876578 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 20","code_information":[{"code":"Sx00-1005-422","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054125","type":"LOCAL"},{"code":"876575","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054125 = Hospital System Supply Identifier | 876575 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 22","code_information":[{"code":"Sx00-1005-422","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054126","type":"LOCAL"},{"code":"876576","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054126 = Hospital System Supply Identifier | 876576 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 30","code_information":[{"code":"Sx00-1005-423","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054130","type":"LOCAL"},{"code":"876580","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054130 = Hospital System Supply Identifier | 876580 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 32","code_information":[{"code":"Sx00-1005-423","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054131","type":"LOCAL"},{"code":"876581","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054131 = Hospital System Supply Identifier | 876581 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 34","code_information":[{"code":"Sx00-1005-423","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054132","type":"LOCAL"},{"code":"876582","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054132 = Hospital System Supply Identifier | 876582 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 35","code_information":[{"code":"Sx00-1005-423","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054133","type":"LOCAL"},{"code":"876583","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054133 = Hospital System Supply Identifier | 876583 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 36","code_information":[{"code":"Sx00-1005-423","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054134","type":"LOCAL"},{"code":"876584","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054134 = Hospital System Supply Identifier | 876584 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 38","code_information":[{"code":"Sx00-1005-423","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054135","type":"LOCAL"},{"code":"876585","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054135 = Hospital System Supply Identifier | 876585 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 46","code_information":[{"code":"Sx00-1005-424","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054140","type":"LOCAL"},{"code":"876590","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054140 = Hospital System Supply Identifier | 876590 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 48","code_information":[{"code":"Sx00-1005-424","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054141","type":"LOCAL"},{"code":"876591","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054141 = Hospital System Supply Identifier | 876591 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 45","code_information":[{"code":"Sx00-1005-424","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054139","type":"LOCAL"},{"code":"876589","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054139 = Hospital System Supply Identifier | 876589 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 40","code_information":[{"code":"Sx00-1005-424","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054136","type":"LOCAL"},{"code":"876586","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054136 = Hospital System Supply Identifier | 876586 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 42","code_information":[{"code":"Sx00-1005-424","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054137","type":"LOCAL"},{"code":"876587","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054137 = Hospital System Supply Identifier | 876587 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 44","code_information":[{"code":"Sx00-1005-424","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054138","type":"LOCAL"},{"code":"876588","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054138 = Hospital System Supply Identifier | 876588 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 50","code_information":[{"code":"Sx00-1005-425","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054142","type":"LOCAL"},{"code":"876592","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054142 = Hospital System Supply Identifier | 876592 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 55","code_information":[{"code":"Sx00-1005-425","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054143","type":"LOCAL"},{"code":"876593","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054143 = Hospital System Supply Identifier | 876593 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 60","code_information":[{"code":"Sx00-1005-426","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054144","type":"LOCAL"},{"code":"876594","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054144 = Hospital System Supply Identifier | 876594 = Lawson ID"}]},{"description":"PLATE CLAV 2.7MM 6HL RT","code_information":[{"code":"Sx00-1005-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054145","type":"LOCAL"},{"code":"876595","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054145 = Hospital System Supply Identifier | 876595 = Lawson ID"}]},{"description":"PLATE CLAV 2.7MM 7HL RT","code_information":[{"code":"Sx00-1005-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054146","type":"LOCAL"},{"code":"876596","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054146 = Hospital System Supply Identifier | 876596 = Lawson ID"}]},{"description":"PLATE CLAV 2.7MM 8HL RT","code_information":[{"code":"Sx00-1005-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054147","type":"LOCAL"},{"code":"876597","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054147 = Hospital System Supply Identifier | 876597 = Lawson ID"}]},{"description":"PLATE CLAV 2.7MM 6HL LT","code_information":[{"code":"Sx00-1005-501","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054148","type":"LOCAL"},{"code":"876598","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054148 = Hospital System Supply Identifier | 876598 = Lawson ID"}]},{"description":"PLATE CLAV 2.7MM 7HL LT","code_information":[{"code":"Sx00-1005-501","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054149","type":"LOCAL"},{"code":"876599","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054149 = Hospital System Supply Identifier | 876599 = Lawson ID"}]},{"description":"PLATE CLAV 2.7MM 8HL LT","code_information":[{"code":"Sx00-1005-501","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054150","type":"LOCAL"},{"code":"876600","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054150 = Hospital System Supply Identifier | 876600 = Lawson ID"}]},{"description":"PLATE CLAV 3.5MM 8HL RT","code_information":[{"code":"Sx00-1005-510","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054153","type":"LOCAL"},{"code":"876603","type":"LOCAL"}],"standard_charges":[{"gross_charge":3601.0,"discounted_cash":2700.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054153 = Hospital System Supply Identifier | 876603 = Lawson ID"}]},{"description":"PLATE CLAV 3.5MM 6HL RT","code_information":[{"code":"Sx00-1005-510","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054151","type":"LOCAL"},{"code":"876601","type":"LOCAL"}],"standard_charges":[{"gross_charge":3601.0,"discounted_cash":2700.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054151 = Hospital System Supply Identifier | 876601 = Lawson ID"}]},{"description":"PLATE CLAV 3.5MM 7HL RT","code_information":[{"code":"Sx00-1005-510","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054152","type":"LOCAL"},{"code":"876602","type":"LOCAL"}],"standard_charges":[{"gross_charge":3601.0,"discounted_cash":2700.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054152 = Hospital System Supply Identifier | 876602 = Lawson ID"}]},{"description":"PLATE CLAV 3.5MM 7HL LT","code_information":[{"code":"Sx00-1005-511","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054155","type":"LOCAL"},{"code":"876605","type":"LOCAL"}],"standard_charges":[{"gross_charge":3601.0,"discounted_cash":2700.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054155 = Hospital System Supply Identifier | 876605 = Lawson ID"}]},{"description":"PLATE CLAV 3.5MM 8HL LT","code_information":[{"code":"Sx00-1005-511","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054156","type":"LOCAL"},{"code":"876606","type":"LOCAL"}],"standard_charges":[{"gross_charge":3601.0,"discounted_cash":2700.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054156 = Hospital System Supply Identifier | 876606 = Lawson ID"}]},{"description":"PLATE CLAV 3.5MM 6HL LT","code_information":[{"code":"Sx00-1005-511","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054154","type":"LOCAL"},{"code":"876604","type":"LOCAL"}],"standard_charges":[{"gross_charge":3601.0,"discounted_cash":2700.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054154 = Hospital System Supply Identifier | 876604 = Lawson ID"}]},{"description":"PLATE WRST FUS 2.7/3.5 99MM","code_information":[{"code":"Sx00-1005-600","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054157","type":"LOCAL"},{"code":"876607","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054157 = Hospital System Supply Identifier | 876607 = Lawson ID"}]},{"description":"PLATE WRST FUS 2.7/3.5 112MM","code_information":[{"code":"Sx00-1005-601","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054158","type":"LOCAL"},{"code":"876608","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054158 = Hospital System Supply Identifier | 876608 = Lawson ID"}]},{"description":"PLATE COMP 2.7MM 2HL 12MM","code_information":[{"code":"Sx00-1007-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054159","type":"LOCAL"},{"code":"876609","type":"LOCAL"}],"standard_charges":[{"gross_charge":4173.12,"discounted_cash":3129.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054159 = Hospital System Supply Identifier | 876609 = Lawson ID"}]},{"description":"PLATE COMP 2.7MM 2HL 15MM","code_information":[{"code":"Sx00-1007-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054160","type":"LOCAL"},{"code":"876610","type":"LOCAL"}],"standard_charges":[{"gross_charge":4173.12,"discounted_cash":3129.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054160 = Hospital System Supply Identifier | 876610 = Lawson ID"}]},{"description":"PLATE COMP 2.7MM 2HL 18MM","code_information":[{"code":"Sx00-1007-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054161","type":"LOCAL"},{"code":"876611","type":"LOCAL"}],"standard_charges":[{"gross_charge":4173.12,"discounted_cash":3129.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054161 = Hospital System Supply Identifier | 876611 = Lawson ID"}]},{"description":"PLATE COMP 2.7MM 2HL 21MM","code_information":[{"code":"Sx00-1007-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054162","type":"LOCAL"},{"code":"876612","type":"LOCAL"}],"standard_charges":[{"gross_charge":4173.12,"discounted_cash":3129.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054162 = Hospital System Supply Identifier | 876612 = Lawson ID"}]},{"description":"PLATE T COMP 2.7MM 3HL 12MM","code_information":[{"code":"Sx00-1007-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054163","type":"LOCAL"},{"code":"876613","type":"LOCAL"}],"standard_charges":[{"gross_charge":4714.08,"discounted_cash":3535.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054163 = Hospital System Supply Identifier | 876613 = Lawson ID"}]},{"description":"PLATE T COMP 2.7MM 3HL 15MM","code_information":[{"code":"Sx00-1007-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054164","type":"LOCAL"},{"code":"876614","type":"LOCAL"}],"standard_charges":[{"gross_charge":4714.08,"discounted_cash":3535.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054164 = Hospital System Supply Identifier | 876614 = Lawson ID"}]},{"description":"PLATE T COMP 2.7MM 4HL 18MM","code_information":[{"code":"Sx00-1007-031","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054165","type":"LOCAL"},{"code":"876615","type":"LOCAL"}],"standard_charges":[{"gross_charge":5005.0,"discounted_cash":3753.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054165 = Hospital System Supply Identifier | 876615 = Lawson ID"}]},{"description":"PLATE T COMP 2.7MM 4HL 21MM","code_information":[{"code":"Sx00-1007-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054166","type":"LOCAL"},{"code":"876616","type":"LOCAL"}],"standard_charges":[{"gross_charge":5005.0,"discounted_cash":3753.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054166 = Hospital System Supply Identifier | 876616 = Lawson ID"}]},{"description":"PLATE T COMP 2.7MM 4HL 24MM","code_information":[{"code":"Sx00-1007-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054167","type":"LOCAL"},{"code":"876617","type":"LOCAL"}],"standard_charges":[{"gross_charge":5005.0,"discounted_cash":3753.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054167 = Hospital System Supply Identifier | 876617 = Lawson ID"}]},{"description":"PLATE CLOVER 2.7MM 4HL","code_information":[{"code":"Sx00-1007-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054168","type":"LOCAL"},{"code":"876618","type":"LOCAL"}],"standard_charges":[{"gross_charge":3424.96,"discounted_cash":2568.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054168 = Hospital System Supply Identifier | 876618 = Lawson ID"}]},{"description":"PLATE I COMP 2.7MM 4HL 15MM","code_information":[{"code":"Sx00-1007-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054169","type":"LOCAL"},{"code":"876619","type":"LOCAL"}],"standard_charges":[{"gross_charge":5159.0,"discounted_cash":3869.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054169 = Hospital System Supply Identifier | 876619 = Lawson ID"}]},{"description":"PLATE I COMP 2.7MM 4HL 18MM","code_information":[{"code":"Sx00-1007-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054170","type":"LOCAL"},{"code":"876620","type":"LOCAL"}],"standard_charges":[{"gross_charge":5159.0,"discounted_cash":3869.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054170 = Hospital System Supply Identifier | 876620 = Lawson ID"}]},{"description":"PLATE I COMP 2.7MM 4HL 21MM","code_information":[{"code":"Sx00-1007-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054171","type":"LOCAL"},{"code":"876621","type":"LOCAL"}],"standard_charges":[{"gross_charge":5159.0,"discounted_cash":3869.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054171 = Hospital System Supply Identifier | 876621 = Lawson ID"}]},{"description":"PLATE I COMP 2.7MM 4HL 24MM","code_information":[{"code":"Sx00-1007-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054172","type":"LOCAL"},{"code":"876622","type":"LOCAL"}],"standard_charges":[{"gross_charge":5159.0,"discounted_cash":3869.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054172 = Hospital System Supply Identifier | 876622 = Lawson ID"}]},{"description":"PLATE I COMP 2.7MM 4HL 27MM","code_information":[{"code":"Sx00-1007-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054173","type":"LOCAL"},{"code":"876623","type":"LOCAL"}],"standard_charges":[{"gross_charge":5159.0,"discounted_cash":3869.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054173 = Hospital System Supply Identifier | 876623 = Lawson ID"}]},{"description":"PLATE I COMP 2.7MM 4HL 30MM","code_information":[{"code":"Sx00-1007-043","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054174","type":"LOCAL"},{"code":"876624","type":"LOCAL"}],"standard_charges":[{"gross_charge":5159.0,"discounted_cash":3869.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054174 = Hospital System Supply Identifier | 876624 = Lawson ID"}]},{"description":"PLATE RECON 2.7MM 2HL","code_information":[{"code":"Sx00-1007-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054175","type":"LOCAL"},{"code":"876625","type":"LOCAL"}],"standard_charges":[{"gross_charge":3102.48,"discounted_cash":2326.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054175 = Hospital System Supply Identifier | 876625 = Lawson ID"}]},{"description":"PLATE RECON 2.7MM 4HL","code_information":[{"code":"Sx00-1007-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054176","type":"LOCAL"},{"code":"876626","type":"LOCAL"}],"standard_charges":[{"gross_charge":3878.0,"discounted_cash":2908.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054176 = Hospital System Supply Identifier | 876626 = Lawson ID"}]},{"description":"PLATE RECON 2.7MM 6HL","code_information":[{"code":"Sx00-1007-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054177","type":"LOCAL"},{"code":"876627","type":"LOCAL"}],"standard_charges":[{"gross_charge":4658.88,"discounted_cash":3494.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054177 = Hospital System Supply Identifier | 876627 = Lawson ID"}]},{"description":"PLATE RECON 2.7MM 8HL","code_information":[{"code":"Sx00-1007-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054178","type":"LOCAL"},{"code":"876628","type":"LOCAL"}],"standard_charges":[{"gross_charge":5412.0,"discounted_cash":4059.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054178 = Hospital System Supply Identifier | 876628 = Lawson ID"}]},{"description":"ANGLE IRON 2.7MM 5MM","code_information":[{"code":"Sx00-1007-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054179","type":"LOCAL"},{"code":"876629","type":"LOCAL"}],"standard_charges":[{"gross_charge":3878.0,"discounted_cash":2908.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054179 = Hospital System Supply Identifier | 876629 = Lawson ID"}]},{"description":"PLATE T WDG 2.7MM 4HL 2MM WDG","code_information":[{"code":"Sx00-1007-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054180","type":"LOCAL"},{"code":"876630","type":"LOCAL"}],"standard_charges":[{"gross_charge":5390.0,"discounted_cash":4042.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054180 = Hospital System Supply Identifier | 876630 = Lawson ID"}]},{"description":"PLATE T WDG 2.7MM 4HL 4MM WDG","code_information":[{"code":"Sx00-1007-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054181","type":"LOCAL"},{"code":"876631","type":"LOCAL"}],"standard_charges":[{"gross_charge":5600.56,"discounted_cash":4200.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054181 = Hospital System Supply Identifier | 876631 = Lawson ID"}]},{"description":"PLATE COMP 3.5MM 2HL 15MM","code_information":[{"code":"Sx00-1007-101","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054182","type":"LOCAL"},{"code":"876632","type":"LOCAL"}],"standard_charges":[{"gross_charge":5005.0,"discounted_cash":3753.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054182 = Hospital System Supply Identifier | 876632 = Lawson ID"}]},{"description":"PLATE COMP 3.5MM 2HL 18MM","code_information":[{"code":"Sx00-1007-101","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054183","type":"LOCAL"},{"code":"876633","type":"LOCAL"}],"standard_charges":[{"gross_charge":5005.0,"discounted_cash":3753.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054183 = Hospital System Supply Identifier | 876633 = Lawson ID"}]},{"description":"PLATE COMP 3.5MM 2HL 21MM","code_information":[{"code":"Sx00-1007-102","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054184","type":"LOCAL"},{"code":"876634","type":"LOCAL"}],"standard_charges":[{"gross_charge":5005.0,"discounted_cash":3753.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054184 = Hospital System Supply Identifier | 876634 = Lawson ID"}]},{"description":"PLATE COMP 3.5MM 2HL 24MM","code_information":[{"code":"Sx00-1007-102","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054185","type":"LOCAL"},{"code":"876635","type":"LOCAL"}],"standard_charges":[{"gross_charge":5005.0,"discounted_cash":3753.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054185 = Hospital System Supply Identifier | 876635 = Lawson ID"}]},{"description":"PLATE T COMP 3.5MM 3HL 15MM","code_information":[{"code":"Sx00-1007-111","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054186","type":"LOCAL"},{"code":"876636","type":"LOCAL"}],"standard_charges":[{"gross_charge":5611.52,"discounted_cash":4208.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054186 = Hospital System Supply Identifier | 876636 = Lawson ID"}]},{"description":"PLATE T COMP 3.5MM 3HL 18MM","code_information":[{"code":"Sx00-1007-111","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054187","type":"LOCAL"},{"code":"876637","type":"LOCAL"}],"standard_charges":[{"gross_charge":5611.52,"discounted_cash":4208.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054187 = Hospital System Supply Identifier | 876637 = Lawson ID"}]},{"description":"PLATE T COMP 3.5MM 4HL 24MM","code_information":[{"code":"Sx00-1007-122","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054189","type":"LOCAL"},{"code":"876639","type":"LOCAL"}],"standard_charges":[{"gross_charge":5984.16,"discounted_cash":4488.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054189 = Hospital System Supply Identifier | 876639 = Lawson ID"}]},{"description":"PLATE T COMP 3.5MM 4HL 27MM","code_information":[{"code":"Sx00-1007-122","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054190","type":"LOCAL"},{"code":"876640","type":"LOCAL"}],"standard_charges":[{"gross_charge":5984.16,"discounted_cash":4488.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054190 = Hospital System Supply Identifier | 876640 = Lawson ID"}]},{"description":"PLATE T COMP 3.5MM 4HL 21MM","code_information":[{"code":"Sx00-1007-122","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054188","type":"LOCAL"},{"code":"876638","type":"LOCAL"}],"standard_charges":[{"gross_charge":5984.16,"discounted_cash":4488.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054188 = Hospital System Supply Identifier | 876638 = Lawson ID"}]},{"description":"PLATE CLOVER 3.5MM 4HL","code_information":[{"code":"Sx00-1007-130","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054191","type":"LOCAL"},{"code":"876641","type":"LOCAL"}],"standard_charges":[{"gross_charge":5087.5,"discounted_cash":3815.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054191 = Hospital System Supply Identifier | 876641 = Lawson ID"}]},{"description":"PLATE I COMP 3.5MM 4HL 15MM","code_information":[{"code":"Sx00-1007-131","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054192","type":"LOCAL"},{"code":"876642","type":"LOCAL"}],"standard_charges":[{"gross_charge":6147.96,"discounted_cash":4610.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054192 = Hospital System Supply Identifier | 876642 = Lawson ID"}]},{"description":"PLATE I COMP 3.5MM 4HL 18MM","code_information":[{"code":"Sx00-1007-131","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054193","type":"LOCAL"},{"code":"876643","type":"LOCAL"}],"standard_charges":[{"gross_charge":6147.96,"discounted_cash":4610.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054193 = Hospital System Supply Identifier | 876643 = Lawson ID"}]},{"description":"PLATE I COMP 3.5MM 4HL 21MM","code_information":[{"code":"Sx00-1007-132","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054194","type":"LOCAL"},{"code":"876644","type":"LOCAL"}],"standard_charges":[{"gross_charge":6147.96,"discounted_cash":4610.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054194 = Hospital System Supply Identifier | 876644 = Lawson ID"}]},{"description":"PLATE I COMP 3.5MM 4HL 24MM","code_information":[{"code":"Sx00-1007-132","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054195","type":"LOCAL"},{"code":"876645","type":"LOCAL"}],"standard_charges":[{"gross_charge":6147.96,"discounted_cash":4610.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054195 = Hospital System Supply Identifier | 876645 = Lawson ID"}]},{"description":"PLATE I COMP 3.5MM 4HL 27MM","code_information":[{"code":"Sx00-1007-132","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054196","type":"LOCAL"},{"code":"876646","type":"LOCAL"}],"standard_charges":[{"gross_charge":6147.96,"discounted_cash":4610.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054196 = Hospital System Supply Identifier | 876646 = Lawson ID"}]},{"description":"PLATE I COMP 3.5MM 4HL 30MM","code_information":[{"code":"Sx00-1007-133","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054197","type":"LOCAL"},{"code":"876647","type":"LOCAL"}],"standard_charges":[{"gross_charge":6147.96,"discounted_cash":4610.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054197 = Hospital System Supply Identifier | 876647 = Lawson ID"}]},{"description":"PLATE I COMP 3.5MM 4HL 33MM","code_information":[{"code":"Sx00-1007-133","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054198","type":"LOCAL"},{"code":"876648","type":"LOCAL"}],"standard_charges":[{"gross_charge":6147.96,"discounted_cash":4610.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054198 = Hospital System Supply Identifier | 876648 = Lawson ID"}]},{"description":"PLATE RECON 3.5MM 8HL","code_information":[{"code":"Sx00-1007-140","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054202","type":"LOCAL"},{"code":"876652","type":"LOCAL"}],"standard_charges":[{"gross_charge":6442.8,"discounted_cash":4832.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054202 = Hospital System Supply Identifier | 876652 = Lawson ID"}]},{"description":"PLATE RECON 3.5MM 6HL","code_information":[{"code":"Sx00-1007-140","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054201","type":"LOCAL"},{"code":"876651","type":"LOCAL"}],"standard_charges":[{"gross_charge":5534.8,"discounted_cash":4151.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054201 = Hospital System Supply Identifier | 876651 = Lawson ID"}]},{"description":"PLATE RECON 3.5MM 4HL","code_information":[{"code":"Sx00-1007-140","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054200","type":"LOCAL"},{"code":"876650","type":"LOCAL"}],"standard_charges":[{"gross_charge":4636.8,"discounted_cash":3477.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054200 = Hospital System Supply Identifier | 876650 = Lawson ID"}]},{"description":"PLATE RECON 3.5MM 2HL","code_information":[{"code":"Sx00-1007-140","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054199","type":"LOCAL"},{"code":"876649","type":"LOCAL"}],"standard_charges":[{"gross_charge":3711.8,"discounted_cash":2783.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054199 = Hospital System Supply Identifier | 876649 = Lawson ID"}]},{"description":"PLATE T WDG 3.5MM 4HL 4MM WDG","code_information":[{"code":"Sx00-1007-150","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054203","type":"LOCAL"},{"code":"876653","type":"LOCAL"}],"standard_charges":[{"gross_charge":6420.96,"discounted_cash":4815.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054203 = Hospital System Supply Identifier | 876653 = Lawson ID"}]},{"description":"PLATE T WDG 3.5MM 4HL 6MM WDG","code_information":[{"code":"Sx00-1007-150","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054204","type":"LOCAL"},{"code":"876654","type":"LOCAL"}],"standard_charges":[{"gross_charge":6661.2,"discounted_cash":4995.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054204 = Hospital System Supply Identifier | 876654 = Lawson ID"}]},{"description":"ANGLE IRON 3.5MM 6MM","code_information":[{"code":"Sx00-1007-160","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054205","type":"LOCAL"},{"code":"876655","type":"LOCAL"}],"standard_charges":[{"gross_charge":4636.8,"discounted_cash":3477.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054205 = Hospital System Supply Identifier | 876655 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X6MM","code_information":[{"code":"Sx00-1007-270","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054206","type":"LOCAL"},{"code":"876656","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054206 = Hospital System Supply Identifier | 876656 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X8MM","code_information":[{"code":"Sx00-1007-270","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054207","type":"LOCAL"},{"code":"876657","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054207 = Hospital System Supply Identifier | 876657 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X18MM","code_information":[{"code":"Sx00-1007-271","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054212","type":"LOCAL"},{"code":"876662","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054212 = Hospital System Supply Identifier | 876662 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X16MM","code_information":[{"code":"Sx00-1007-271","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054211","type":"LOCAL"},{"code":"876661","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054211 = Hospital System Supply Identifier | 876661 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X14MM","code_information":[{"code":"Sx00-1007-271","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054210","type":"LOCAL"},{"code":"876660","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054210 = Hospital System Supply Identifier | 876660 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X12MM","code_information":[{"code":"Sx00-1007-271","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054209","type":"LOCAL"},{"code":"876659","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054209 = Hospital System Supply Identifier | 876659 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X10MM","code_information":[{"code":"Sx00-1007-271","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054208","type":"LOCAL"},{"code":"876658","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054208 = Hospital System Supply Identifier | 876658 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X20MM","code_information":[{"code":"Sx00-1007-272","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054213","type":"LOCAL"},{"code":"876663","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054213 = Hospital System Supply Identifier | 876663 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X22MM","code_information":[{"code":"Sx00-1007-272","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054214","type":"LOCAL"},{"code":"876664","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054214 = Hospital System Supply Identifier | 876664 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X24MM","code_information":[{"code":"Sx00-1007-272","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054215","type":"LOCAL"},{"code":"876665","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054215 = Hospital System Supply Identifier | 876665 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X26MM","code_information":[{"code":"Sx00-1007-272","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054216","type":"LOCAL"},{"code":"876666","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054216 = Hospital System Supply Identifier | 876666 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X28MM","code_information":[{"code":"Sx00-1007-272","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054217","type":"LOCAL"},{"code":"876667","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054217 = Hospital System Supply Identifier | 876667 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X36MM","code_information":[{"code":"Sx00-1007-273","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054221","type":"LOCAL"},{"code":"876671","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054221 = Hospital System Supply Identifier | 876671 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X34MM","code_information":[{"code":"Sx00-1007-273","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054220","type":"LOCAL"},{"code":"876670","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054220 = Hospital System Supply Identifier | 876670 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X38MM","code_information":[{"code":"Sx00-1007-273","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054222","type":"LOCAL"},{"code":"876672","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054222 = Hospital System Supply Identifier | 876672 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X30MM","code_information":[{"code":"Sx00-1007-273","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054218","type":"LOCAL"},{"code":"876668","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054218 = Hospital System Supply Identifier | 876668 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X32MM","code_information":[{"code":"Sx00-1007-273","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054219","type":"LOCAL"},{"code":"876669","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054219 = Hospital System Supply Identifier | 876669 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X40MM","code_information":[{"code":"Sx00-1007-274","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054223","type":"LOCAL"},{"code":"876673","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054223 = Hospital System Supply Identifier | 876673 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X44MM","code_information":[{"code":"Sx00-1007-274","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054224","type":"LOCAL"},{"code":"876674","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054224 = Hospital System Supply Identifier | 876674 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X48MM","code_information":[{"code":"Sx00-1007-274","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054225","type":"LOCAL"},{"code":"876675","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054225 = Hospital System Supply Identifier | 876675 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X52MM","code_information":[{"code":"Sx00-1007-275","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054226","type":"LOCAL"},{"code":"876676","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054226 = Hospital System Supply Identifier | 876676 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X56MM","code_information":[{"code":"Sx00-1007-275","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054227","type":"LOCAL"},{"code":"876677","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054227 = Hospital System Supply Identifier | 876677 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X60MM","code_information":[{"code":"Sx00-1007-276","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054228","type":"LOCAL"},{"code":"876678","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054228 = Hospital System Supply Identifier | 876678 = Lawson ID"}]},{"description":"SCREW CORT 2.7X6MM","code_information":[{"code":"Sx00-1007-280","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054229","type":"LOCAL"},{"code":"876679","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.8,"discounted_cash":351.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054229 = Hospital System Supply Identifier | 876679 = Lawson ID"}]},{"description":"SCREW CORT 2.7X8MM","code_information":[{"code":"Sx00-1007-280","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054230","type":"LOCAL"},{"code":"876680","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.8,"discounted_cash":351.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054230 = Hospital System Supply Identifier | 876680 = Lawson ID"}]},{"description":"SCREW CORT 2.7X18MM","code_information":[{"code":"Sx00-1007-281","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054235","type":"LOCAL"},{"code":"876685","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.8,"discounted_cash":351.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054235 = Hospital System Supply Identifier | 876685 = Lawson ID"}]},{"description":"SCREW CORT 2.7X16MM","code_information":[{"code":"Sx00-1007-281","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054234","type":"LOCAL"},{"code":"876684","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.8,"discounted_cash":351.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054234 = Hospital System Supply Identifier | 876684 = Lawson ID"}]},{"description":"SCREW CORT 2.7X10MM","code_information":[{"code":"Sx00-1007-281","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054231","type":"LOCAL"},{"code":"876681","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.8,"discounted_cash":351.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054231 = Hospital System Supply Identifier | 876681 = Lawson ID"}]},{"description":"SCREW CORT 2.7X12MM","code_information":[{"code":"Sx00-1007-281","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054232","type":"LOCAL"},{"code":"876682","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.8,"discounted_cash":351.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054232 = Hospital System Supply Identifier | 876682 = Lawson ID"}]},{"description":"SCREW CORT 2.7X14MM","code_information":[{"code":"Sx00-1007-281","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054233","type":"LOCAL"},{"code":"876683","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.8,"discounted_cash":351.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054233 = Hospital System Supply Identifier | 876683 = Lawson ID"}]},{"description":"SCREW CORT 2.7X20MM","code_information":[{"code":"Sx00-1007-282","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054236","type":"LOCAL"},{"code":"876686","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.8,"discounted_cash":351.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054236 = Hospital System Supply Identifier | 876686 = Lawson ID"}]},{"description":"SCREW CORT 2.7X22MM","code_information":[{"code":"Sx00-1007-282","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054237","type":"LOCAL"},{"code":"876687","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.8,"discounted_cash":351.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054237 = Hospital System Supply Identifier | 876687 = Lawson ID"}]},{"description":"SCREW CORT 2.7X24MM","code_information":[{"code":"Sx00-1007-282","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054238","type":"LOCAL"},{"code":"876688","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.8,"discounted_cash":351.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054238 = Hospital System Supply Identifier | 876688 = Lawson ID"}]},{"description":"SCREW CORT 2.7X26MM","code_information":[{"code":"Sx00-1007-282","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054239","type":"LOCAL"},{"code":"876689","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.8,"discounted_cash":351.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054239 = Hospital System Supply Identifier | 876689 = Lawson ID"}]},{"description":"SCREW CORT 2.7X28MM","code_information":[{"code":"Sx00-1007-282","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054240","type":"LOCAL"},{"code":"876690","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.8,"discounted_cash":351.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054240 = Hospital System Supply Identifier | 876690 = Lawson ID"}]},{"description":"SCREW CORT 2.7X38MM","code_information":[{"code":"Sx00-1007-283","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054245","type":"LOCAL"},{"code":"876695","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.8,"discounted_cash":351.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054245 = Hospital System Supply Identifier | 876695 = Lawson ID"}]},{"description":"SCREW CORT 2.7X36MM","code_information":[{"code":"Sx00-1007-283","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054244","type":"LOCAL"},{"code":"876694","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.8,"discounted_cash":351.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054244 = Hospital System Supply Identifier | 876694 = Lawson ID"}]},{"description":"SCREW CORT 2.7X30MM","code_information":[{"code":"Sx00-1007-283","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054241","type":"LOCAL"},{"code":"876691","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.8,"discounted_cash":351.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054241 = Hospital System Supply Identifier | 876691 = Lawson ID"}]},{"description":"SCREW CORT 2.7X32MM","code_information":[{"code":"Sx00-1007-283","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054242","type":"LOCAL"},{"code":"876692","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.8,"discounted_cash":351.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054242 = Hospital System Supply Identifier | 876692 = Lawson ID"}]},{"description":"SCREW CORT 2.7X34MM","code_information":[{"code":"Sx00-1007-283","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054243","type":"LOCAL"},{"code":"876693","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.8,"discounted_cash":351.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054243 = Hospital System Supply Identifier | 876693 = Lawson ID"}]},{"description":"SCREW CORT 2.7X40MM","code_information":[{"code":"Sx00-1007-284","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054246","type":"LOCAL"},{"code":"876696","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.8,"discounted_cash":351.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054246 = Hospital System Supply Identifier | 876696 = Lawson ID"}]},{"description":"SCREW CORT 2.7X44MM","code_information":[{"code":"Sx00-1007-284","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054247","type":"LOCAL"},{"code":"876697","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.8,"discounted_cash":351.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054247 = Hospital System Supply Identifier | 876697 = Lawson ID"}]},{"description":"SCREW CORT 2.7X48MM","code_information":[{"code":"Sx00-1007-284","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054248","type":"LOCAL"},{"code":"876698","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.8,"discounted_cash":351.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054248 = Hospital System Supply Identifier | 876698 = Lawson ID"}]},{"description":"SCREW CORT 2.7X52MM","code_information":[{"code":"Sx00-1007-285","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054249","type":"LOCAL"},{"code":"876699","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.8,"discounted_cash":351.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054249 = Hospital System Supply Identifier | 876699 = Lawson ID"}]},{"description":"SCREW CORT 2.7X56MM","code_information":[{"code":"Sx00-1007-285","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054250","type":"LOCAL"},{"code":"876700","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.8,"discounted_cash":351.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054250 = Hospital System Supply Identifier | 876700 = Lawson ID"}]},{"description":"SCREW CORT 2.7X60MM","code_information":[{"code":"Sx00-1007-286","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054251","type":"LOCAL"},{"code":"876701","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.8,"discounted_cash":351.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054251 = Hospital System Supply Identifier | 876701 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X8MM","code_information":[{"code":"Sx00-1007-350","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054252","type":"LOCAL"},{"code":"876702","type":"LOCAL"}],"standard_charges":[{"gross_charge":894.28,"discounted_cash":670.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054252 = Hospital System Supply Identifier | 876702 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X10MM","code_information":[{"code":"Sx00-1007-351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054253","type":"LOCAL"},{"code":"876703","type":"LOCAL"}],"standard_charges":[{"gross_charge":894.28,"discounted_cash":670.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054253 = Hospital System Supply Identifier | 876703 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X12MM","code_information":[{"code":"Sx00-1007-351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054254","type":"LOCAL"},{"code":"876704","type":"LOCAL"}],"standard_charges":[{"gross_charge":894.28,"discounted_cash":670.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054254 = Hospital System Supply Identifier | 876704 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X14MM","code_information":[{"code":"Sx00-1007-351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054255","type":"LOCAL"},{"code":"876705","type":"LOCAL"}],"standard_charges":[{"gross_charge":894.28,"discounted_cash":670.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054255 = Hospital System Supply Identifier | 876705 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X16MM","code_information":[{"code":"Sx00-1007-351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054256","type":"LOCAL"},{"code":"876706","type":"LOCAL"}],"standard_charges":[{"gross_charge":894.28,"discounted_cash":670.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054256 = Hospital System Supply Identifier | 876706 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X18MM","code_information":[{"code":"Sx00-1007-351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054257","type":"LOCAL"},{"code":"876707","type":"LOCAL"}],"standard_charges":[{"gross_charge":894.28,"discounted_cash":670.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054257 = Hospital System Supply Identifier | 876707 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X26MM","code_information":[{"code":"Sx00-1007-352","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054261","type":"LOCAL"},{"code":"876711","type":"LOCAL"}],"standard_charges":[{"gross_charge":894.28,"discounted_cash":670.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054261 = Hospital System Supply Identifier | 876711 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X24MM","code_information":[{"code":"Sx00-1007-352","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054260","type":"LOCAL"},{"code":"876710","type":"LOCAL"}],"standard_charges":[{"gross_charge":894.28,"discounted_cash":670.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054260 = Hospital System Supply Identifier | 876710 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X28MM","code_information":[{"code":"Sx00-1007-352","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054262","type":"LOCAL"},{"code":"876712","type":"LOCAL"}],"standard_charges":[{"gross_charge":894.28,"discounted_cash":670.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054262 = Hospital System Supply Identifier | 876712 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X20MM","code_information":[{"code":"Sx00-1007-352","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054258","type":"LOCAL"},{"code":"876708","type":"LOCAL"}],"standard_charges":[{"gross_charge":894.28,"discounted_cash":670.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054258 = Hospital System Supply Identifier | 876708 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X22MM","code_information":[{"code":"Sx00-1007-352","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054259","type":"LOCAL"},{"code":"876709","type":"LOCAL"}],"standard_charges":[{"gross_charge":894.28,"discounted_cash":670.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054259 = Hospital System Supply Identifier | 876709 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X30MM","code_information":[{"code":"Sx00-1007-353","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054263","type":"LOCAL"},{"code":"876713","type":"LOCAL"}],"standard_charges":[{"gross_charge":894.28,"discounted_cash":670.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054263 = Hospital System Supply Identifier | 876713 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X32MM","code_information":[{"code":"Sx00-1007-353","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054264","type":"LOCAL"},{"code":"876714","type":"LOCAL"}],"standard_charges":[{"gross_charge":894.28,"discounted_cash":670.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054264 = Hospital System Supply Identifier | 876714 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X34MM","code_information":[{"code":"Sx00-1007-353","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054265","type":"LOCAL"},{"code":"876715","type":"LOCAL"}],"standard_charges":[{"gross_charge":894.28,"discounted_cash":670.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054265 = Hospital System Supply Identifier | 876715 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X36MM","code_information":[{"code":"Sx00-1007-353","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054266","type":"LOCAL"},{"code":"876716","type":"LOCAL"}],"standard_charges":[{"gross_charge":894.28,"discounted_cash":670.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054266 = Hospital System Supply Identifier | 876716 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X38MM","code_information":[{"code":"Sx00-1007-353","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054267","type":"LOCAL"},{"code":"876717","type":"LOCAL"}],"standard_charges":[{"gross_charge":894.28,"discounted_cash":670.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054267 = Hospital System Supply Identifier | 876717 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X40MM","code_information":[{"code":"Sx00-1007-354","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054268","type":"LOCAL"},{"code":"876718","type":"LOCAL"}],"standard_charges":[{"gross_charge":894.28,"discounted_cash":670.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054268 = Hospital System Supply Identifier | 876718 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X44MM","code_information":[{"code":"Sx00-1007-354","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054269","type":"LOCAL"},{"code":"876719","type":"LOCAL"}],"standard_charges":[{"gross_charge":894.28,"discounted_cash":670.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054269 = Hospital System Supply Identifier | 876719 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X48MM","code_information":[{"code":"Sx00-1007-354","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054270","type":"LOCAL"},{"code":"876720","type":"LOCAL"}],"standard_charges":[{"gross_charge":894.28,"discounted_cash":670.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054270 = Hospital System Supply Identifier | 876720 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X56MM","code_information":[{"code":"Sx00-1007-355","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054272","type":"LOCAL"},{"code":"876722","type":"LOCAL"}],"standard_charges":[{"gross_charge":894.28,"discounted_cash":670.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054272 = Hospital System Supply Identifier | 876722 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X52MM","code_information":[{"code":"Sx00-1007-355","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054271","type":"LOCAL"},{"code":"876721","type":"LOCAL"}],"standard_charges":[{"gross_charge":894.28,"discounted_cash":670.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054271 = Hospital System Supply Identifier | 876721 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X60MM","code_information":[{"code":"Sx00-1007-356","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054273","type":"LOCAL"},{"code":"876723","type":"LOCAL"}],"standard_charges":[{"gross_charge":894.28,"discounted_cash":670.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054273 = Hospital System Supply Identifier | 876723 = Lawson ID"}]},{"description":"SCREW CORT 3.5X8MM","code_information":[{"code":"Sx00-1007-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054274","type":"LOCAL"},{"code":"876724","type":"LOCAL"}],"standard_charges":[{"gross_charge":574.28,"discounted_cash":430.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054274 = Hospital System Supply Identifier | 876724 = Lawson ID"}]},{"description":"SCREW CORT 3.5X10MM","code_information":[{"code":"Sx00-1007-361","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054275","type":"LOCAL"},{"code":"876725","type":"LOCAL"}],"standard_charges":[{"gross_charge":574.28,"discounted_cash":430.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054275 = Hospital System Supply Identifier | 876725 = Lawson ID"}]},{"description":"SCREW CORT 3.5X12MM","code_information":[{"code":"Sx00-1007-361","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054276","type":"LOCAL"},{"code":"876726","type":"LOCAL"}],"standard_charges":[{"gross_charge":574.28,"discounted_cash":430.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054276 = Hospital System Supply Identifier | 876726 = Lawson ID"}]},{"description":"SCREW CORT 3.5X14MM","code_information":[{"code":"Sx00-1007-361","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054277","type":"LOCAL"},{"code":"876727","type":"LOCAL"}],"standard_charges":[{"gross_charge":574.28,"discounted_cash":430.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054277 = Hospital System Supply Identifier | 876727 = Lawson ID"}]},{"description":"SCREW CORT 3.5X16MM","code_information":[{"code":"Sx00-1007-361","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054278","type":"LOCAL"},{"code":"876728","type":"LOCAL"}],"standard_charges":[{"gross_charge":574.28,"discounted_cash":430.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054278 = Hospital System Supply Identifier | 876728 = Lawson ID"}]},{"description":"SCREW CORT 3.5X18MM","code_information":[{"code":"Sx00-1007-361","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054279","type":"LOCAL"},{"code":"876729","type":"LOCAL"}],"standard_charges":[{"gross_charge":574.28,"discounted_cash":430.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054279 = Hospital System Supply Identifier | 876729 = Lawson ID"}]},{"description":"SCREW CORT 3.5X26MM","code_information":[{"code":"Sx00-1007-362","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054283","type":"LOCAL"},{"code":"876733","type":"LOCAL"}],"standard_charges":[{"gross_charge":574.28,"discounted_cash":430.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054283 = Hospital System Supply Identifier | 876733 = Lawson ID"}]},{"description":"SCREW CORT 3.5X24MM","code_information":[{"code":"Sx00-1007-362","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054282","type":"LOCAL"},{"code":"876732","type":"LOCAL"}],"standard_charges":[{"gross_charge":574.28,"discounted_cash":430.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054282 = Hospital System Supply Identifier | 876732 = Lawson ID"}]},{"description":"SCREW CORT 3.5X28MM","code_information":[{"code":"Sx00-1007-362","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054284","type":"LOCAL"},{"code":"876734","type":"LOCAL"}],"standard_charges":[{"gross_charge":574.28,"discounted_cash":430.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054284 = Hospital System Supply Identifier | 876734 = Lawson ID"}]},{"description":"SCREW CORT 3.5X20MM","code_information":[{"code":"Sx00-1007-362","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054280","type":"LOCAL"},{"code":"876730","type":"LOCAL"}],"standard_charges":[{"gross_charge":574.28,"discounted_cash":430.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054280 = Hospital System Supply Identifier | 876730 = Lawson ID"}]},{"description":"SCREW CORT 3.5X22MM","code_information":[{"code":"Sx00-1007-362","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054281","type":"LOCAL"},{"code":"876731","type":"LOCAL"}],"standard_charges":[{"gross_charge":574.28,"discounted_cash":430.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054281 = Hospital System Supply Identifier | 876731 = Lawson ID"}]},{"description":"SCREW CORT 3.5X30MM","code_information":[{"code":"Sx00-1007-363","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054285","type":"LOCAL"},{"code":"876735","type":"LOCAL"}],"standard_charges":[{"gross_charge":574.28,"discounted_cash":430.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054285 = Hospital System Supply Identifier | 876735 = Lawson ID"}]},{"description":"SCREW CORT 3.5X32MM","code_information":[{"code":"Sx00-1007-363","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054286","type":"LOCAL"},{"code":"876736","type":"LOCAL"}],"standard_charges":[{"gross_charge":574.28,"discounted_cash":430.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054286 = Hospital System Supply Identifier | 876736 = Lawson ID"}]},{"description":"SCREW CORT 3.5X34MM","code_information":[{"code":"Sx00-1007-363","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054287","type":"LOCAL"},{"code":"876737","type":"LOCAL"}],"standard_charges":[{"gross_charge":574.28,"discounted_cash":430.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054287 = Hospital System Supply Identifier | 876737 = Lawson ID"}]},{"description":"SCREW CORT 3.5X36MM","code_information":[{"code":"Sx00-1007-363","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054288","type":"LOCAL"},{"code":"876738","type":"LOCAL"}],"standard_charges":[{"gross_charge":574.28,"discounted_cash":430.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054288 = Hospital System Supply Identifier | 876738 = Lawson ID"}]},{"description":"SCREW CORT 3.5X38MM","code_information":[{"code":"Sx00-1007-363","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054289","type":"LOCAL"},{"code":"876739","type":"LOCAL"}],"standard_charges":[{"gross_charge":574.28,"discounted_cash":430.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054289 = Hospital System Supply Identifier | 876739 = Lawson ID"}]},{"description":"SCREW CORT 3.5X44MM","code_information":[{"code":"Sx00-1007-364","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054291","type":"LOCAL"},{"code":"876741","type":"LOCAL"}],"standard_charges":[{"gross_charge":574.28,"discounted_cash":430.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054291 = Hospital System Supply Identifier | 876741 = Lawson ID"}]},{"description":"SCREW CORT 3.5X48MM","code_information":[{"code":"Sx00-1007-364","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054292","type":"LOCAL"},{"code":"876742","type":"LOCAL"}],"standard_charges":[{"gross_charge":574.28,"discounted_cash":430.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054292 = Hospital System Supply Identifier | 876742 = Lawson ID"}]},{"description":"SCREW CORT 3.5X40MM","code_information":[{"code":"Sx00-1007-364","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054290","type":"LOCAL"},{"code":"876740","type":"LOCAL"}],"standard_charges":[{"gross_charge":574.28,"discounted_cash":430.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054290 = Hospital System Supply Identifier | 876740 = Lawson ID"}]},{"description":"SCREW CORT 3.5X52MM","code_information":[{"code":"Sx00-1007-365","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054293","type":"LOCAL"},{"code":"876743","type":"LOCAL"}],"standard_charges":[{"gross_charge":574.28,"discounted_cash":430.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054293 = Hospital System Supply Identifier | 876743 = Lawson ID"}]},{"description":"SCREW CORT 3.5X56MM","code_information":[{"code":"Sx00-1007-365","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054294","type":"LOCAL"},{"code":"876744","type":"LOCAL"}],"standard_charges":[{"gross_charge":574.28,"discounted_cash":430.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054294 = Hospital System Supply Identifier | 876744 = Lawson ID"}]},{"description":"SCREW CORT 3.5X60MM","code_information":[{"code":"Sx00-1007-366","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054295","type":"LOCAL"},{"code":"876745","type":"LOCAL"}],"standard_charges":[{"gross_charge":574.28,"discounted_cash":430.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054295 = Hospital System Supply Identifier | 876745 = Lawson ID"}]},{"description":"PLATE LVL1 MINI STR 20HL 100MM","code_information":[{"code":"Sx00-101-30-9","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"700594","type":"LOCAL"},{"code":"723730","type":"LOCAL"}],"standard_charges":[{"gross_charge":241.22,"discounted_cash":180.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 700594 = Hospital System Supply Identifier | 723730 = Lawson ID"}]},{"description":"PLATE LVL1 L-SHP RT 2X2HL 20MM","code_information":[{"code":"Sx00-101-56-0","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"700596","type":"LOCAL"},{"code":"723732","type":"LOCAL"}],"standard_charges":[{"gross_charge":303.51,"discounted_cash":227.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 700596 = Hospital System Supply Identifier | 723732 = Lawson ID"}]},{"description":"PLATE LVL1 L-SHP LT 2X2HL 20MM","code_information":[{"code":"Sx00-101-57-0","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"700597","type":"LOCAL"},{"code":"723733","type":"LOCAL"}],"standard_charges":[{"gross_charge":303.51,"discounted_cash":227.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 700597 = Hospital System Supply Identifier | 723733 = Lawson ID"}]},{"description":"PLATE LVL1 L-SHP RT 2X2HL 24MM","code_information":[{"code":"Sx00-101-58-0","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"700598","type":"LOCAL"},{"code":"723734","type":"LOCAL"}],"standard_charges":[{"gross_charge":221.12,"discounted_cash":165.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 700598 = Hospital System Supply Identifier | 723734 = Lawson ID"}]},{"description":"PLATE LVL1 L-SHP LT 2X2HL 24MM","code_information":[{"code":"Sx00-101-59-0","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"700599","type":"LOCAL"},{"code":"723735","type":"LOCAL"}],"standard_charges":[{"gross_charge":221.12,"discounted_cash":165.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 700599 = Hospital System Supply Identifier | 723735 = Lawson ID"}]},{"description":"IMPLANT-PLATE-BONE KNEE STAINLESS-STEEL CENTER-HOLE","code_information":[{"code":"Sx00-1010-214","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356749","type":"LOCAL"},{"code":"1083608","type":"LOCAL"}],"standard_charges":[{"gross_charge":1635.36,"discounted_cash":1226.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356749 = Hospital System Supply Identifier | 1083608 = Lawson ID"}]},{"description":"IMPLANT-PLATE-BONE KNEE STAINLESS-STEEL CENTER-HOLE","code_information":[{"code":"Sx00-1010-217","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356990","type":"LOCAL"},{"code":"1083538","type":"LOCAL"}],"standard_charges":[{"gross_charge":1635.36,"discounted_cash":1226.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356990 = Hospital System Supply Identifier | 1083538 = Lawson ID"}]},{"description":"IMPLANT-PLATE-BONE KNEE STAINLESS-STEEL CENTER-HOLE","code_information":[{"code":"Sx00-1010-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356711","type":"LOCAL"},{"code":"1083690","type":"LOCAL"}],"standard_charges":[{"gross_charge":1635.36,"discounted_cash":1226.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356711 = Hospital System Supply Identifier | 1083690 = Lawson ID"}]},{"description":"PLATE-O DELTA 16MM","code_information":[{"code":"Sx00-1012-031","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"899729","type":"LOCAL"},{"code":"593216","type":"LOCAL"}],"standard_charges":[{"gross_charge":2036.91,"discounted_cash":1527.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 899729 = Hospital System Supply Identifier | 593216 = Lawson ID"}]},{"description":"PLATE DELTA 12MM","code_information":[{"code":"Sx00-1012-031","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054296","type":"LOCAL"},{"code":"876746","type":"LOCAL"}],"standard_charges":[{"gross_charge":2036.91,"discounted_cash":1527.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054296 = Hospital System Supply Identifier | 876746 = Lawson ID"}]},{"description":"PLATE-O DELTA 24MM","code_information":[{"code":"Sx00-1012-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"899728","type":"LOCAL"},{"code":"593215","type":"LOCAL"}],"standard_charges":[{"gross_charge":2036.91,"discounted_cash":1527.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 899728 = Hospital System Supply Identifier | 593215 = Lawson ID"}]},{"description":"PLATE DELTA 20MM","code_information":[{"code":"Sx00-1012-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054297","type":"LOCAL"},{"code":"876747","type":"LOCAL"}],"standard_charges":[{"gross_charge":2036.91,"discounted_cash":1527.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054297 = Hospital System Supply Identifier | 876747 = Lawson ID"}]},{"description":"PLATE PEDI O W/HLDR 12MM","code_information":[{"code":"Sx00-1012-212","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"833246","type":"LOCAL"},{"code":"S366146","type":"LOCAL"}],"standard_charges":[{"gross_charge":1635.36,"discounted_cash":1226.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 833246 = Hospital System Supply Identifier | S366146 = Lawson ID"}]},{"description":"PLATE PEDI O W/HLDR 16MM","code_information":[{"code":"Sx00-1012-216","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"786764","type":"LOCAL"},{"code":"410073","type":"LOCAL"}],"standard_charges":[{"gross_charge":1635.36,"discounted_cash":1226.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 786764 = Hospital System Supply Identifier | 410073 = Lawson ID"}]},{"description":"PLATE PEDI O W/HLDR 20MM","code_information":[{"code":"Sx00-1012-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"786763","type":"LOCAL"},{"code":"410074","type":"LOCAL"}],"standard_charges":[{"gross_charge":1635.36,"discounted_cash":1226.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 786763 = Hospital System Supply Identifier | 410074 = Lawson ID"}]},{"description":"PLATE PEDI O W/HLDR 24MM","code_information":[{"code":"Sx00-1012-224","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"833244","type":"LOCAL"},{"code":"S121116","type":"LOCAL"}],"standard_charges":[{"gross_charge":1635.36,"discounted_cash":1226.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 833244 = Hospital System Supply Identifier | S121116 = Lawson ID"}]},{"description":"SCREW CANN DELTA 4.5X16MM","code_information":[{"code":"Sx00-1015-071","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"899731","type":"LOCAL"},{"code":"593218","type":"LOCAL"}],"standard_charges":[{"gross_charge":1006.26,"discounted_cash":754.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 899731 = Hospital System Supply Identifier | 593218 = Lawson ID"}]},{"description":"SCREW CANN F/T 4.5X28MM","code_information":[{"code":"Sx00-1015-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054298","type":"LOCAL"},{"code":"876748","type":"LOCAL"}],"standard_charges":[{"gross_charge":1006.26,"discounted_cash":754.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054298 = Hospital System Supply Identifier | 876748 = Lawson ID"}]},{"description":"SCREW CANN DELTA 4.5X20MM","code_information":[{"code":"Sx00-1015-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"899732","type":"LOCAL"},{"code":"593219","type":"LOCAL"}],"standard_charges":[{"gross_charge":1006.26,"discounted_cash":754.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 899732 = Hospital System Supply Identifier | 593219 = Lawson ID"}]},{"description":"SCREW CANN DELTA 4.5X24MM","code_information":[{"code":"Sx00-1015-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"899730","type":"LOCAL"},{"code":"593217","type":"LOCAL"}],"standard_charges":[{"gross_charge":1006.26,"discounted_cash":754.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 899730 = Hospital System Supply Identifier | 593217 = Lawson ID"}]},{"description":"SCREW CANN F/T 4.5X32MM","code_information":[{"code":"Sx00-1015-073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054299","type":"LOCAL"},{"code":"876749","type":"LOCAL"}],"standard_charges":[{"gross_charge":1006.26,"discounted_cash":754.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054299 = Hospital System Supply Identifier | 876749 = Lawson ID"}]},{"description":"SCREW CANN F/T 4.5X36MM","code_information":[{"code":"Sx00-1015-073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054300","type":"LOCAL"},{"code":"876750","type":"LOCAL"}],"standard_charges":[{"gross_charge":1006.26,"discounted_cash":754.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054300 = Hospital System Supply Identifier | 876750 = Lawson ID"}]},{"description":"SCREW PEDPLATE CRTX 3.5X12MM","code_information":[{"code":"Sx00-1015-212","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1063351","type":"LOCAL"},{"code":"418940","type":"LOCAL"}],"standard_charges":[{"gross_charge":130.47,"discounted_cash":97.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1063351 = Hospital System Supply Identifier | 418940 = Lawson ID"}]},{"description":"SCREW-BONE CORTICAL CANNULATED STAINLESS-STEEL SELF-TAPPING FT FOR-LAT","code_information":[{"code":"Sx00-1015-214","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356483","type":"LOCAL"},{"code":"1083673","type":"LOCAL"}],"standard_charges":[{"gross_charge":130.47,"discounted_cash":97.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356483 = Hospital System Supply Identifier | 1083673 = Lawson ID"}]},{"description":"SCREW PEDPLATE CRTX 3.5X16MM","code_information":[{"code":"Sx00-1015-216","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1063321","type":"LOCAL"},{"code":"399815","type":"LOCAL"}],"standard_charges":[{"gross_charge":130.47,"discounted_cash":97.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1063321 = Hospital System Supply Identifier | 399815 = Lawson ID"}]},{"description":"SCREW PEDPLATE CRTX 3.5X18MM","code_information":[{"code":"Sx00-1015-218","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1063352","type":"LOCAL"},{"code":"418942","type":"LOCAL"}],"standard_charges":[{"gross_charge":130.47,"discounted_cash":97.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1063352 = Hospital System Supply Identifier | 418942 = Lawson ID"}]},{"description":"SCREW PEDPLATE CRTX 3.5X24MM","code_information":[{"code":"Sx00-1015-224","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1063322","type":"LOCAL"},{"code":"399817","type":"LOCAL"}],"standard_charges":[{"gross_charge":130.47,"discounted_cash":97.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1063322 = Hospital System Supply Identifier | 399817 = Lawson ID"}]},{"description":"SCREW PEDPLATE CRTX 3.5X26MM","code_information":[{"code":"Sx00-1015-226","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1063353","type":"LOCAL"},{"code":"418944","type":"LOCAL"}],"standard_charges":[{"gross_charge":130.47,"discounted_cash":97.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1063353 = Hospital System Supply Identifier | 418944 = Lawson ID"}]},{"description":"SCREW-BONE CORTICAL CANNULATED STAINLESS-STEEL ST","code_information":[{"code":"Sx00-1015-228","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356841","type":"LOCAL"},{"code":"1083629","type":"LOCAL"}],"standard_charges":[{"gross_charge":130.47,"discounted_cash":97.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356841 = Hospital System Supply Identifier | 1083629 = Lawson ID"}]},{"description":"SCREW-BONE CORTICAL CANNULATED STAINLESS-STEEL FT FOR-LAT DIST FEM","code_information":[{"code":"Sx00-1015-230","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356633","type":"LOCAL"},{"code":"1083563","type":"LOCAL"}],"standard_charges":[{"gross_charge":130.47,"discounted_cash":97.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356633 = Hospital System Supply Identifier | 1083563 = Lawson ID"}]},{"description":"SCREW-BONE CORTICAL CANNULATED STAINLESS-STEEL FT LAT DIST FEM","code_information":[{"code":"Sx00-1015-232","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357108","type":"LOCAL"},{"code":"1083682","type":"LOCAL"}],"standard_charges":[{"gross_charge":130.47,"discounted_cash":97.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357108 = Hospital System Supply Identifier | 1083682 = Lawson ID"}]},{"description":"SCREW-BONE CORTICAL CANNULATED STAINLESS-STEEL FT FOR-LAT","code_information":[{"code":"Sx00-1015-234","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356484","type":"LOCAL"},{"code":"1083676","type":"LOCAL"}],"standard_charges":[{"gross_charge":130.47,"discounted_cash":97.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356484 = Hospital System Supply Identifier | 1083676 = Lawson ID"}]},{"description":"SCREW-BONE CORTICAL CANNULATED STAINLESS-STEEL FT FOR-LAT","code_information":[{"code":"Sx00-1015-236","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357258","type":"LOCAL"},{"code":"1083560","type":"LOCAL"}],"standard_charges":[{"gross_charge":130.47,"discounted_cash":97.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357258 = Hospital System Supply Identifier | 1083560 = Lawson ID"}]},{"description":"SCREW-BONE CORTICAL CANNULATED STAINLESS-STEEL FT FOR-LAT","code_information":[{"code":"Sx00-1015-238","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356968","type":"LOCAL"},{"code":"1083601","type":"LOCAL"}],"standard_charges":[{"gross_charge":130.47,"discounted_cash":97.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356968 = Hospital System Supply Identifier | 1083601 = Lawson ID"}]},{"description":"SCREW-BONE CORTICAL CANNULATED STAINLESS-STEEL FULL-THREAD","code_information":[{"code":"Sx00-1015-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356878","type":"LOCAL"},{"code":"1083646","type":"LOCAL"}],"standard_charges":[{"gross_charge":130.47,"discounted_cash":97.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356878 = Hospital System Supply Identifier | 1083646 = Lawson ID"}]},{"description":"SCREW-BONE CORTICAL CANNULATED STAINLESS-STEEL FULL-THREAD","code_information":[{"code":"Sx00-1015-242","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356502","type":"LOCAL"},{"code":"1083652","type":"LOCAL"}],"standard_charges":[{"gross_charge":130.47,"discounted_cash":97.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356502 = Hospital System Supply Identifier | 1083652 = Lawson ID"}]},{"description":"SCREW-BONE CORTICAL CANNULATED STAINLESS-STEEL FULL-THREAD","code_information":[{"code":"Sx00-1015-244","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356755","type":"LOCAL"},{"code":"1083606","type":"LOCAL"}],"standard_charges":[{"gross_charge":130.47,"discounted_cash":97.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356755 = Hospital System Supply Identifier | 1083606 = Lawson ID"}]},{"description":"SCREW-BONE CORTICAL CANNULATED STAINLESS-STEEL FULL-THREAD","code_information":[{"code":"Sx00-1015-246","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357234","type":"LOCAL"},{"code":"1083678","type":"LOCAL"}],"standard_charges":[{"gross_charge":130.47,"discounted_cash":97.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357234 = Hospital System Supply Identifier | 1083678 = Lawson ID"}]},{"description":"SCREW-BONE CORTICAL CANNULATED STAINLESS-STEEL FULL-THREAD","code_information":[{"code":"Sx00-1015-248","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356754","type":"LOCAL"},{"code":"1083567","type":"LOCAL"}],"standard_charges":[{"gross_charge":130.47,"discounted_cash":97.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356754 = Hospital System Supply Identifier | 1083567 = Lawson ID"}]},{"description":"SCREW-BONE CORTICAL CANNULATED STAINLESS-STEEL FULL-THREAD","code_information":[{"code":"Sx00-1015-250","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357260","type":"LOCAL"},{"code":"1083541","type":"LOCAL"}],"standard_charges":[{"gross_charge":130.47,"discounted_cash":97.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357260 = Hospital System Supply Identifier | 1083541 = Lawson ID"}]},{"description":"SCREW CANN PED-PLT 4.5X16MM","code_information":[{"code":"Sx00-1015-316","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050834","type":"LOCAL"},{"code":"405712","type":"LOCAL"}],"standard_charges":[{"gross_charge":805.47,"discounted_cash":604.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050834 = Hospital System Supply Identifier | 405712 = Lawson ID"}]},{"description":"SCREW CANN PEDIPLATE 4.5","code_information":[{"code":"Sx00-1015-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1051019","type":"LOCAL"},{"code":"424925","type":"LOCAL"}],"standard_charges":[{"gross_charge":805.47,"discounted_cash":604.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1051019 = Hospital System Supply Identifier | 424925 = Lawson ID"}]},{"description":"SCREW CANN PED-PLT 4.5X24MM","code_information":[{"code":"Sx00-1015-324","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050835","type":"LOCAL"},{"code":"405713","type":"LOCAL"}],"standard_charges":[{"gross_charge":805.47,"discounted_cash":604.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050835 = Hospital System Supply Identifier | 405713 = Lawson ID"}]},{"description":"SCREW CANN 4.5X28MM","code_information":[{"code":"Sx00-1015-328","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054301","type":"LOCAL"},{"code":"876751","type":"LOCAL"}],"standard_charges":[{"gross_charge":805.47,"discounted_cash":604.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054301 = Hospital System Supply Identifier | 876751 = Lawson ID"}]},{"description":"SCREW CANN PED-PLT 4.5X32MM","code_information":[{"code":"Sx00-1015-332","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"821527","type":"LOCAL"},{"code":"S281320","type":"LOCAL"}],"standard_charges":[{"gross_charge":805.47,"discounted_cash":604.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 821527 = Hospital System Supply Identifier | S281320 = Lawson ID"}]},{"description":"SCREW CANN PED-PLT 4.5X36MM","code_information":[{"code":"Sx00-1015-336","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050836","type":"LOCAL"},{"code":"405715","type":"LOCAL"}],"standard_charges":[{"gross_charge":805.47,"discounted_cash":604.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050836 = Hospital System Supply Identifier | 405715 = Lawson ID"}]},{"description":"PLATE PEDI I W/HLDR 16MM","code_information":[{"code":"Sx00-1015-416","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"833247","type":"LOCAL"},{"code":"S379497","type":"LOCAL"}],"standard_charges":[{"gross_charge":1635.36,"discounted_cash":1226.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 833247 = Hospital System Supply Identifier | S379497 = Lawson ID"}]},{"description":"PLATE PEDI I W/HLDR 22MM","code_information":[{"code":"Sx00-1015-422","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"833245","type":"LOCAL"},{"code":"S287226","type":"LOCAL"}],"standard_charges":[{"gross_charge":1635.36,"discounted_cash":1226.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 833245 = Hospital System Supply Identifier | S287226 = Lawson ID"}]},{"description":"PLATE PEDI I W/HLDR 32MM","code_information":[{"code":"Sx00-1015-432","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050837","type":"LOCAL"},{"code":"410078","type":"LOCAL"}],"standard_charges":[{"gross_charge":1635.36,"discounted_cash":1226.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050837 = Hospital System Supply Identifier | 410078 = Lawson ID"}]},{"description":"SCREW SOLID 4.5X16MM","code_information":[{"code":"Sx00-1015-516","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054302","type":"LOCAL"},{"code":"876752","type":"LOCAL"}],"standard_charges":[{"gross_charge":805.47,"discounted_cash":604.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054302 = Hospital System Supply Identifier | 876752 = Lawson ID"}]},{"description":"SCREW SOLID 4.5X20MM","code_information":[{"code":"Sx00-1015-520","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054303","type":"LOCAL"},{"code":"876753","type":"LOCAL"}],"standard_charges":[{"gross_charge":805.47,"discounted_cash":604.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054303 = Hospital System Supply Identifier | 876753 = Lawson ID"}]},{"description":"SCREW BONE 244.5PEDIATRIC CANC","code_information":[{"code":"Sx00-1015-524","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"939746","type":"LOCAL"},{"code":"824274","type":"LOCAL"}],"standard_charges":[{"gross_charge":805.47,"discounted_cash":604.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 939746 = Hospital System Supply Identifier | 824274 = Lawson ID"}]},{"description":"SCREW BONE 284.5SELF TAP LOW P","code_information":[{"code":"Sx00-1015-528","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"939745","type":"LOCAL"},{"code":"824273","type":"LOCAL"}],"standard_charges":[{"gross_charge":805.47,"discounted_cash":604.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 939745 = Hospital System Supply Identifier | 824273 = Lawson ID"}]},{"description":"SCREW BONE 324.5LOW PROFILE SO","code_information":[{"code":"Sx00-1015-532","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"939744","type":"LOCAL"},{"code":"824272","type":"LOCAL"}],"standard_charges":[{"gross_charge":805.47,"discounted_cash":604.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 939744 = Hospital System Supply Identifier | 824272 = Lawson ID"}]},{"description":"SCREW SOLID 4.5X36MM","code_information":[{"code":"Sx00-1015-536","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054304","type":"LOCAL"},{"code":"876754","type":"LOCAL"}],"standard_charges":[{"gross_charge":805.47,"discounted_cash":604.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054304 = Hospital System Supply Identifier | 876754 = Lawson ID"}]},{"description":"SCREW BONE 164.5CANN LOW PROFI","code_information":[{"code":"Sx00-1015-616","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"942930","type":"LOCAL"},{"code":"827490","type":"LOCAL"}],"standard_charges":[{"gross_charge":805.47,"discounted_cash":604.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 942930 = Hospital System Supply Identifier | 827490 = Lawson ID"}]},{"description":"SCREW CANN PEDIPLATE 4.5X20MM","code_information":[{"code":"Sx00-1015-620","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"802570","type":"LOCAL"},{"code":"S366668","type":"LOCAL"}],"standard_charges":[{"gross_charge":805.47,"discounted_cash":604.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 802570 = Hospital System Supply Identifier | S366668 = Lawson ID"}]},{"description":"SCREW CANN LP 4.5X24MM","code_information":[{"code":"Sx00-1015-624","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"892141","type":"LOCAL"},{"code":"536297","type":"LOCAL"}],"standard_charges":[{"gross_charge":805.47,"discounted_cash":604.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 892141 = Hospital System Supply Identifier | 536297 = Lawson ID"}]},{"description":"SCREW CANN PEDIPLATE 4.5X28MM","code_information":[{"code":"Sx00-1015-628","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"887630","type":"LOCAL"},{"code":"461781","type":"LOCAL"}],"standard_charges":[{"gross_charge":805.47,"discounted_cash":604.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 887630 = Hospital System Supply Identifier | 461781 = Lawson ID"}]},{"description":"SCREW CANN PEDIPLATE 4.5X32MM","code_information":[{"code":"Sx00-1015-632","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"835986","type":"LOCAL"},{"code":"461782","type":"LOCAL"}],"standard_charges":[{"gross_charge":805.47,"discounted_cash":604.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 835986 = Hospital System Supply Identifier | 461782 = Lawson ID"}]},{"description":"SCREW BONE 364.5FEMORAL PHYSEA","code_information":[{"code":"Sx00-1015-636","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"939471","type":"LOCAL"},{"code":"823995","type":"LOCAL"}],"standard_charges":[{"gross_charge":805.47,"discounted_cash":604.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 939471 = Hospital System Supply Identifier | 823995 = Lawson ID"}]},{"description":"SCREW CANN TI 4.5X 16MM","code_information":[{"code":"Sx00-1015-801","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054305","type":"LOCAL"},{"code":"876755","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054305 = Hospital System Supply Identifier | 876755 = Lawson ID"}]},{"description":"SCREW CANN TI 4.5X 20MM","code_information":[{"code":"Sx00-1015-802","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054306","type":"LOCAL"},{"code":"876756","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054306 = Hospital System Supply Identifier | 876756 = Lawson ID"}]},{"description":"SCREW CANN TI 4.5X 24MM","code_information":[{"code":"Sx00-1015-802","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054307","type":"LOCAL"},{"code":"876757","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054307 = Hospital System Supply Identifier | 876757 = Lawson ID"}]},{"description":"SCREW CANN TI 4.5X 28MM","code_information":[{"code":"Sx00-1015-802","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054308","type":"LOCAL"},{"code":"876758","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054308 = Hospital System Supply Identifier | 876758 = Lawson ID"}]},{"description":"SCREW CANN TI 4.5X 32MM","code_information":[{"code":"Sx00-1015-803","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054309","type":"LOCAL"},{"code":"876759","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054309 = Hospital System Supply Identifier | 876759 = Lawson ID"}]},{"description":"SCREW CANN TI 4.5X 36MM","code_information":[{"code":"Sx00-1015-803","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054310","type":"LOCAL"},{"code":"876760","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054310 = Hospital System Supply Identifier | 876760 = Lawson ID"}]},{"description":"SCREW SOLID TI 4.5X 16MM","code_information":[{"code":"Sx00-1015-811","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054311","type":"LOCAL"},{"code":"876761","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054311 = Hospital System Supply Identifier | 876761 = Lawson ID"}]},{"description":"SCREW SOLID TI 4.5X 24MM","code_information":[{"code":"Sx00-1015-812","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054313","type":"LOCAL"},{"code":"876763","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054313 = Hospital System Supply Identifier | 876763 = Lawson ID"}]},{"description":"SCREW SOLID TI 4.5X 28MM","code_information":[{"code":"Sx00-1015-812","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054314","type":"LOCAL"},{"code":"876764","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054314 = Hospital System Supply Identifier | 876764 = Lawson ID"}]},{"description":"SCREW SOLID TI 4.5X 20MM","code_information":[{"code":"Sx00-1015-812","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054312","type":"LOCAL"},{"code":"876762","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054312 = Hospital System Supply Identifier | 876762 = Lawson ID"}]},{"description":"SCREW SOLID TI 4.5X 32MM","code_information":[{"code":"Sx00-1015-813","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054315","type":"LOCAL"},{"code":"876765","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054315 = Hospital System Supply Identifier | 876765 = Lawson ID"}]},{"description":"SCREW SOLID TI 4.5X 36MM","code_information":[{"code":"Sx00-1015-813","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054316","type":"LOCAL"},{"code":"876766","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054316 = Hospital System Supply Identifier | 876766 = Lawson ID"}]},{"description":"O-PLATE TI 12MM","code_information":[{"code":"Sx00-1015-821","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054317","type":"LOCAL"},{"code":"876767","type":"LOCAL"}],"standard_charges":[{"gross_charge":2150.4,"discounted_cash":1612.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054317 = Hospital System Supply Identifier | 876767 = Lawson ID"}]},{"description":"O-PLATE TI 16MM","code_information":[{"code":"Sx00-1015-821","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054318","type":"LOCAL"},{"code":"876768","type":"LOCAL"}],"standard_charges":[{"gross_charge":2150.4,"discounted_cash":1612.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054318 = Hospital System Supply Identifier | 876768 = Lawson ID"}]},{"description":"O-PLATE TI 20MM","code_information":[{"code":"Sx00-1015-822","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054319","type":"LOCAL"},{"code":"876769","type":"LOCAL"}],"standard_charges":[{"gross_charge":2150.4,"discounted_cash":1612.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054319 = Hospital System Supply Identifier | 876769 = Lawson ID"}]},{"description":"O-PLATE TI 24MM","code_information":[{"code":"Sx00-1015-822","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054320","type":"LOCAL"},{"code":"876770","type":"LOCAL"}],"standard_charges":[{"gross_charge":2150.4,"discounted_cash":1612.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054320 = Hospital System Supply Identifier | 876770 = Lawson ID"}]},{"description":"I-PLATE TI 16MM","code_information":[{"code":"Sx00-1015-841","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054321","type":"LOCAL"},{"code":"876771","type":"LOCAL"}],"standard_charges":[{"gross_charge":2150.4,"discounted_cash":1612.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054321 = Hospital System Supply Identifier | 876771 = Lawson ID"}]},{"description":"I-PLATE TI 22MM","code_information":[{"code":"Sx00-1015-842","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054322","type":"LOCAL"},{"code":"876772","type":"LOCAL"}],"standard_charges":[{"gross_charge":2150.4,"discounted_cash":1612.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054322 = Hospital System Supply Identifier | 876772 = Lawson ID"}]},{"description":"I-PLATE TI 32MM","code_information":[{"code":"Sx00-1015-843","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054323","type":"LOCAL"},{"code":"876773","type":"LOCAL"}],"standard_charges":[{"gross_charge":2150.4,"discounted_cash":1612.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054323 = Hospital System Supply Identifier | 876773 = Lawson ID"}]},{"description":"WASHER","code_information":[{"code":"Sx00-1030-000","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054324","type":"LOCAL"},{"code":"876774","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054324 = Hospital System Supply Identifier | 876774 = Lawson ID"}]},{"description":"SCREW MED THRD SS 4.0X30MM","code_information":[{"code":"Sx00-1030-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054325","type":"LOCAL"},{"code":"876775","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054325 = Hospital System Supply Identifier | 876775 = Lawson ID"}]},{"description":"SCREW MED THRD SS 4.0X32MM","code_information":[{"code":"Sx00-1030-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054326","type":"LOCAL"},{"code":"876776","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054326 = Hospital System Supply Identifier | 876776 = Lawson ID"}]},{"description":"SCREW MED THRD SS 4.0X34MM","code_information":[{"code":"Sx00-1030-034","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054327","type":"LOCAL"},{"code":"876777","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054327 = Hospital System Supply Identifier | 876777 = Lawson ID"}]},{"description":"SCREW MED THRD SS 4.0X36MM","code_information":[{"code":"Sx00-1030-036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054328","type":"LOCAL"},{"code":"876778","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054328 = Hospital System Supply Identifier | 876778 = Lawson ID"}]},{"description":"SCREW MED THRD SS 4.0X38MM","code_information":[{"code":"Sx00-1030-038","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054329","type":"LOCAL"},{"code":"876779","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054329 = Hospital System Supply Identifier | 876779 = Lawson ID"}]},{"description":"SCREW MED THRD SS 4.0X40MM","code_information":[{"code":"Sx00-1030-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054330","type":"LOCAL"},{"code":"876780","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054330 = Hospital System Supply Identifier | 876780 = Lawson ID"}]},{"description":"SCREW MED THRD SS 4.0X42MM","code_information":[{"code":"Sx00-1030-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054331","type":"LOCAL"},{"code":"876781","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054331 = Hospital System Supply Identifier | 876781 = Lawson ID"}]},{"description":"SCREW MED THRD SS 4.0X44MM","code_information":[{"code":"Sx00-1030-044","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054332","type":"LOCAL"},{"code":"876782","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054332 = Hospital System Supply Identifier | 876782 = Lawson ID"}]},{"description":"SCREW MED THRD SS 4.0X46MM","code_information":[{"code":"Sx00-1030-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054333","type":"LOCAL"},{"code":"876783","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054333 = Hospital System Supply Identifier | 876783 = Lawson ID"}]},{"description":"SCREW MED THRD SS 4.0X48MM","code_information":[{"code":"Sx00-1030-048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054334","type":"LOCAL"},{"code":"876784","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054334 = Hospital System Supply Identifier | 876784 = Lawson ID"}]},{"description":"SCREW MED THRD SS 4.0X50MM","code_information":[{"code":"Sx00-1030-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054335","type":"LOCAL"},{"code":"876785","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054335 = Hospital System Supply Identifier | 876785 = Lawson ID"}]},{"description":"SCREW MED THRD SS 4.0X52MM","code_information":[{"code":"Sx00-1030-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054336","type":"LOCAL"},{"code":"876786","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054336 = Hospital System Supply Identifier | 876786 = Lawson ID"}]},{"description":"SCREW MED THRD SS 4.0X54MM","code_information":[{"code":"Sx00-1030-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054337","type":"LOCAL"},{"code":"876787","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054337 = Hospital System Supply Identifier | 876787 = Lawson ID"}]},{"description":"SCREW MED THRD SS 4.0X56MM","code_information":[{"code":"Sx00-1030-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054338","type":"LOCAL"},{"code":"876788","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054338 = Hospital System Supply Identifier | 876788 = Lawson ID"}]},{"description":"SCREW MED THRD SS 4.0X58MM","code_information":[{"code":"Sx00-1030-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054339","type":"LOCAL"},{"code":"876789","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054339 = Hospital System Supply Identifier | 876789 = Lawson ID"}]},{"description":"SCREW MED THRD SS 4.0X60MM","code_information":[{"code":"Sx00-1030-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054340","type":"LOCAL"},{"code":"876790","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054340 = Hospital System Supply Identifier | 876790 = Lawson ID"}]},{"description":"SCREW MED THRD SS 4.0X65MM","code_information":[{"code":"Sx00-1030-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054341","type":"LOCAL"},{"code":"876791","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054341 = Hospital System Supply Identifier | 876791 = Lawson ID"}]},{"description":"SCREW MED THRD SS 4.0X70MM","code_information":[{"code":"Sx00-1030-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054342","type":"LOCAL"},{"code":"876792","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054342 = Hospital System Supply Identifier | 876792 = Lawson ID"}]},{"description":"SCREW FULL THRD SS 4.0X20MM","code_information":[{"code":"Sx00-1030-120","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054343","type":"LOCAL"},{"code":"876793","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054343 = Hospital System Supply Identifier | 876793 = Lawson ID"}]},{"description":"SCREW FULL THRD SS 4.0X22MM","code_information":[{"code":"Sx00-1030-122","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054344","type":"LOCAL"},{"code":"876794","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054344 = Hospital System Supply Identifier | 876794 = Lawson ID"}]},{"description":"SCREW FULL THRD SS 4.0X24MM","code_information":[{"code":"Sx00-1030-124","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054345","type":"LOCAL"},{"code":"876795","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054345 = Hospital System Supply Identifier | 876795 = Lawson ID"}]},{"description":"SCREW FULL THRD SS 4.0X26MM","code_information":[{"code":"Sx00-1030-126","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054346","type":"LOCAL"},{"code":"876796","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054346 = Hospital System Supply Identifier | 876796 = Lawson ID"}]},{"description":"SCREW FULL THRD SS 4.0X28MM","code_information":[{"code":"Sx00-1030-128","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054347","type":"LOCAL"},{"code":"876797","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054347 = Hospital System Supply Identifier | 876797 = Lawson ID"}]},{"description":"SCREW FULL THRD SS 4.0X30MM","code_information":[{"code":"Sx00-1030-130","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054348","type":"LOCAL"},{"code":"876798","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054348 = Hospital System Supply Identifier | 876798 = Lawson ID"}]},{"description":"SCREW FULL THRD SS 4.0X35MM","code_information":[{"code":"Sx00-1030-135","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054349","type":"LOCAL"},{"code":"876799","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054349 = Hospital System Supply Identifier | 876799 = Lawson ID"}]},{"description":"SCREW FULL THRD SS 4.0X40MM","code_information":[{"code":"Sx00-1030-140","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054350","type":"LOCAL"},{"code":"876800","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054350 = Hospital System Supply Identifier | 876800 = Lawson ID"}]},{"description":"SCREW FULL THRD SS 4.0X45MM","code_information":[{"code":"Sx00-1030-145","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054351","type":"LOCAL"},{"code":"876801","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054351 = Hospital System Supply Identifier | 876801 = Lawson ID"}]},{"description":"SCREW FULL THRD SS 4.0X50MM","code_information":[{"code":"Sx00-1030-150","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054352","type":"LOCAL"},{"code":"876802","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054352 = Hospital System Supply Identifier | 876802 = Lawson ID"}]},{"description":"SCREW FULL THRD SS 4.0X55MM","code_information":[{"code":"Sx00-1030-155","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054353","type":"LOCAL"},{"code":"876803","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054353 = Hospital System Supply Identifier | 876803 = Lawson ID"}]},{"description":"SCREW FULL THRD SS 4.0X60MM","code_information":[{"code":"Sx00-1030-160","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054354","type":"LOCAL"},{"code":"876804","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054354 = Hospital System Supply Identifier | 876804 = Lawson ID"}]},{"description":"SCREW FULL THRD SS 4.0X65MM","code_information":[{"code":"Sx00-1030-165","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054355","type":"LOCAL"},{"code":"876805","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054355 = Hospital System Supply Identifier | 876805 = Lawson ID"}]},{"description":"SCREW FULL THRD SS 4.0X70MM","code_information":[{"code":"Sx00-1030-170","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054356","type":"LOCAL"},{"code":"876806","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054356 = Hospital System Supply Identifier | 876806 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X10MM","code_information":[{"code":"Sx00-1030-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054357","type":"LOCAL"},{"code":"876807","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054357 = Hospital System Supply Identifier | 876807 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X12MM","code_information":[{"code":"Sx00-1030-212","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054358","type":"LOCAL"},{"code":"876808","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054358 = Hospital System Supply Identifier | 876808 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X14MM","code_information":[{"code":"Sx00-1030-214","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054359","type":"LOCAL"},{"code":"876809","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054359 = Hospital System Supply Identifier | 876809 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X16MM","code_information":[{"code":"Sx00-1030-216","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054360","type":"LOCAL"},{"code":"876810","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054360 = Hospital System Supply Identifier | 876810 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X18MM","code_information":[{"code":"Sx00-1030-218","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054361","type":"LOCAL"},{"code":"876811","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054361 = Hospital System Supply Identifier | 876811 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X20MM","code_information":[{"code":"Sx00-1030-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054362","type":"LOCAL"},{"code":"876812","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054362 = Hospital System Supply Identifier | 876812 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X22MM","code_information":[{"code":"Sx00-1030-222","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054363","type":"LOCAL"},{"code":"876813","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054363 = Hospital System Supply Identifier | 876813 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X24MM","code_information":[{"code":"Sx00-1030-224","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054364","type":"LOCAL"},{"code":"876814","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054364 = Hospital System Supply Identifier | 876814 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X26MM","code_information":[{"code":"Sx00-1030-226","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054365","type":"LOCAL"},{"code":"876815","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054365 = Hospital System Supply Identifier | 876815 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X28MM","code_information":[{"code":"Sx00-1030-228","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054366","type":"LOCAL"},{"code":"876816","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054366 = Hospital System Supply Identifier | 876816 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X30MM","code_information":[{"code":"Sx00-1030-230","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054367","type":"LOCAL"},{"code":"876817","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054367 = Hospital System Supply Identifier | 876817 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X32MM","code_information":[{"code":"Sx00-1030-232","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054368","type":"LOCAL"},{"code":"876818","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054368 = Hospital System Supply Identifier | 876818 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X34MM","code_information":[{"code":"Sx00-1030-234","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054369","type":"LOCAL"},{"code":"876819","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054369 = Hospital System Supply Identifier | 876819 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X36MM","code_information":[{"code":"Sx00-1030-236","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054370","type":"LOCAL"},{"code":"876820","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054370 = Hospital System Supply Identifier | 876820 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X38MM","code_information":[{"code":"Sx00-1030-238","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054371","type":"LOCAL"},{"code":"876821","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054371 = Hospital System Supply Identifier | 876821 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X40MM","code_information":[{"code":"Sx00-1030-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054372","type":"LOCAL"},{"code":"876822","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054372 = Hospital System Supply Identifier | 876822 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X42MM","code_information":[{"code":"Sx00-1030-242","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054373","type":"LOCAL"},{"code":"876823","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054373 = Hospital System Supply Identifier | 876823 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X44MM","code_information":[{"code":"Sx00-1030-244","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054374","type":"LOCAL"},{"code":"876824","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054374 = Hospital System Supply Identifier | 876824 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X46MM","code_information":[{"code":"Sx00-1030-246","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054375","type":"LOCAL"},{"code":"876825","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054375 = Hospital System Supply Identifier | 876825 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X48MM","code_information":[{"code":"Sx00-1030-248","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054376","type":"LOCAL"},{"code":"876826","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054376 = Hospital System Supply Identifier | 876826 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X50MM","code_information":[{"code":"Sx00-1030-250","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054377","type":"LOCAL"},{"code":"876827","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054377 = Hospital System Supply Identifier | 876827 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X52MM","code_information":[{"code":"Sx00-1030-252","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054378","type":"LOCAL"},{"code":"876828","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054378 = Hospital System Supply Identifier | 876828 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X54MM","code_information":[{"code":"Sx00-1030-254","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054379","type":"LOCAL"},{"code":"876829","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054379 = Hospital System Supply Identifier | 876829 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X56MM","code_information":[{"code":"Sx00-1030-256","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054380","type":"LOCAL"},{"code":"876830","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054380 = Hospital System Supply Identifier | 876830 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X58MM","code_information":[{"code":"Sx00-1030-258","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054381","type":"LOCAL"},{"code":"876831","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054381 = Hospital System Supply Identifier | 876831 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X60MM","code_information":[{"code":"Sx00-1030-260","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054382","type":"LOCAL"},{"code":"876832","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054382 = Hospital System Supply Identifier | 876832 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X65MM","code_information":[{"code":"Sx00-1030-265","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054383","type":"LOCAL"},{"code":"876833","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054383 = Hospital System Supply Identifier | 876833 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X70MM","code_information":[{"code":"Sx00-1030-270","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054384","type":"LOCAL"},{"code":"876834","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054384 = Hospital System Supply Identifier | 876834 = Lawson ID"}]},{"description":"PLATE KLS GRIFFIN 03MM","code_information":[{"code":"Sx00-104-19-0","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"92839","type":"LOCAL"},{"code":"144792","type":"LOCAL"}],"standard_charges":[{"gross_charge":467.62,"discounted_cash":350.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 92839 = Hospital System Supply Identifier | 144792 = Lawson ID"}]},{"description":"PLATE KLS GRIFFIN 05MM","code_information":[{"code":"Sx00-104-20-0","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"205625","type":"LOCAL"},{"code":"144793","type":"LOCAL"}],"standard_charges":[{"gross_charge":467.62,"discounted_cash":350.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 205625 = Hospital System Supply Identifier | 144793 = Lawson ID"}]},{"description":"PLATE KLS GRIFFIN 07MM","code_information":[{"code":"Sx00-104-21-0","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"205626","type":"LOCAL"},{"code":"144794","type":"LOCAL"}],"standard_charges":[{"gross_charge":467.62,"discounted_cash":350.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 205626 = Hospital System Supply Identifier | 144794 = Lawson ID"}]},{"description":"PLATE CHIN GRIFFIN 9MM ADV","code_information":[{"code":"Sx00-104-22-0","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"192176","type":"LOCAL"},{"code":"232039","type":"LOCAL"}],"standard_charges":[{"gross_charge":467.62,"discounted_cash":350.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 192176 = Hospital System Supply Identifier | 232039 = Lawson ID"}]},{"description":"PLATE LVL1 ORTHOG GRIFFIN","code_information":[{"code":"Sx00-104-23-0","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"700425","type":"LOCAL"},{"code":"723561","type":"LOCAL"}],"standard_charges":[{"gross_charge":467.62,"discounted_cash":350.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 700425 = Hospital System Supply Identifier | 723561 = Lawson ID"}]},{"description":"DRILL TWIST MIDAS REX 1.0 X5MM","code_information":[{"code":"Sx00-104-49-0","type":"CDM"},{"code":"272","type":"RC"},{"code":"157623","type":"LOCAL"},{"code":"310249","type":"LOCAL"}],"standard_charges":[{"gross_charge":234.4,"discounted_cash":175.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 157623 = Hospital System Supply Identifier | 310249 = Lawson ID"}]},{"description":"MESH L1 STD ORTHOG STRIP 117MM","code_information":[{"code":"Sx00-105-49-0","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"779932","type":"LOCAL"},{"code":"773377","type":"LOCAL"}],"standard_charges":[{"gross_charge":1133.21,"discounted_cash":849.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 779932 = Hospital System Supply Identifier | 773377 = Lawson ID"}]},{"description":"PLATE LVL1 MINI BAYS T-SHP 4HL","code_information":[{"code":"Sx00-105-59-0","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"700557","type":"LOCAL"},{"code":"723693","type":"LOCAL"}],"standard_charges":[{"gross_charge":372.54,"discounted_cash":279.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 700557 = Hospital System Supply Identifier | 723693 = Lawson ID"}]},{"description":"PLATE LOK TBLR 1/3 6H","code_information":[{"code":"Sx00-1050-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050838","type":"LOCAL"},{"code":"410079","type":"LOCAL"}],"standard_charges":[{"gross_charge":410.2,"discounted_cash":307.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050838 = Hospital System Supply Identifier | 410079 = Lawson ID"}]},{"description":"PLATE PED TBLR 1/3 LOK 4H","code_information":[{"code":"Sx00-1050-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050846","type":"LOCAL"},{"code":"414027","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.9,"discounted_cash":285.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050846 = Hospital System Supply Identifier | 414027 = Lawson ID"}]},{"description":"PLATE PED TBLR 1/3 LOK 5H","code_information":[{"code":"Sx00-1050-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050847","type":"LOCAL"},{"code":"414028","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050847 = Hospital System Supply Identifier | 414028 = Lawson ID"}]},{"description":"PLATE PED TBLR 1/3 LOK 7H","code_information":[{"code":"Sx00-1050-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050848","type":"LOCAL"},{"code":"414029","type":"LOCAL"}],"standard_charges":[{"gross_charge":424.85,"discounted_cash":318.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050848 = Hospital System Supply Identifier | 414029 = Lawson ID"}]},{"description":"PLATE PED TBLR 1/3 LOK 8H","code_information":[{"code":"Sx00-1050-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050849","type":"LOCAL"},{"code":"414030","type":"LOCAL"}],"standard_charges":[{"gross_charge":439.5,"discounted_cash":329.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050849 = Hospital System Supply Identifier | 414030 = Lawson ID"}]},{"description":"PLATE PED TBLR 1/3 LOK 10H","code_information":[{"code":"Sx00-1050-211","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050850","type":"LOCAL"},{"code":"414031","type":"LOCAL"}],"standard_charges":[{"gross_charge":454.15,"discounted_cash":340.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050850 = Hospital System Supply Identifier | 414031 = Lawson ID"}]},{"description":"PLATE PED COMPR LOK FEM 4H","code_information":[{"code":"Sx00-1050-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050851","type":"LOCAL"},{"code":"414032","type":"LOCAL"}],"standard_charges":[{"gross_charge":849.0,"discounted_cash":636.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050851 = Hospital System Supply Identifier | 414032 = Lawson ID"}]},{"description":"PLATE PED COMPR LOK FEM 6H","code_information":[{"code":"Sx00-1050-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050852","type":"LOCAL"},{"code":"414033","type":"LOCAL"}],"standard_charges":[{"gross_charge":919.75,"discounted_cash":689.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050852 = Hospital System Supply Identifier | 414033 = Lawson ID"}]},{"description":"PLATE PED COMPR LOK FEM 8H","code_information":[{"code":"Sx00-1050-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050853","type":"LOCAL"},{"code":"414034","type":"LOCAL"}],"standard_charges":[{"gross_charge":987.0,"discounted_cash":740.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050853 = Hospital System Supply Identifier | 414034 = Lawson ID"}]},{"description":"PLATE PED COMPR LOK FEM 10H","code_information":[{"code":"Sx00-1050-221","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050854","type":"LOCAL"},{"code":"414035","type":"LOCAL"}],"standard_charges":[{"gross_charge":1057.5,"discounted_cash":793.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050854 = Hospital System Supply Identifier | 414035 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 3.5 6H RT","code_information":[{"code":"Sx00-1050-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1051006","type":"LOCAL"},{"code":"414193","type":"LOCAL"}],"standard_charges":[{"gross_charge":8790.75,"discounted_cash":6593.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1051006 = Hospital System Supply Identifier | 414193 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 3.5 8H RT","code_information":[{"code":"Sx00-1050-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"833243","type":"LOCAL"},{"code":"S392027","type":"LOCAL"}],"standard_charges":[{"gross_charge":8790.75,"discounted_cash":6593.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 833243 = Hospital System Supply Identifier | S392027 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 10H RT","code_information":[{"code":"Sx00-1050-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"819438","type":"LOCAL"},{"code":"S282456","type":"LOCAL"}],"standard_charges":[{"gross_charge":8806.74,"discounted_cash":6605.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 819438 = Hospital System Supply Identifier | S282456 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 3.5 14H RT","code_information":[{"code":"Sx00-1050-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050856","type":"LOCAL"},{"code":"414037","type":"LOCAL"}],"standard_charges":[{"gross_charge":9203.26,"discounted_cash":6902.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050856 = Hospital System Supply Identifier | 414037 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 3.5 16H RT","code_information":[{"code":"Sx00-1050-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050857","type":"LOCAL"},{"code":"414038","type":"LOCAL"}],"standard_charges":[{"gross_charge":10727.26,"discounted_cash":8045.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050857 = Hospital System Supply Identifier | 414038 = Lawson ID"}]},{"description":"IMPLANT-PLATE-BONE COMPRESSION LOCKING FEMORAL TITANIUM 18-HOLE","code_information":[{"code":"Sx00-1050-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357259","type":"LOCAL"},{"code":"1083572","type":"LOCAL"}],"standard_charges":[{"gross_charge":10727.26,"discounted_cash":8045.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357259 = Hospital System Supply Identifier | 1083572 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 3.5 12H RT","code_information":[{"code":"Sx00-1050-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050855","type":"LOCAL"},{"code":"414036","type":"LOCAL"}],"standard_charges":[{"gross_charge":9005.0,"discounted_cash":6753.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050855 = Hospital System Supply Identifier | 414036 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 6H LT","code_information":[{"code":"Sx00-1050-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050839","type":"LOCAL"},{"code":"410081","type":"LOCAL"}],"standard_charges":[{"gross_charge":8790.75,"discounted_cash":6593.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050839 = Hospital System Supply Identifier | 410081 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 8H LT","code_information":[{"code":"Sx00-1050-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050840","type":"LOCAL"},{"code":"410082","type":"LOCAL"}],"standard_charges":[{"gross_charge":8790.75,"discounted_cash":6593.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050840 = Hospital System Supply Identifier | 410082 = Lawson ID"}]},{"description":"PLATE BONE COMPRESSION LOCKING 18 HOLE PEDILOC 0010503118 3.5MM","code_information":[{"code":"Sx00-1050-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356461","type":"LOCAL"},{"code":"1083743","type":"LOCAL"}],"standard_charges":[{"gross_charge":10727.26,"discounted_cash":8045.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356461 = Hospital System Supply Identifier | 1083743 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 3.5 10H LT","code_information":[{"code":"Sx00-1050-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050858","type":"LOCAL"},{"code":"414040","type":"LOCAL"}],"standard_charges":[{"gross_charge":8806.74,"discounted_cash":6605.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050858 = Hospital System Supply Identifier | 414040 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 3.5 12H LT","code_information":[{"code":"Sx00-1050-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050859","type":"LOCAL"},{"code":"414041","type":"LOCAL"}],"standard_charges":[{"gross_charge":9005.0,"discounted_cash":6753.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050859 = Hospital System Supply Identifier | 414041 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 3.5 14H LT","code_information":[{"code":"Sx00-1050-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050860","type":"LOCAL"},{"code":"414042","type":"LOCAL"}],"standard_charges":[{"gross_charge":9203.26,"discounted_cash":6902.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050860 = Hospital System Supply Identifier | 414042 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 3.5 16H LT","code_information":[{"code":"Sx00-1050-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050861","type":"LOCAL"},{"code":"414043","type":"LOCAL"}],"standard_charges":[{"gross_charge":10727.26,"discounted_cash":8045.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050861 = Hospital System Supply Identifier | 414043 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 3.5MM 18H","code_information":[{"code":"Sx00-1050-321","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050865","type":"LOCAL"},{"code":"414048","type":"LOCAL"}],"standard_charges":[{"gross_charge":8113.86,"discounted_cash":6085.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050865 = Hospital System Supply Identifier | 414048 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 3.5MM 16H","code_information":[{"code":"Sx00-1050-321","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050864","type":"LOCAL"},{"code":"414047","type":"LOCAL"}],"standard_charges":[{"gross_charge":7860.31,"discounted_cash":5895.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050864 = Hospital System Supply Identifier | 414047 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 3.5MM 12H","code_information":[{"code":"Sx00-1050-321","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050863","type":"LOCAL"},{"code":"414046","type":"LOCAL"}],"standard_charges":[{"gross_charge":6223.74,"discounted_cash":4667.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050863 = Hospital System Supply Identifier | 414046 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 3.5MM 10H","code_information":[{"code":"Sx00-1050-321","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050862","type":"LOCAL"},{"code":"414045","type":"LOCAL"}],"standard_charges":[{"gross_charge":6010.51,"discounted_cash":4507.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050862 = Hospital System Supply Identifier | 414045 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 3.5MM 14H","code_information":[{"code":"Sx00-1050-321","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050841","type":"LOCAL"},{"code":"410083","type":"LOCAL"}],"standard_charges":[{"gross_charge":6703.73,"discounted_cash":5027.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050841 = Hospital System Supply Identifier | 410083 = Lawson ID"}]},{"description":"PLATE PED TBLR 1/3 N-LOK 4H","code_information":[{"code":"Sx00-1050-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050866","type":"LOCAL"},{"code":"414049","type":"LOCAL"}],"standard_charges":[{"gross_charge":290.94,"discounted_cash":218.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050866 = Hospital System Supply Identifier | 414049 = Lawson ID"}]},{"description":"PLATE PED TBLR 1/3 N-LOK 5H","code_information":[{"code":"Sx00-1050-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050867","type":"LOCAL"},{"code":"414050","type":"LOCAL"}],"standard_charges":[{"gross_charge":303.48,"discounted_cash":227.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050867 = Hospital System Supply Identifier | 414050 = Lawson ID"}]},{"description":"PLATE PED TBLR 1/3 N-LOK 6H","code_information":[{"code":"Sx00-1050-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050868","type":"LOCAL"},{"code":"414051","type":"LOCAL"}],"standard_charges":[{"gross_charge":303.48,"discounted_cash":227.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050868 = Hospital System Supply Identifier | 414051 = Lawson ID"}]},{"description":"PLATE PED TBLR 1/3 N-LOK 7H","code_information":[{"code":"Sx00-1050-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050869","type":"LOCAL"},{"code":"414052","type":"LOCAL"}],"standard_charges":[{"gross_charge":316.02,"discounted_cash":237.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050869 = Hospital System Supply Identifier | 414052 = Lawson ID"}]},{"description":"PLATE PED TBLR 1/3 N-LOK 8H","code_information":[{"code":"Sx00-1050-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050870","type":"LOCAL"},{"code":"414053","type":"LOCAL"}],"standard_charges":[{"gross_charge":316.02,"discounted_cash":237.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050870 = Hospital System Supply Identifier | 414053 = Lawson ID"}]},{"description":"PLATE PED TBLR 1/3 N-LOK 10H","code_information":[{"code":"Sx00-1050-341","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050871","type":"LOCAL"},{"code":"414054","type":"LOCAL"}],"standard_charges":[{"gross_charge":360.3,"discounted_cash":270.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050871 = Hospital System Supply Identifier | 414054 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X14","code_information":[{"code":"Sx00-1050-351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050874","type":"LOCAL"},{"code":"414057","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050874 = Hospital System Supply Identifier | 414057 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X12","code_information":[{"code":"Sx00-1050-351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050873","type":"LOCAL"},{"code":"414056","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050873 = Hospital System Supply Identifier | 414056 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X18","code_information":[{"code":"Sx00-1050-351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050833","type":"LOCAL"},{"code":"402529","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050833 = Hospital System Supply Identifier | 402529 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X16","code_information":[{"code":"Sx00-1050-351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050832","type":"LOCAL"},{"code":"402528","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050832 = Hospital System Supply Identifier | 402528 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X10","code_information":[{"code":"Sx00-1050-351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050872","type":"LOCAL"},{"code":"414055","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050872 = Hospital System Supply Identifier | 414055 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X22","code_information":[{"code":"Sx00-1050-352","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050717","type":"LOCAL"},{"code":"399821","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050717 = Hospital System Supply Identifier | 399821 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X24","code_information":[{"code":"Sx00-1050-352","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050718","type":"LOCAL"},{"code":"399822","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050718 = Hospital System Supply Identifier | 399822 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X28","code_information":[{"code":"Sx00-1050-352","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050719","type":"LOCAL"},{"code":"399824","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050719 = Hospital System Supply Identifier | 399824 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X20","code_information":[{"code":"Sx00-1050-352","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"821159","type":"LOCAL"},{"code":"S282457","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 821159 = Hospital System Supply Identifier | S282457 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X26","code_information":[{"code":"Sx00-1050-352","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"821174","type":"LOCAL"},{"code":"S282468","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 821174 = Hospital System Supply Identifier | S282468 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X32","code_information":[{"code":"Sx00-1050-353","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"833237","type":"LOCAL"},{"code":"S392021","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 833237 = Hospital System Supply Identifier | S392021 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X30","code_information":[{"code":"Sx00-1050-353","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"833236","type":"LOCAL"},{"code":"S392020","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 833236 = Hospital System Supply Identifier | S392020 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X34","code_information":[{"code":"Sx00-1050-353","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"833238","type":"LOCAL"},{"code":"S392022","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 833238 = Hospital System Supply Identifier | S392022 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X36","code_information":[{"code":"Sx00-1050-353","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050720","type":"LOCAL"},{"code":"399828","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050720 = Hospital System Supply Identifier | 399828 = Lawson ID"}]},{"description":"SCREW CORT NLOK FT 3.5X38MM","code_information":[{"code":"Sx00-1050-353","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1051020","type":"LOCAL"},{"code":"431449","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1051020 = Hospital System Supply Identifier | 431449 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X48","code_information":[{"code":"Sx00-1050-354","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050721","type":"LOCAL"},{"code":"399829","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050721 = Hospital System Supply Identifier | 399829 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X40","code_information":[{"code":"Sx00-1050-354","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050875","type":"LOCAL"},{"code":"414058","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050875 = Hospital System Supply Identifier | 414058 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X42","code_information":[{"code":"Sx00-1050-354","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050876","type":"LOCAL"},{"code":"414059","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050876 = Hospital System Supply Identifier | 414059 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X44","code_information":[{"code":"Sx00-1050-354","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050877","type":"LOCAL"},{"code":"414060","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050877 = Hospital System Supply Identifier | 414060 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X46","code_information":[{"code":"Sx00-1050-354","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"833239","type":"LOCAL"},{"code":"S392023","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 833239 = Hospital System Supply Identifier | S392023 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X58","code_information":[{"code":"Sx00-1050-355","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050882","type":"LOCAL"},{"code":"414066","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050882 = Hospital System Supply Identifier | 414066 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X54","code_information":[{"code":"Sx00-1050-355","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050880","type":"LOCAL"},{"code":"414064","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050880 = Hospital System Supply Identifier | 414064 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X56","code_information":[{"code":"Sx00-1050-355","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050881","type":"LOCAL"},{"code":"414065","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050881 = Hospital System Supply Identifier | 414065 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X50","code_information":[{"code":"Sx00-1050-355","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050878","type":"LOCAL"},{"code":"414062","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050878 = Hospital System Supply Identifier | 414062 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X52","code_information":[{"code":"Sx00-1050-355","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050879","type":"LOCAL"},{"code":"414063","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050879 = Hospital System Supply Identifier | 414063 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X60","code_information":[{"code":"Sx00-1050-356","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"833240","type":"LOCAL"},{"code":"S392024","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 833240 = Hospital System Supply Identifier | S392024 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X65","code_information":[{"code":"Sx00-1050-356","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"833241","type":"LOCAL"},{"code":"S392025","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 833241 = Hospital System Supply Identifier | S392025 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X70","code_information":[{"code":"Sx00-1050-357","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050883","type":"LOCAL"},{"code":"414069","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050883 = Hospital System Supply Identifier | 414069 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X12MM","code_information":[{"code":"Sx00-1050-361","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050722","type":"LOCAL"},{"code":"399830","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050722 = Hospital System Supply Identifier | 399830 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X16MM","code_information":[{"code":"Sx00-1050-361","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"880906","type":"LOCAL"},{"code":"399831","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 880906 = Hospital System Supply Identifier | 399831 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X18MM","code_information":[{"code":"Sx00-1050-361","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050723","type":"LOCAL"},{"code":"399832","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050723 = Hospital System Supply Identifier | 399832 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X10MM","code_information":[{"code":"Sx00-1050-361","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050884","type":"LOCAL"},{"code":"414070","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050884 = Hospital System Supply Identifier | 414070 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X14MM","code_information":[{"code":"Sx00-1050-361","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050885","type":"LOCAL"},{"code":"414071","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050885 = Hospital System Supply Identifier | 414071 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X28MM","code_information":[{"code":"Sx00-1050-362","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"821181","type":"LOCAL"},{"code":"S282460","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 821181 = Hospital System Supply Identifier | S282460 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X22MM","code_information":[{"code":"Sx00-1050-362","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"821164","type":"LOCAL"},{"code":"S282459","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 821164 = Hospital System Supply Identifier | S282459 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X20MM","code_information":[{"code":"Sx00-1050-362","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050724","type":"LOCAL"},{"code":"399833","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050724 = Hospital System Supply Identifier | 399833 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X24MM","code_information":[{"code":"Sx00-1050-362","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050725","type":"LOCAL"},{"code":"399835","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050725 = Hospital System Supply Identifier | 399835 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X26MM","code_information":[{"code":"Sx00-1050-362","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050726","type":"LOCAL"},{"code":"399836","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050726 = Hospital System Supply Identifier | 399836 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X32MM","code_information":[{"code":"Sx00-1050-363","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050727","type":"LOCAL"},{"code":"399839","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050727 = Hospital System Supply Identifier | 399839 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X34MM","code_information":[{"code":"Sx00-1050-363","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050728","type":"LOCAL"},{"code":"399840","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050728 = Hospital System Supply Identifier | 399840 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X36MM","code_information":[{"code":"Sx00-1050-363","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050729","type":"LOCAL"},{"code":"399841","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050729 = Hospital System Supply Identifier | 399841 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X38MM","code_information":[{"code":"Sx00-1050-363","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050886","type":"LOCAL"},{"code":"414072","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050886 = Hospital System Supply Identifier | 414072 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X30MM","code_information":[{"code":"Sx00-1050-363","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"821186","type":"LOCAL"},{"code":"S282461","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 821186 = Hospital System Supply Identifier | S282461 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X48MM","code_information":[{"code":"Sx00-1050-364","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050734","type":"LOCAL"},{"code":"399846","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050734 = Hospital System Supply Identifier | 399846 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X46MM","code_information":[{"code":"Sx00-1050-364","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050733","type":"LOCAL"},{"code":"399845","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050733 = Hospital System Supply Identifier | 399845 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X44MM","code_information":[{"code":"Sx00-1050-364","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050732","type":"LOCAL"},{"code":"399844","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050732 = Hospital System Supply Identifier | 399844 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X40MM","code_information":[{"code":"Sx00-1050-364","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050730","type":"LOCAL"},{"code":"399842","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050730 = Hospital System Supply Identifier | 399842 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X42MM","code_information":[{"code":"Sx00-1050-364","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050731","type":"LOCAL"},{"code":"399843","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050731 = Hospital System Supply Identifier | 399843 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X52MM","code_information":[{"code":"Sx00-1050-365","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050735","type":"LOCAL"},{"code":"399847","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050735 = Hospital System Supply Identifier | 399847 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X58MM","code_information":[{"code":"Sx00-1050-365","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050736","type":"LOCAL"},{"code":"399848","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050736 = Hospital System Supply Identifier | 399848 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X50MM","code_information":[{"code":"Sx00-1050-365","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050887","type":"LOCAL"},{"code":"414073","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050887 = Hospital System Supply Identifier | 414073 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X56MM","code_information":[{"code":"Sx00-1050-365","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050888","type":"LOCAL"},{"code":"414075","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050888 = Hospital System Supply Identifier | 414075 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X54MM","code_information":[{"code":"Sx00-1050-365","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"833242","type":"LOCAL"},{"code":"S392026","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 833242 = Hospital System Supply Identifier | S392026 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X60MM","code_information":[{"code":"Sx00-1050-366","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050889","type":"LOCAL"},{"code":"414076","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050889 = Hospital System Supply Identifier | 414076 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X65MM","code_information":[{"code":"Sx00-1050-366","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050890","type":"LOCAL"},{"code":"414077","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050890 = Hospital System Supply Identifier | 414077 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X70MM","code_information":[{"code":"Sx00-1050-367","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050891","type":"LOCAL"},{"code":"414078","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050891 = Hospital System Supply Identifier | 414078 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X10","code_information":[{"code":"Sx00-1050-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050892","type":"LOCAL"},{"code":"414079","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050892 = Hospital System Supply Identifier | 414079 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X12","code_information":[{"code":"Sx00-1050-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050893","type":"LOCAL"},{"code":"414080","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050893 = Hospital System Supply Identifier | 414080 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X14","code_information":[{"code":"Sx00-1050-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050894","type":"LOCAL"},{"code":"414081","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050894 = Hospital System Supply Identifier | 414081 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X16","code_information":[{"code":"Sx00-1050-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050895","type":"LOCAL"},{"code":"414082","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050895 = Hospital System Supply Identifier | 414082 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X18","code_information":[{"code":"Sx00-1050-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050896","type":"LOCAL"},{"code":"414083","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050896 = Hospital System Supply Identifier | 414083 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X20","code_information":[{"code":"Sx00-1050-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050897","type":"LOCAL"},{"code":"414084","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050897 = Hospital System Supply Identifier | 414084 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X22","code_information":[{"code":"Sx00-1050-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050898","type":"LOCAL"},{"code":"414085","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050898 = Hospital System Supply Identifier | 414085 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X24","code_information":[{"code":"Sx00-1050-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050899","type":"LOCAL"},{"code":"414086","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050899 = Hospital System Supply Identifier | 414086 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X26","code_information":[{"code":"Sx00-1050-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050900","type":"LOCAL"},{"code":"414087","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050900 = Hospital System Supply Identifier | 414087 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X28","code_information":[{"code":"Sx00-1050-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050901","type":"LOCAL"},{"code":"414088","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050901 = Hospital System Supply Identifier | 414088 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X38","code_information":[{"code":"Sx00-1050-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050906","type":"LOCAL"},{"code":"414093","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050906 = Hospital System Supply Identifier | 414093 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X36","code_information":[{"code":"Sx00-1050-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050905","type":"LOCAL"},{"code":"414092","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050905 = Hospital System Supply Identifier | 414092 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X30","code_information":[{"code":"Sx00-1050-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050902","type":"LOCAL"},{"code":"414089","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050902 = Hospital System Supply Identifier | 414089 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X32","code_information":[{"code":"Sx00-1050-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050903","type":"LOCAL"},{"code":"414090","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050903 = Hospital System Supply Identifier | 414090 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X34","code_information":[{"code":"Sx00-1050-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050904","type":"LOCAL"},{"code":"414091","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050904 = Hospital System Supply Identifier | 414091 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X40","code_information":[{"code":"Sx00-1050-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050907","type":"LOCAL"},{"code":"414094","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050907 = Hospital System Supply Identifier | 414094 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X42","code_information":[{"code":"Sx00-1050-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050908","type":"LOCAL"},{"code":"414095","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050908 = Hospital System Supply Identifier | 414095 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X44","code_information":[{"code":"Sx00-1050-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050909","type":"LOCAL"},{"code":"414096","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050909 = Hospital System Supply Identifier | 414096 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X46","code_information":[{"code":"Sx00-1050-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050910","type":"LOCAL"},{"code":"414097","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050910 = Hospital System Supply Identifier | 414097 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X48","code_information":[{"code":"Sx00-1050-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050911","type":"LOCAL"},{"code":"414098","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050911 = Hospital System Supply Identifier | 414098 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X58","code_information":[{"code":"Sx00-1050-405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050916","type":"LOCAL"},{"code":"414103","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050916 = Hospital System Supply Identifier | 414103 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X56","code_information":[{"code":"Sx00-1050-405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050915","type":"LOCAL"},{"code":"414102","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050915 = Hospital System Supply Identifier | 414102 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X52","code_information":[{"code":"Sx00-1050-405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050913","type":"LOCAL"},{"code":"414100","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050913 = Hospital System Supply Identifier | 414100 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X50","code_information":[{"code":"Sx00-1050-405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050912","type":"LOCAL"},{"code":"414099","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050912 = Hospital System Supply Identifier | 414099 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X54","code_information":[{"code":"Sx00-1050-405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050914","type":"LOCAL"},{"code":"414101","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050914 = Hospital System Supply Identifier | 414101 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X60","code_information":[{"code":"Sx00-1050-406","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050917","type":"LOCAL"},{"code":"414104","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050917 = Hospital System Supply Identifier | 414104 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X10","code_information":[{"code":"Sx00-1050-411","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050918","type":"LOCAL"},{"code":"414105","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050918 = Hospital System Supply Identifier | 414105 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X12","code_information":[{"code":"Sx00-1050-411","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050919","type":"LOCAL"},{"code":"414106","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050919 = Hospital System Supply Identifier | 414106 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X14","code_information":[{"code":"Sx00-1050-411","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050920","type":"LOCAL"},{"code":"414107","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050920 = Hospital System Supply Identifier | 414107 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X16","code_information":[{"code":"Sx00-1050-411","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050921","type":"LOCAL"},{"code":"414108","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050921 = Hospital System Supply Identifier | 414108 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X18","code_information":[{"code":"Sx00-1050-411","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050922","type":"LOCAL"},{"code":"414109","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050922 = Hospital System Supply Identifier | 414109 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X22","code_information":[{"code":"Sx00-1050-412","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050924","type":"LOCAL"},{"code":"414111","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050924 = Hospital System Supply Identifier | 414111 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X28","code_information":[{"code":"Sx00-1050-412","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050927","type":"LOCAL"},{"code":"414114","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050927 = Hospital System Supply Identifier | 414114 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X26","code_information":[{"code":"Sx00-1050-412","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050926","type":"LOCAL"},{"code":"414113","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050926 = Hospital System Supply Identifier | 414113 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X20","code_information":[{"code":"Sx00-1050-412","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050923","type":"LOCAL"},{"code":"414110","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050923 = Hospital System Supply Identifier | 414110 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X24","code_information":[{"code":"Sx00-1050-412","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050925","type":"LOCAL"},{"code":"414112","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050925 = Hospital System Supply Identifier | 414112 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X36","code_information":[{"code":"Sx00-1050-413","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050931","type":"LOCAL"},{"code":"414118","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050931 = Hospital System Supply Identifier | 414118 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X30","code_information":[{"code":"Sx00-1050-413","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050928","type":"LOCAL"},{"code":"414115","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050928 = Hospital System Supply Identifier | 414115 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X32","code_information":[{"code":"Sx00-1050-413","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050929","type":"LOCAL"},{"code":"414116","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050929 = Hospital System Supply Identifier | 414116 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X34","code_information":[{"code":"Sx00-1050-413","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050930","type":"LOCAL"},{"code":"414117","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050930 = Hospital System Supply Identifier | 414117 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X38","code_information":[{"code":"Sx00-1050-413","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050932","type":"LOCAL"},{"code":"414119","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050932 = Hospital System Supply Identifier | 414119 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X48","code_information":[{"code":"Sx00-1050-414","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050937","type":"LOCAL"},{"code":"414124","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050937 = Hospital System Supply Identifier | 414124 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X46","code_information":[{"code":"Sx00-1050-414","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050936","type":"LOCAL"},{"code":"414123","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050936 = Hospital System Supply Identifier | 414123 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X40","code_information":[{"code":"Sx00-1050-414","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050933","type":"LOCAL"},{"code":"414120","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050933 = Hospital System Supply Identifier | 414120 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X42","code_information":[{"code":"Sx00-1050-414","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050934","type":"LOCAL"},{"code":"414121","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050934 = Hospital System Supply Identifier | 414121 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X44","code_information":[{"code":"Sx00-1050-414","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050935","type":"LOCAL"},{"code":"414122","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050935 = Hospital System Supply Identifier | 414122 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X50","code_information":[{"code":"Sx00-1050-415","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050938","type":"LOCAL"},{"code":"414125","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050938 = Hospital System Supply Identifier | 414125 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X52","code_information":[{"code":"Sx00-1050-415","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050939","type":"LOCAL"},{"code":"414126","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050939 = Hospital System Supply Identifier | 414126 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X54","code_information":[{"code":"Sx00-1050-415","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050940","type":"LOCAL"},{"code":"414127","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050940 = Hospital System Supply Identifier | 414127 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X56","code_information":[{"code":"Sx00-1050-415","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050941","type":"LOCAL"},{"code":"414128","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050941 = Hospital System Supply Identifier | 414128 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X58","code_information":[{"code":"Sx00-1050-415","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050942","type":"LOCAL"},{"code":"414129","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050942 = Hospital System Supply Identifier | 414129 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X60","code_information":[{"code":"Sx00-1050-416","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050943","type":"LOCAL"},{"code":"414130","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050943 = Hospital System Supply Identifier | 414130 = Lawson ID"}]},{"description":"PLATE PEDI COMP FEM 4.5MM 6H","code_information":[{"code":"Sx00-1050-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050842","type":"LOCAL"},{"code":"410084","type":"LOCAL"}],"standard_charges":[{"gross_charge":11074.78,"discounted_cash":8306.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050842 = Hospital System Supply Identifier | 410084 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.52 8H RT","code_information":[{"code":"Sx00-1050-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050944","type":"LOCAL"},{"code":"414131","type":"LOCAL"}],"standard_charges":[{"gross_charge":11074.78,"discounted_cash":8306.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050944 = Hospital System Supply Identifier | 414131 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5 18H RT","code_information":[{"code":"Sx00-1050-421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050949","type":"LOCAL"},{"code":"414136","type":"LOCAL"}],"standard_charges":[{"gross_charge":12493.65,"discounted_cash":9370.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050949 = Hospital System Supply Identifier | 414136 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5 16H RT","code_information":[{"code":"Sx00-1050-421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050948","type":"LOCAL"},{"code":"414135","type":"LOCAL"}],"standard_charges":[{"gross_charge":11560.43,"discounted_cash":8670.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050948 = Hospital System Supply Identifier | 414135 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5 10H RT","code_information":[{"code":"Sx00-1050-421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050945","type":"LOCAL"},{"code":"414132","type":"LOCAL"}],"standard_charges":[{"gross_charge":11074.78,"discounted_cash":8306.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050945 = Hospital System Supply Identifier | 414132 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5 12H RT","code_information":[{"code":"Sx00-1050-421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050946","type":"LOCAL"},{"code":"414133","type":"LOCAL"}],"standard_charges":[{"gross_charge":11074.78,"discounted_cash":8306.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050946 = Hospital System Supply Identifier | 414133 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5 14H RT","code_information":[{"code":"Sx00-1050-421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050947","type":"LOCAL"},{"code":"414134","type":"LOCAL"}],"standard_charges":[{"gross_charge":11325.54,"discounted_cash":8494.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050947 = Hospital System Supply Identifier | 414134 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5 20H RT","code_information":[{"code":"Sx00-1050-422","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050950","type":"LOCAL"},{"code":"414137","type":"LOCAL"}],"standard_charges":[{"gross_charge":13017.39,"discounted_cash":9763.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050950 = Hospital System Supply Identifier | 414137 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5 8H LT","code_information":[{"code":"Sx00-1050-430","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050952","type":"LOCAL"},{"code":"414139","type":"LOCAL"}],"standard_charges":[{"gross_charge":11074.78,"discounted_cash":8306.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050952 = Hospital System Supply Identifier | 414139 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5 6H LT","code_information":[{"code":"Sx00-1050-430","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050951","type":"LOCAL"},{"code":"414138","type":"LOCAL"}],"standard_charges":[{"gross_charge":11074.78,"discounted_cash":8306.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050951 = Hospital System Supply Identifier | 414138 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5 18H LT","code_information":[{"code":"Sx00-1050-431","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050955","type":"LOCAL"},{"code":"414142","type":"LOCAL"}],"standard_charges":[{"gross_charge":12493.65,"discounted_cash":9370.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050955 = Hospital System Supply Identifier | 414142 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5 12H LT","code_information":[{"code":"Sx00-1050-431","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050954","type":"LOCAL"},{"code":"414141","type":"LOCAL"}],"standard_charges":[{"gross_charge":11074.78,"discounted_cash":8306.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050954 = Hospital System Supply Identifier | 414141 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5 10H LT","code_information":[{"code":"Sx00-1050-431","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050953","type":"LOCAL"},{"code":"414140","type":"LOCAL"}],"standard_charges":[{"gross_charge":11074.78,"discounted_cash":8306.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050953 = Hospital System Supply Identifier | 414140 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5MM 14H","code_information":[{"code":"Sx00-1050-431","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050843","type":"LOCAL"},{"code":"410085","type":"LOCAL"}],"standard_charges":[{"gross_charge":11325.54,"discounted_cash":8494.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050843 = Hospital System Supply Identifier | 410085 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5MM 16H","code_information":[{"code":"Sx00-1050-431","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050844","type":"LOCAL"},{"code":"410086","type":"LOCAL"}],"standard_charges":[{"gross_charge":11560.43,"discounted_cash":8670.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050844 = Hospital System Supply Identifier | 410086 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5 20H LT","code_information":[{"code":"Sx00-1050-432","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050956","type":"LOCAL"},{"code":"414143","type":"LOCAL"}],"standard_charges":[{"gross_charge":13017.39,"discounted_cash":9763.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050956 = Hospital System Supply Identifier | 414143 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5MM 10H","code_information":[{"code":"Sx00-1050-441","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050845","type":"LOCAL"},{"code":"410087","type":"LOCAL"}],"standard_charges":[{"gross_charge":6223.74,"discounted_cash":4667.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050845 = Hospital System Supply Identifier | 410087 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5MM 12H","code_information":[{"code":"Sx00-1050-441","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050957","type":"LOCAL"},{"code":"414144","type":"LOCAL"}],"standard_charges":[{"gross_charge":6458.9,"discounted_cash":4844.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050957 = Hospital System Supply Identifier | 414144 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5MM 14H","code_information":[{"code":"Sx00-1050-441","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050958","type":"LOCAL"},{"code":"414145","type":"LOCAL"}],"standard_charges":[{"gross_charge":6801.14,"discounted_cash":5100.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050958 = Hospital System Supply Identifier | 414145 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5MM 16H","code_information":[{"code":"Sx00-1050-441","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050959","type":"LOCAL"},{"code":"414146","type":"LOCAL"}],"standard_charges":[{"gross_charge":7998.32,"discounted_cash":5998.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050959 = Hospital System Supply Identifier | 414146 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5MM 18H","code_information":[{"code":"Sx00-1050-441","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050960","type":"LOCAL"},{"code":"414147","type":"LOCAL"}],"standard_charges":[{"gross_charge":8320.67,"discounted_cash":6240.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050960 = Hospital System Supply Identifier | 414147 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X18","code_information":[{"code":"Sx00-1050-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050965","type":"LOCAL"},{"code":"414152","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.25,"discounted_cash":82.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050965 = Hospital System Supply Identifier | 414152 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X16","code_information":[{"code":"Sx00-1050-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050964","type":"LOCAL"},{"code":"414151","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.25,"discounted_cash":82.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050964 = Hospital System Supply Identifier | 414151 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X12","code_information":[{"code":"Sx00-1050-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050962","type":"LOCAL"},{"code":"414149","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.25,"discounted_cash":82.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050962 = Hospital System Supply Identifier | 414149 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X10","code_information":[{"code":"Sx00-1050-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050961","type":"LOCAL"},{"code":"414148","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.25,"discounted_cash":82.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050961 = Hospital System Supply Identifier | 414148 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X14","code_information":[{"code":"Sx00-1050-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050963","type":"LOCAL"},{"code":"414150","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.25,"discounted_cash":82.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050963 = Hospital System Supply Identifier | 414150 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X22","code_information":[{"code":"Sx00-1050-452","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050737","type":"LOCAL"},{"code":"399849","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.25,"discounted_cash":82.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050737 = Hospital System Supply Identifier | 399849 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X26","code_information":[{"code":"Sx00-1050-452","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050738","type":"LOCAL"},{"code":"399850","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.25,"discounted_cash":82.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050738 = Hospital System Supply Identifier | 399850 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X20","code_information":[{"code":"Sx00-1050-452","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050966","type":"LOCAL"},{"code":"414153","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.25,"discounted_cash":82.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050966 = Hospital System Supply Identifier | 414153 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X24","code_information":[{"code":"Sx00-1050-452","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050967","type":"LOCAL"},{"code":"414154","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.25,"discounted_cash":82.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050967 = Hospital System Supply Identifier | 414154 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X28","code_information":[{"code":"Sx00-1050-452","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050968","type":"LOCAL"},{"code":"414155","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.25,"discounted_cash":82.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050968 = Hospital System Supply Identifier | 414155 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X38","code_information":[{"code":"Sx00-1050-453","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050972","type":"LOCAL"},{"code":"414159","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.25,"discounted_cash":82.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050972 = Hospital System Supply Identifier | 414159 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X36","code_information":[{"code":"Sx00-1050-453","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050971","type":"LOCAL"},{"code":"414158","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.25,"discounted_cash":82.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050971 = Hospital System Supply Identifier | 414158 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X34","code_information":[{"code":"Sx00-1050-453","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050970","type":"LOCAL"},{"code":"414157","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.25,"discounted_cash":82.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050970 = Hospital System Supply Identifier | 414157 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X32","code_information":[{"code":"Sx00-1050-453","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050739","type":"LOCAL"},{"code":"399851","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.25,"discounted_cash":82.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050739 = Hospital System Supply Identifier | 399851 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X30","code_information":[{"code":"Sx00-1050-453","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050969","type":"LOCAL"},{"code":"414156","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.25,"discounted_cash":82.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050969 = Hospital System Supply Identifier | 414156 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X42","code_information":[{"code":"Sx00-1050-454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050740","type":"LOCAL"},{"code":"399852","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.25,"discounted_cash":82.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050740 = Hospital System Supply Identifier | 399852 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X44","code_information":[{"code":"Sx00-1050-454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050741","type":"LOCAL"},{"code":"399853","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.25,"discounted_cash":82.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050741 = Hospital System Supply Identifier | 399853 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X48","code_information":[{"code":"Sx00-1050-454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050742","type":"LOCAL"},{"code":"399854","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.25,"discounted_cash":82.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050742 = Hospital System Supply Identifier | 399854 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X40","code_information":[{"code":"Sx00-1050-454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050973","type":"LOCAL"},{"code":"414160","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.25,"discounted_cash":82.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050973 = Hospital System Supply Identifier | 414160 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X46","code_information":[{"code":"Sx00-1050-454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050974","type":"LOCAL"},{"code":"414161","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.25,"discounted_cash":82.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050974 = Hospital System Supply Identifier | 414161 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X50","code_information":[{"code":"Sx00-1050-455","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050975","type":"LOCAL"},{"code":"414162","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.25,"discounted_cash":82.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050975 = Hospital System Supply Identifier | 414162 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X58","code_information":[{"code":"Sx00-1050-455","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050977","type":"LOCAL"},{"code":"414164","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.25,"discounted_cash":82.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050977 = Hospital System Supply Identifier | 414164 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X52","code_information":[{"code":"Sx00-1050-455","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050743","type":"LOCAL"},{"code":"399855","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.25,"discounted_cash":82.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050743 = Hospital System Supply Identifier | 399855 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X54","code_information":[{"code":"Sx00-1050-455","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050744","type":"LOCAL"},{"code":"399856","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.25,"discounted_cash":82.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050744 = Hospital System Supply Identifier | 399856 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X56","code_information":[{"code":"Sx00-1050-455","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050976","type":"LOCAL"},{"code":"414163","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.25,"discounted_cash":82.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050976 = Hospital System Supply Identifier | 414163 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X60","code_information":[{"code":"Sx00-1050-456","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050745","type":"LOCAL"},{"code":"399857","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.25,"discounted_cash":82.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050745 = Hospital System Supply Identifier | 399857 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X65","code_information":[{"code":"Sx00-1050-456","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050978","type":"LOCAL"},{"code":"414165","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.25,"discounted_cash":82.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050978 = Hospital System Supply Identifier | 414165 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X70","code_information":[{"code":"Sx00-1050-457","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050746","type":"LOCAL"},{"code":"399858","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.25,"discounted_cash":82.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050746 = Hospital System Supply Identifier | 399858 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X75","code_information":[{"code":"Sx00-1050-457","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050747","type":"LOCAL"},{"code":"399859","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.25,"discounted_cash":82.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050747 = Hospital System Supply Identifier | 399859 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X80","code_information":[{"code":"Sx00-1050-458","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050979","type":"LOCAL"},{"code":"414166","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.25,"discounted_cash":82.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050979 = Hospital System Supply Identifier | 414166 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X85","code_information":[{"code":"Sx00-1050-458","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050980","type":"LOCAL"},{"code":"414167","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.25,"discounted_cash":82.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050980 = Hospital System Supply Identifier | 414167 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X90","code_information":[{"code":"Sx00-1050-459","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050981","type":"LOCAL"},{"code":"414168","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.25,"discounted_cash":82.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050981 = Hospital System Supply Identifier | 414168 = Lawson ID"}]},{"description":"SCREW PED CORT LOK F/T 4.5X16","code_information":[{"code":"Sx00-1050-461","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050985","type":"LOCAL"},{"code":"414172","type":"LOCAL"}],"standard_charges":[{"gross_charge":901.63,"discounted_cash":676.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050985 = Hospital System Supply Identifier | 414172 = Lawson ID"}]},{"description":"SCREW PED CORT LOK F/T 4.5X18","code_information":[{"code":"Sx00-1050-461","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050986","type":"LOCAL"},{"code":"414173","type":"LOCAL"}],"standard_charges":[{"gross_charge":901.63,"discounted_cash":676.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050986 = Hospital System Supply Identifier | 414173 = Lawson ID"}]},{"description":"SCREW PED CORT LOK F/T 4.5X12","code_information":[{"code":"Sx00-1050-461","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050983","type":"LOCAL"},{"code":"414170","type":"LOCAL"}],"standard_charges":[{"gross_charge":901.63,"discounted_cash":676.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050983 = Hospital System Supply Identifier | 414170 = Lawson ID"}]},{"description":"SCREW PED CORT LOK F/T 4.5X10","code_information":[{"code":"Sx00-1050-461","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050982","type":"LOCAL"},{"code":"414169","type":"LOCAL"}],"standard_charges":[{"gross_charge":901.63,"discounted_cash":676.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050982 = Hospital System Supply Identifier | 414169 = Lawson ID"}]},{"description":"SCREW PED CORT LOK F/T 4.5X14","code_information":[{"code":"Sx00-1050-461","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050984","type":"LOCAL"},{"code":"414171","type":"LOCAL"}],"standard_charges":[{"gross_charge":901.63,"discounted_cash":676.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050984 = Hospital System Supply Identifier | 414171 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 4.5X26MM","code_information":[{"code":"Sx00-1050-462","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050748","type":"LOCAL"},{"code":"399860","type":"LOCAL"}],"standard_charges":[{"gross_charge":901.63,"discounted_cash":676.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050748 = Hospital System Supply Identifier | 399860 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 4.5X28MM","code_information":[{"code":"Sx00-1050-462","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050749","type":"LOCAL"},{"code":"399861","type":"LOCAL"}],"standard_charges":[{"gross_charge":901.63,"discounted_cash":676.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050749 = Hospital System Supply Identifier | 399861 = Lawson ID"}]},{"description":"SCREW PED CORT LOK F/T 4.5X20","code_information":[{"code":"Sx00-1050-462","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050987","type":"LOCAL"},{"code":"414174","type":"LOCAL"}],"standard_charges":[{"gross_charge":901.63,"discounted_cash":676.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050987 = Hospital System Supply Identifier | 414174 = Lawson ID"}]},{"description":"SCREW PED CORT LOK F/T 4.5X22","code_information":[{"code":"Sx00-1050-462","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050988","type":"LOCAL"},{"code":"414175","type":"LOCAL"}],"standard_charges":[{"gross_charge":901.63,"discounted_cash":676.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050988 = Hospital System Supply Identifier | 414175 = Lawson ID"}]},{"description":"SCREW PED CORT LOK F/T 4.5X24","code_information":[{"code":"Sx00-1050-462","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050989","type":"LOCAL"},{"code":"414176","type":"LOCAL"}],"standard_charges":[{"gross_charge":901.63,"discounted_cash":676.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050989 = Hospital System Supply Identifier | 414176 = Lawson ID"}]},{"description":"SCREW PED CORT LOK F/T 4.5X36","code_information":[{"code":"Sx00-1050-463","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050990","type":"LOCAL"},{"code":"414177","type":"LOCAL"}],"standard_charges":[{"gross_charge":901.63,"discounted_cash":676.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050990 = Hospital System Supply Identifier | 414177 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 4.5X38MM","code_information":[{"code":"Sx00-1050-463","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050753","type":"LOCAL"},{"code":"399865","type":"LOCAL"}],"standard_charges":[{"gross_charge":901.63,"discounted_cash":676.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050753 = Hospital System Supply Identifier | 399865 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 4.5X34MM","code_information":[{"code":"Sx00-1050-463","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050752","type":"LOCAL"},{"code":"399864","type":"LOCAL"}],"standard_charges":[{"gross_charge":901.63,"discounted_cash":676.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050752 = Hospital System Supply Identifier | 399864 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 4.5X30MM","code_information":[{"code":"Sx00-1050-463","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050750","type":"LOCAL"},{"code":"399862","type":"LOCAL"}],"standard_charges":[{"gross_charge":901.63,"discounted_cash":676.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050750 = Hospital System Supply Identifier | 399862 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 4.5X32MM","code_information":[{"code":"Sx00-1050-463","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050751","type":"LOCAL"},{"code":"399863","type":"LOCAL"}],"standard_charges":[{"gross_charge":901.63,"discounted_cash":676.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050751 = Hospital System Supply Identifier | 399863 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 4.5X42MM","code_information":[{"code":"Sx00-1050-464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050754","type":"LOCAL"},{"code":"399866","type":"LOCAL"}],"standard_charges":[{"gross_charge":901.63,"discounted_cash":676.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050754 = Hospital System Supply Identifier | 399866 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 4.5X44MM","code_information":[{"code":"Sx00-1050-464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050755","type":"LOCAL"},{"code":"399867","type":"LOCAL"}],"standard_charges":[{"gross_charge":901.63,"discounted_cash":676.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050755 = Hospital System Supply Identifier | 399867 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 4.5X46MM","code_information":[{"code":"Sx00-1050-464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050756","type":"LOCAL"},{"code":"399868","type":"LOCAL"}],"standard_charges":[{"gross_charge":901.63,"discounted_cash":676.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050756 = Hospital System Supply Identifier | 399868 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 4.5X48MM","code_information":[{"code":"Sx00-1050-464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050757","type":"LOCAL"},{"code":"399869","type":"LOCAL"}],"standard_charges":[{"gross_charge":901.63,"discounted_cash":676.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050757 = Hospital System Supply Identifier | 399869 = Lawson ID"}]},{"description":"SCREW PED CORT LOK F/T 4.5X40","code_information":[{"code":"Sx00-1050-464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050991","type":"LOCAL"},{"code":"414178","type":"LOCAL"}],"standard_charges":[{"gross_charge":901.63,"discounted_cash":676.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050991 = Hospital System Supply Identifier | 414178 = Lawson ID"}]},{"description":"SCREW PED CORT LOK F/T 4.5X54","code_information":[{"code":"Sx00-1050-465","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050993","type":"LOCAL"},{"code":"414180","type":"LOCAL"}],"standard_charges":[{"gross_charge":901.63,"discounted_cash":676.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050993 = Hospital System Supply Identifier | 414180 = Lawson ID"}]},{"description":"SCREW PED CORT LOK F/T 4.5X50","code_information":[{"code":"Sx00-1050-465","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050992","type":"LOCAL"},{"code":"414179","type":"LOCAL"}],"standard_charges":[{"gross_charge":901.63,"discounted_cash":676.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050992 = Hospital System Supply Identifier | 414179 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 4.5X52MM","code_information":[{"code":"Sx00-1050-465","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050758","type":"LOCAL"},{"code":"399870","type":"LOCAL"}],"standard_charges":[{"gross_charge":901.63,"discounted_cash":676.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050758 = Hospital System Supply Identifier | 399870 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 4.5X56MM","code_information":[{"code":"Sx00-1050-465","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050759","type":"LOCAL"},{"code":"399871","type":"LOCAL"}],"standard_charges":[{"gross_charge":901.63,"discounted_cash":676.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050759 = Hospital System Supply Identifier | 399871 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 4.5X58MM","code_information":[{"code":"Sx00-1050-465","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050760","type":"LOCAL"},{"code":"399872","type":"LOCAL"}],"standard_charges":[{"gross_charge":901.63,"discounted_cash":676.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050760 = Hospital System Supply Identifier | 399872 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 4.5X60MM","code_information":[{"code":"Sx00-1050-466","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050761","type":"LOCAL"},{"code":"399873","type":"LOCAL"}],"standard_charges":[{"gross_charge":901.63,"discounted_cash":676.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050761 = Hospital System Supply Identifier | 399873 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 4.5X65MM","code_information":[{"code":"Sx00-1050-466","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050762","type":"LOCAL"},{"code":"399874","type":"LOCAL"}],"standard_charges":[{"gross_charge":901.63,"discounted_cash":676.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050762 = Hospital System Supply Identifier | 399874 = Lawson ID"}]},{"description":"SCREW PED CORT LOK F/T 4.5X70","code_information":[{"code":"Sx00-1050-467","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050994","type":"LOCAL"},{"code":"414181","type":"LOCAL"}],"standard_charges":[{"gross_charge":901.63,"discounted_cash":676.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050994 = Hospital System Supply Identifier | 414181 = Lawson ID"}]},{"description":"SCREW PED CORT LOK F/T 4.5X75","code_information":[{"code":"Sx00-1050-467","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050995","type":"LOCAL"},{"code":"414182","type":"LOCAL"}],"standard_charges":[{"gross_charge":901.63,"discounted_cash":676.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050995 = Hospital System Supply Identifier | 414182 = Lawson ID"}]},{"description":"SCREW PED CORT LOK F/T 4.5X80","code_information":[{"code":"Sx00-1050-468","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050996","type":"LOCAL"},{"code":"414183","type":"LOCAL"}],"standard_charges":[{"gross_charge":901.63,"discounted_cash":676.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050996 = Hospital System Supply Identifier | 414183 = Lawson ID"}]},{"description":"SCREW PED CORT LOK F/T 4.5X85","code_information":[{"code":"Sx00-1050-468","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050997","type":"LOCAL"},{"code":"414184","type":"LOCAL"}],"standard_charges":[{"gross_charge":901.63,"discounted_cash":676.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050997 = Hospital System Supply Identifier | 414184 = Lawson ID"}]},{"description":"SCREW PED CORT LOK F/T 4.5X90","code_information":[{"code":"Sx00-1050-469","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050998","type":"LOCAL"},{"code":"414185","type":"LOCAL"}],"standard_charges":[{"gross_charge":901.63,"discounted_cash":676.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1050998 = Hospital System Supply Identifier | 414185 = Lawson ID"}]},{"description":"PLATE DFOS 90D 3.5 5D N/OFF 6H","code_information":[{"code":"Sx00-1050-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054386","type":"LOCAL"},{"code":"876836","type":"LOCAL"}],"standard_charges":[{"gross_charge":9214.0,"discounted_cash":6910.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054386 = Hospital System Supply Identifier | 876836 = Lawson ID"}]},{"description":"PLATE DFOS 90D 3.5 5D N/OFF 4H","code_information":[{"code":"Sx00-1050-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054385","type":"LOCAL"},{"code":"876835","type":"LOCAL"}],"standard_charges":[{"gross_charge":9214.0,"discounted_cash":6910.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054385 = Hospital System Supply Identifier | 876835 = Lawson ID"}]},{"description":"PLATE DFOS 90D 3.5 18D 4OFF 4H","code_information":[{"code":"Sx00-1050-510","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054387","type":"LOCAL"},{"code":"876837","type":"LOCAL"}],"standard_charges":[{"gross_charge":9214.0,"discounted_cash":6910.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054387 = Hospital System Supply Identifier | 876837 = Lawson ID"}]},{"description":"PLATE DFOS 90D 3.5 18D 4OFF 6H","code_information":[{"code":"Sx00-1050-510","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054388","type":"LOCAL"},{"code":"876838","type":"LOCAL"}],"standard_charges":[{"gross_charge":9214.0,"discounted_cash":6910.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054388 = Hospital System Supply Identifier | 876838 = Lawson ID"}]},{"description":"PLATE DFOS 90D 3.5 18D 8OFF 4H","code_information":[{"code":"Sx00-1050-520","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054389","type":"LOCAL"},{"code":"876839","type":"LOCAL"}],"standard_charges":[{"gross_charge":9214.0,"discounted_cash":6910.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054389 = Hospital System Supply Identifier | 876839 = Lawson ID"}]},{"description":"PLATE DFOS 90D 3.5 18D 8OFF 6H","code_information":[{"code":"Sx00-1050-520","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054390","type":"LOCAL"},{"code":"876840","type":"LOCAL"}],"standard_charges":[{"gross_charge":9214.0,"discounted_cash":6910.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054390 = Hospital System Supply Identifier | 876840 = Lawson ID"}]},{"description":"PLATE DFOS 90D 4.5 5D N/OFF 4H","code_information":[{"code":"Sx00-1050-600","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054391","type":"LOCAL"},{"code":"876841","type":"LOCAL"}],"standard_charges":[{"gross_charge":11298.0,"discounted_cash":8473.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054391 = Hospital System Supply Identifier | 876841 = Lawson ID"}]},{"description":"PLATE DFOS 90D 4.5 5D N/OFF 6H","code_information":[{"code":"Sx00-1050-600","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054392","type":"LOCAL"},{"code":"876842","type":"LOCAL"}],"standard_charges":[{"gross_charge":11298.0,"discounted_cash":8473.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054392 = Hospital System Supply Identifier | 876842 = Lawson ID"}]},{"description":"PLATE DFOS 90D 4.5 18D 4OFF 4H","code_information":[{"code":"Sx00-1050-610","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054393","type":"LOCAL"},{"code":"876843","type":"LOCAL"}],"standard_charges":[{"gross_charge":11298.0,"discounted_cash":8473.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054393 = Hospital System Supply Identifier | 876843 = Lawson ID"}]},{"description":"PLATE DFOS 90D 4.5 18D 4OFF 6H","code_information":[{"code":"Sx00-1050-610","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054394","type":"LOCAL"},{"code":"876844","type":"LOCAL"}],"standard_charges":[{"gross_charge":11298.0,"discounted_cash":8473.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054394 = Hospital System Supply Identifier | 876844 = Lawson ID"}]},{"description":"PLATE DFOS 90D 4.5 18D 8OFF 6H","code_information":[{"code":"Sx00-1050-620","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054395","type":"LOCAL"},{"code":"876845","type":"LOCAL"}],"standard_charges":[{"gross_charge":11298.0,"discounted_cash":8473.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054395 = Hospital System Supply Identifier | 876845 = Lawson ID"}]},{"description":"PLATE BONE 4.5MM 90D DFOS 18D","code_information":[{"code":"Sx00-1050-620","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"971153","type":"LOCAL"},{"code":"841865","type":"LOCAL"}],"standard_charges":[{"gross_charge":11298.0,"discounted_cash":8473.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 971153 = Hospital System Supply Identifier | 841865 = Lawson ID"}]},{"description":"PLATE DFOS 80D 3.5 5D N/OFF 4H","code_information":[{"code":"Sx00-1050-700","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054396","type":"LOCAL"},{"code":"876846","type":"LOCAL"}],"standard_charges":[{"gross_charge":9214.0,"discounted_cash":6910.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054396 = Hospital System Supply Identifier | 876846 = Lawson ID"}]},{"description":"PLATE DFOS 80D 3.5 5D N/OFF 6H","code_information":[{"code":"Sx00-1050-700","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054397","type":"LOCAL"},{"code":"876847","type":"LOCAL"}],"standard_charges":[{"gross_charge":9214.0,"discounted_cash":6910.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054397 = Hospital System Supply Identifier | 876847 = Lawson ID"}]},{"description":"PLATE DFOS 80D 4.5 5D N/OFF 4H","code_information":[{"code":"Sx00-1050-800","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054398","type":"LOCAL"},{"code":"876848","type":"LOCAL"}],"standard_charges":[{"gross_charge":11298.0,"discounted_cash":8473.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054398 = Hospital System Supply Identifier | 876848 = Lawson ID"}]},{"description":"PLATE DFOS 80D 4.5 5D N/OFF 6H","code_information":[{"code":"Sx00-1050-800","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054399","type":"LOCAL"},{"code":"876849","type":"LOCAL"}],"standard_charges":[{"gross_charge":11298.0,"discounted_cash":8473.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054399 = Hospital System Supply Identifier | 876849 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 3.5 R SZ4","code_information":[{"code":"Sx00-1065-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054400","type":"LOCAL"},{"code":"876850","type":"LOCAL"}],"standard_charges":[{"gross_charge":7789.53,"discounted_cash":5842.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054400 = Hospital System Supply Identifier | 876850 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 3.5 R SZ6","code_information":[{"code":"Sx00-1065-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054401","type":"LOCAL"},{"code":"876851","type":"LOCAL"}],"standard_charges":[{"gross_charge":7978.03,"discounted_cash":5983.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054401 = Hospital System Supply Identifier | 876851 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 3.5 R SZ8","code_information":[{"code":"Sx00-1065-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054402","type":"LOCAL"},{"code":"876852","type":"LOCAL"}],"standard_charges":[{"gross_charge":8134.06,"discounted_cash":6100.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054402 = Hospital System Supply Identifier | 876852 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 3.5 R SZ14","code_information":[{"code":"Sx00-1065-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054405","type":"LOCAL"},{"code":"876855","type":"LOCAL"}],"standard_charges":[{"gross_charge":8697.47,"discounted_cash":6523.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054405 = Hospital System Supply Identifier | 876855 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 3.5 R SZ16","code_information":[{"code":"Sx00-1065-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054406","type":"LOCAL"},{"code":"876856","type":"LOCAL"}],"standard_charges":[{"gross_charge":10137.96,"discounted_cash":7603.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054406 = Hospital System Supply Identifier | 876856 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 3.5 R SZ12","code_information":[{"code":"Sx00-1065-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054404","type":"LOCAL"},{"code":"876854","type":"LOCAL"}],"standard_charges":[{"gross_charge":8509.67,"discounted_cash":6382.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054404 = Hospital System Supply Identifier | 876854 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 3.5 R SZ10","code_information":[{"code":"Sx00-1065-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054403","type":"LOCAL"},{"code":"876853","type":"LOCAL"}],"standard_charges":[{"gross_charge":8321.86,"discounted_cash":6241.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054403 = Hospital System Supply Identifier | 876853 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 3.5 L SZ4","code_information":[{"code":"Sx00-1065-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054407","type":"LOCAL"},{"code":"876857","type":"LOCAL"}],"standard_charges":[{"gross_charge":7789.53,"discounted_cash":5842.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054407 = Hospital System Supply Identifier | 876857 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 3.5 L SZ6","code_information":[{"code":"Sx00-1065-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054408","type":"LOCAL"},{"code":"876858","type":"LOCAL"}],"standard_charges":[{"gross_charge":7978.03,"discounted_cash":5983.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054408 = Hospital System Supply Identifier | 876858 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 3.5 L SZ8","code_information":[{"code":"Sx00-1065-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054409","type":"LOCAL"},{"code":"876859","type":"LOCAL"}],"standard_charges":[{"gross_charge":8134.06,"discounted_cash":6100.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054409 = Hospital System Supply Identifier | 876859 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 3.5 L SZ10","code_information":[{"code":"Sx00-1065-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054410","type":"LOCAL"},{"code":"876860","type":"LOCAL"}],"standard_charges":[{"gross_charge":8321.86,"discounted_cash":6241.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054410 = Hospital System Supply Identifier | 876860 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 3.5 L SZ12","code_information":[{"code":"Sx00-1065-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054411","type":"LOCAL"},{"code":"876861","type":"LOCAL"}],"standard_charges":[{"gross_charge":8509.67,"discounted_cash":6382.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054411 = Hospital System Supply Identifier | 876861 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 3.5 L SZ14","code_information":[{"code":"Sx00-1065-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054412","type":"LOCAL"},{"code":"876862","type":"LOCAL"}],"standard_charges":[{"gross_charge":8697.47,"discounted_cash":6523.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054412 = Hospital System Supply Identifier | 876862 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 3.5 L SZ16","code_information":[{"code":"Sx00-1065-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054413","type":"LOCAL"},{"code":"876863","type":"LOCAL"}],"standard_charges":[{"gross_charge":10137.96,"discounted_cash":7603.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054413 = Hospital System Supply Identifier | 876863 = Lawson ID"}]},{"description":"PLATE FEM BOW LOK 3.5 18HL","code_information":[{"code":"Sx00-1065-321","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054418","type":"LOCAL"},{"code":"876868","type":"LOCAL"}],"standard_charges":[{"gross_charge":7667.13,"discounted_cash":5750.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054418 = Hospital System Supply Identifier | 876868 = Lawson ID"}]},{"description":"PLATE FEM BOW LOK 3.5 16HL","code_information":[{"code":"Sx00-1065-321","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054417","type":"LOCAL"},{"code":"876867","type":"LOCAL"}],"standard_charges":[{"gross_charge":7427.23,"discounted_cash":5570.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054417 = Hospital System Supply Identifier | 876867 = Lawson ID"}]},{"description":"PLATE FEM BOW LOK 3.5 12HL","code_information":[{"code":"Sx00-1065-321","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054415","type":"LOCAL"},{"code":"876865","type":"LOCAL"}],"standard_charges":[{"gross_charge":5903.6,"discounted_cash":4427.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054415 = Hospital System Supply Identifier | 876865 = Lawson ID"}]},{"description":"PLATE FEM BOW LOK 3.5 10HL","code_information":[{"code":"Sx00-1065-321","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054414","type":"LOCAL"},{"code":"876864","type":"LOCAL"}],"standard_charges":[{"gross_charge":5679.19,"discounted_cash":4259.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054414 = Hospital System Supply Identifier | 876864 = Lawson ID"}]},{"description":"PLATE FEM BOW LOK 3.5 14HL","code_information":[{"code":"Sx00-1065-321","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054416","type":"LOCAL"},{"code":"876866","type":"LOCAL"}],"standard_charges":[{"gross_charge":6334.14,"discounted_cash":4750.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054416 = Hospital System Supply Identifier | 876866 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 4.5 R SZ4","code_information":[{"code":"Sx00-1065-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054419","type":"LOCAL"},{"code":"876869","type":"LOCAL"}],"standard_charges":[{"gross_charge":9114.54,"discounted_cash":6835.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054419 = Hospital System Supply Identifier | 876869 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 4.5 R SZ6","code_information":[{"code":"Sx00-1065-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054420","type":"LOCAL"},{"code":"876870","type":"LOCAL"}],"standard_charges":[{"gross_charge":9346.24,"discounted_cash":7009.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054420 = Hospital System Supply Identifier | 876870 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 4.5 R SZ8","code_information":[{"code":"Sx00-1065-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054421","type":"LOCAL"},{"code":"876871","type":"LOCAL"}],"standard_charges":[{"gross_charge":9545.04,"discounted_cash":7158.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054421 = Hospital System Supply Identifier | 876871 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 4.5 R SZ16","code_information":[{"code":"Sx00-1065-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054425","type":"LOCAL"},{"code":"876875","type":"LOCAL"}],"standard_charges":[{"gross_charge":10923.55,"discounted_cash":8192.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054425 = Hospital System Supply Identifier | 876875 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 4.5 R SZ10","code_information":[{"code":"Sx00-1065-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054422","type":"LOCAL"},{"code":"876872","type":"LOCAL"}],"standard_charges":[{"gross_charge":10264.32,"discounted_cash":7698.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054422 = Hospital System Supply Identifier | 876872 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 4.5 R SZ12","code_information":[{"code":"Sx00-1065-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054423","type":"LOCAL"},{"code":"876873","type":"LOCAL"}],"standard_charges":[{"gross_charge":10504.89,"discounted_cash":7878.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054423 = Hospital System Supply Identifier | 876873 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 4.5 R SZ14","code_information":[{"code":"Sx00-1065-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054424","type":"LOCAL"},{"code":"876874","type":"LOCAL"}],"standard_charges":[{"gross_charge":10743.03,"discounted_cash":8057.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054424 = Hospital System Supply Identifier | 876874 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 4.5 R SZ18","code_information":[{"code":"Sx00-1065-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054426","type":"LOCAL"},{"code":"876876","type":"LOCAL"}],"standard_charges":[{"gross_charge":11807.21,"discounted_cash":8855.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054426 = Hospital System Supply Identifier | 876876 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 4.5 L SZ8","code_information":[{"code":"Sx00-1065-410","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054429","type":"LOCAL"},{"code":"876879","type":"LOCAL"}],"standard_charges":[{"gross_charge":9545.04,"discounted_cash":7158.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054429 = Hospital System Supply Identifier | 876879 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 4.5 L SZ4","code_information":[{"code":"Sx00-1065-410","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054427","type":"LOCAL"},{"code":"876877","type":"LOCAL"}],"standard_charges":[{"gross_charge":9114.54,"discounted_cash":6835.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054427 = Hospital System Supply Identifier | 876877 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 4.5 L SZ6","code_information":[{"code":"Sx00-1065-410","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054428","type":"LOCAL"},{"code":"876878","type":"LOCAL"}],"standard_charges":[{"gross_charge":9346.24,"discounted_cash":7009.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054428 = Hospital System Supply Identifier | 876878 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 4.5 L SZ16","code_information":[{"code":"Sx00-1065-411","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054433","type":"LOCAL"},{"code":"876883","type":"LOCAL"}],"standard_charges":[{"gross_charge":10923.55,"discounted_cash":8192.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054433 = Hospital System Supply Identifier | 876883 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 4.5 L SZ10","code_information":[{"code":"Sx00-1065-411","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054430","type":"LOCAL"},{"code":"876880","type":"LOCAL"}],"standard_charges":[{"gross_charge":10264.32,"discounted_cash":7698.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054430 = Hospital System Supply Identifier | 876880 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 4.5 L SZ12","code_information":[{"code":"Sx00-1065-411","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054431","type":"LOCAL"},{"code":"876881","type":"LOCAL"}],"standard_charges":[{"gross_charge":10504.89,"discounted_cash":7878.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054431 = Hospital System Supply Identifier | 876881 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 4.5 L SZ14","code_information":[{"code":"Sx00-1065-411","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054432","type":"LOCAL"},{"code":"876882","type":"LOCAL"}],"standard_charges":[{"gross_charge":10743.03,"discounted_cash":8057.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054432 = Hospital System Supply Identifier | 876882 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 4.5 L SZ18","code_information":[{"code":"Sx00-1065-411","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054434","type":"LOCAL"},{"code":"876884","type":"LOCAL"}],"standard_charges":[{"gross_charge":11807.21,"discounted_cash":8855.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054434 = Hospital System Supply Identifier | 876884 = Lawson ID"}]},{"description":"PLATE FEM BOW LOK 4.5 12HL","code_information":[{"code":"Sx00-1065-421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054436","type":"LOCAL"},{"code":"876886","type":"LOCAL"}],"standard_charges":[{"gross_charge":6125.54,"discounted_cash":4594.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054436 = Hospital System Supply Identifier | 876886 = Lawson ID"}]},{"description":"PLATE FEM BOW LOK 4.5 18HL","code_information":[{"code":"Sx00-1065-421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054439","type":"LOCAL"},{"code":"876889","type":"LOCAL"}],"standard_charges":[{"gross_charge":7892.35,"discounted_cash":5919.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054439 = Hospital System Supply Identifier | 876889 = Lawson ID"}]},{"description":"PLATE FEM BOW LOK 4.5 16HL","code_information":[{"code":"Sx00-1065-421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054438","type":"LOCAL"},{"code":"876888","type":"LOCAL"}],"standard_charges":[{"gross_charge":7559.42,"discounted_cash":5669.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054438 = Hospital System Supply Identifier | 876888 = Lawson ID"}]},{"description":"PLATE FEM BOW LOK 4.5 10HL","code_information":[{"code":"Sx00-1065-421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054435","type":"LOCAL"},{"code":"876885","type":"LOCAL"}],"standard_charges":[{"gross_charge":5903.6,"discounted_cash":4427.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054435 = Hospital System Supply Identifier | 876885 = Lawson ID"}]},{"description":"PLATE FEM BOW LOK 4.5 14HL","code_information":[{"code":"Sx00-1065-421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054437","type":"LOCAL"},{"code":"876887","type":"LOCAL"}],"standard_charges":[{"gross_charge":6449.62,"discounted_cash":4837.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054437 = Hospital System Supply Identifier | 876887 = Lawson ID"}]},{"description":"PLATE FEM STR LOK 4.5 4HL","code_information":[{"code":"Sx00-1065-430","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054440","type":"LOCAL"},{"code":"876890","type":"LOCAL"}],"standard_charges":[{"gross_charge":4220.31,"discounted_cash":3165.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054440 = Hospital System Supply Identifier | 876890 = Lawson ID"}]},{"description":"PLATE FEM STR LOK 4.5 6HL","code_information":[{"code":"Sx00-1065-430","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054441","type":"LOCAL"},{"code":"876891","type":"LOCAL"}],"standard_charges":[{"gross_charge":4794.12,"discounted_cash":3595.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054441 = Hospital System Supply Identifier | 876891 = Lawson ID"}]},{"description":"PLATE FEM STR LOK 4.5 8HL","code_information":[{"code":"Sx00-1065-430","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054442","type":"LOCAL"},{"code":"876892","type":"LOCAL"}],"standard_charges":[{"gross_charge":5350.95,"discounted_cash":4013.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054442 = Hospital System Supply Identifier | 876892 = Lawson ID"}]},{"description":"PLATE FEM STR LOK 4.5 10HL","code_information":[{"code":"Sx00-1065-431","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054443","type":"LOCAL"},{"code":"876893","type":"LOCAL"}],"standard_charges":[{"gross_charge":5903.6,"discounted_cash":4427.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054443 = Hospital System Supply Identifier | 876893 = Lawson ID"}]},{"description":"PLATE FEM STR LOK 4.5 14HL","code_information":[{"code":"Sx00-1065-431","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054444","type":"LOCAL"},{"code":"876894","type":"LOCAL"}],"standard_charges":[{"gross_charge":6449.62,"discounted_cash":4837.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054444 = Hospital System Supply Identifier | 876894 = Lawson ID"}]},{"description":"WASHERS","code_information":[{"code":"Sx00-1071-000","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054445","type":"LOCAL"},{"code":"876895","type":"LOCAL"}],"standard_charges":[{"gross_charge":94.5,"discounted_cash":70.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054445 = Hospital System Supply Identifier | 876895 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X30MM","code_information":[{"code":"Sx00-1071-103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054446","type":"LOCAL"},{"code":"876896","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054446 = Hospital System Supply Identifier | 876896 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X35MM","code_information":[{"code":"Sx00-1071-103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054447","type":"LOCAL"},{"code":"876897","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054447 = Hospital System Supply Identifier | 876897 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X40MM","code_information":[{"code":"Sx00-1071-104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054448","type":"LOCAL"},{"code":"876898","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054448 = Hospital System Supply Identifier | 876898 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X45MM","code_information":[{"code":"Sx00-1071-104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054449","type":"LOCAL"},{"code":"876899","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054449 = Hospital System Supply Identifier | 876899 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X50MM","code_information":[{"code":"Sx00-1071-105","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054450","type":"LOCAL"},{"code":"876900","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054450 = Hospital System Supply Identifier | 876900 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X55MM","code_information":[{"code":"Sx00-1071-105","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054451","type":"LOCAL"},{"code":"876901","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054451 = Hospital System Supply Identifier | 876901 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X60MM","code_information":[{"code":"Sx00-1071-106","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054452","type":"LOCAL"},{"code":"876902","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054452 = Hospital System Supply Identifier | 876902 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X65MM","code_information":[{"code":"Sx00-1071-106","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054453","type":"LOCAL"},{"code":"876903","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054453 = Hospital System Supply Identifier | 876903 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X75MM","code_information":[{"code":"Sx00-1071-107","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054455","type":"LOCAL"},{"code":"876905","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054455 = Hospital System Supply Identifier | 876905 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X70MM","code_information":[{"code":"Sx00-1071-107","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054454","type":"LOCAL"},{"code":"876904","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054454 = Hospital System Supply Identifier | 876904 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X85MM","code_information":[{"code":"Sx00-1071-108","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054457","type":"LOCAL"},{"code":"876907","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054457 = Hospital System Supply Identifier | 876907 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X80MM","code_information":[{"code":"Sx00-1071-108","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054456","type":"LOCAL"},{"code":"876906","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054456 = Hospital System Supply Identifier | 876906 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X90MM","code_information":[{"code":"Sx00-1071-109","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054458","type":"LOCAL"},{"code":"876908","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054458 = Hospital System Supply Identifier | 876908 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X95MM","code_information":[{"code":"Sx00-1071-109","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054459","type":"LOCAL"},{"code":"876909","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054459 = Hospital System Supply Identifier | 876909 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X100MM","code_information":[{"code":"Sx00-1071-110","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054460","type":"LOCAL"},{"code":"876910","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054460 = Hospital System Supply Identifier | 876910 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X105MM","code_information":[{"code":"Sx00-1071-110","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054461","type":"LOCAL"},{"code":"876911","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054461 = Hospital System Supply Identifier | 876911 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X110MM","code_information":[{"code":"Sx00-1071-111","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054462","type":"LOCAL"},{"code":"876912","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054462 = Hospital System Supply Identifier | 876912 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X115MM","code_information":[{"code":"Sx00-1071-111","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054463","type":"LOCAL"},{"code":"876913","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054463 = Hospital System Supply Identifier | 876913 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X120MM","code_information":[{"code":"Sx00-1071-112","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054464","type":"LOCAL"},{"code":"876914","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054464 = Hospital System Supply Identifier | 876914 = Lawson ID"}]},{"description":"SCREW CANN 32MM THRD 7X50MM","code_information":[{"code":"Sx00-1071-205","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054465","type":"LOCAL"},{"code":"876915","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054465 = Hospital System Supply Identifier | 876915 = Lawson ID"}]},{"description":"SCREW CANN 32MM THRD 7X55MM","code_information":[{"code":"Sx00-1071-205","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054466","type":"LOCAL"},{"code":"876916","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054466 = Hospital System Supply Identifier | 876916 = Lawson ID"}]},{"description":"SCREW CANN 32MM THRD 7X65MM","code_information":[{"code":"Sx00-1071-206","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054468","type":"LOCAL"},{"code":"876918","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054468 = Hospital System Supply Identifier | 876918 = Lawson ID"}]},{"description":"SCREW CANN 32MM THRD 7X60MM","code_information":[{"code":"Sx00-1071-206","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054467","type":"LOCAL"},{"code":"876917","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054467 = Hospital System Supply Identifier | 876917 = Lawson ID"}]},{"description":"SCREW CANN 32MM THRD 7X70MM","code_information":[{"code":"Sx00-1071-207","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054469","type":"LOCAL"},{"code":"876919","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054469 = Hospital System Supply Identifier | 876919 = Lawson ID"}]},{"description":"SCREW CANN 32MM THRD 7X75MM","code_information":[{"code":"Sx00-1071-207","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054470","type":"LOCAL"},{"code":"876920","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054470 = Hospital System Supply Identifier | 876920 = Lawson ID"}]},{"description":"SCREW CANN 32MM THRD 7X80MM","code_information":[{"code":"Sx00-1071-208","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054471","type":"LOCAL"},{"code":"876921","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054471 = Hospital System Supply Identifier | 876921 = Lawson ID"}]},{"description":"SCREW CANN 32MM THRD 7X85MM","code_information":[{"code":"Sx00-1071-208","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054472","type":"LOCAL"},{"code":"876922","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054472 = Hospital System Supply Identifier | 876922 = Lawson ID"}]},{"description":"SCREW CANN 32MM THRD 7X90MM","code_information":[{"code":"Sx00-1071-209","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054473","type":"LOCAL"},{"code":"876923","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054473 = Hospital System Supply Identifier | 876923 = Lawson ID"}]},{"description":"SCREW CANN 32MM THRD 7X95MM","code_information":[{"code":"Sx00-1071-209","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054474","type":"LOCAL"},{"code":"876924","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054474 = Hospital System Supply Identifier | 876924 = Lawson ID"}]},{"description":"SCREW CANN 32MM THRD 7X100MM","code_information":[{"code":"Sx00-1071-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054475","type":"LOCAL"},{"code":"876925","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054475 = Hospital System Supply Identifier | 876925 = Lawson ID"}]},{"description":"SCREW CANN 32MM THRD 7X105MM","code_information":[{"code":"Sx00-1071-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054476","type":"LOCAL"},{"code":"876926","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054476 = Hospital System Supply Identifier | 876926 = Lawson ID"}]},{"description":"SCREW CANN 32MM THRD 7X115MM","code_information":[{"code":"Sx00-1071-211","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054478","type":"LOCAL"},{"code":"876928","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054478 = Hospital System Supply Identifier | 876928 = Lawson ID"}]},{"description":"SCREW CANN 32MM THRD 7X110MM","code_information":[{"code":"Sx00-1071-211","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054477","type":"LOCAL"},{"code":"876927","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054477 = Hospital System Supply Identifier | 876927 = Lawson ID"}]},{"description":"SCREW CANN 32MM THRD 7X120MM","code_information":[{"code":"Sx00-1071-212","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054479","type":"LOCAL"},{"code":"876929","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054479 = Hospital System Supply Identifier | 876929 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X30MM","code_information":[{"code":"Sx00-1071-303","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054480","type":"LOCAL"},{"code":"876930","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054480 = Hospital System Supply Identifier | 876930 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X35MM","code_information":[{"code":"Sx00-1071-303","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054481","type":"LOCAL"},{"code":"876931","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054481 = Hospital System Supply Identifier | 876931 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X40MM","code_information":[{"code":"Sx00-1071-304","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054482","type":"LOCAL"},{"code":"876932","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054482 = Hospital System Supply Identifier | 876932 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X45MM","code_information":[{"code":"Sx00-1071-304","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054483","type":"LOCAL"},{"code":"876933","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054483 = Hospital System Supply Identifier | 876933 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X50MM","code_information":[{"code":"Sx00-1071-305","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054484","type":"LOCAL"},{"code":"876934","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054484 = Hospital System Supply Identifier | 876934 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X55MM","code_information":[{"code":"Sx00-1071-305","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054485","type":"LOCAL"},{"code":"876935","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054485 = Hospital System Supply Identifier | 876935 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X60MM","code_information":[{"code":"Sx00-1071-306","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054486","type":"LOCAL"},{"code":"876936","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054486 = Hospital System Supply Identifier | 876936 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X65MM","code_information":[{"code":"Sx00-1071-306","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054487","type":"LOCAL"},{"code":"876937","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054487 = Hospital System Supply Identifier | 876937 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X75MM","code_information":[{"code":"Sx00-1071-307","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054489","type":"LOCAL"},{"code":"876939","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054489 = Hospital System Supply Identifier | 876939 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X70MM","code_information":[{"code":"Sx00-1071-307","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054488","type":"LOCAL"},{"code":"876938","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054488 = Hospital System Supply Identifier | 876938 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X80MM","code_information":[{"code":"Sx00-1071-308","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054490","type":"LOCAL"},{"code":"876940","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054490 = Hospital System Supply Identifier | 876940 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X85MM","code_information":[{"code":"Sx00-1071-308","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054491","type":"LOCAL"},{"code":"876941","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054491 = Hospital System Supply Identifier | 876941 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X90MM","code_information":[{"code":"Sx00-1071-309","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054492","type":"LOCAL"},{"code":"876942","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054492 = Hospital System Supply Identifier | 876942 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X95MM","code_information":[{"code":"Sx00-1071-309","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054493","type":"LOCAL"},{"code":"876943","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054493 = Hospital System Supply Identifier | 876943 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X100MM","code_information":[{"code":"Sx00-1071-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054494","type":"LOCAL"},{"code":"876944","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054494 = Hospital System Supply Identifier | 876944 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X105MM","code_information":[{"code":"Sx00-1071-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054495","type":"LOCAL"},{"code":"876945","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054495 = Hospital System Supply Identifier | 876945 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X110MM","code_information":[{"code":"Sx00-1071-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054496","type":"LOCAL"},{"code":"876946","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054496 = Hospital System Supply Identifier | 876946 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X115MM","code_information":[{"code":"Sx00-1071-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054497","type":"LOCAL"},{"code":"876947","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054497 = Hospital System Supply Identifier | 876947 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X120MM","code_information":[{"code":"Sx00-1071-312","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054498","type":"LOCAL"},{"code":"876948","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054498 = Hospital System Supply Identifier | 876948 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X14MM","code_information":[{"code":"Sx00-1071-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054499","type":"LOCAL"},{"code":"876949","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054499 = Hospital System Supply Identifier | 876949 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X15MM","code_information":[{"code":"Sx00-1071-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054500","type":"LOCAL"},{"code":"876950","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054500 = Hospital System Supply Identifier | 876950 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X16MM","code_information":[{"code":"Sx00-1071-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054501","type":"LOCAL"},{"code":"876951","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054501 = Hospital System Supply Identifier | 876951 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X17MM","code_information":[{"code":"Sx00-1071-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054502","type":"LOCAL"},{"code":"876952","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054502 = Hospital System Supply Identifier | 876952 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X18MM","code_information":[{"code":"Sx00-1071-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054503","type":"LOCAL"},{"code":"876953","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054503 = Hospital System Supply Identifier | 876953 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X19MM","code_information":[{"code":"Sx00-1071-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054504","type":"LOCAL"},{"code":"876954","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054504 = Hospital System Supply Identifier | 876954 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X28MM","code_information":[{"code":"Sx00-1071-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054511","type":"LOCAL"},{"code":"876961","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054511 = Hospital System Supply Identifier | 876961 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X26MM","code_information":[{"code":"Sx00-1071-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054510","type":"LOCAL"},{"code":"876960","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054510 = Hospital System Supply Identifier | 876960 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X24MM","code_information":[{"code":"Sx00-1071-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054509","type":"LOCAL"},{"code":"876959","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054509 = Hospital System Supply Identifier | 876959 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X22MM","code_information":[{"code":"Sx00-1071-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054507","type":"LOCAL"},{"code":"876957","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054507 = Hospital System Supply Identifier | 876957 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X21MM","code_information":[{"code":"Sx00-1071-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054506","type":"LOCAL"},{"code":"876956","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054506 = Hospital System Supply Identifier | 876956 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X20MM","code_information":[{"code":"Sx00-1071-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054505","type":"LOCAL"},{"code":"876955","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054505 = Hospital System Supply Identifier | 876955 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X23MM","code_information":[{"code":"Sx00-1071-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054508","type":"LOCAL"},{"code":"876958","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054508 = Hospital System Supply Identifier | 876958 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X36MM","code_information":[{"code":"Sx00-1071-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054515","type":"LOCAL"},{"code":"876965","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054515 = Hospital System Supply Identifier | 876965 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X30MM","code_information":[{"code":"Sx00-1071-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054512","type":"LOCAL"},{"code":"876962","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054512 = Hospital System Supply Identifier | 876962 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X32MM","code_information":[{"code":"Sx00-1071-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054513","type":"LOCAL"},{"code":"876963","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054513 = Hospital System Supply Identifier | 876963 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X34MM","code_information":[{"code":"Sx00-1071-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054514","type":"LOCAL"},{"code":"876964","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054514 = Hospital System Supply Identifier | 876964 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X38MM","code_information":[{"code":"Sx00-1071-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054516","type":"LOCAL"},{"code":"876966","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054516 = Hospital System Supply Identifier | 876966 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X45MM","code_information":[{"code":"Sx00-1071-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054518","type":"LOCAL"},{"code":"876968","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054518 = Hospital System Supply Identifier | 876968 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X40MM","code_information":[{"code":"Sx00-1071-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054517","type":"LOCAL"},{"code":"876967","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054517 = Hospital System Supply Identifier | 876967 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X50MM","code_information":[{"code":"Sx00-1071-405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054519","type":"LOCAL"},{"code":"876969","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054519 = Hospital System Supply Identifier | 876969 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X18MM","code_information":[{"code":"Sx00-1071-501","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054528","type":"LOCAL"},{"code":"876978","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054528 = Hospital System Supply Identifier | 876978 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X19MM","code_information":[{"code":"Sx00-1071-501","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054529","type":"LOCAL"},{"code":"876979","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054529 = Hospital System Supply Identifier | 876979 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X16MM","code_information":[{"code":"Sx00-1071-501","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054526","type":"LOCAL"},{"code":"876976","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054526 = Hospital System Supply Identifier | 876976 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X15MM","code_information":[{"code":"Sx00-1071-501","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054525","type":"LOCAL"},{"code":"876975","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054525 = Hospital System Supply Identifier | 876975 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X17MM","code_information":[{"code":"Sx00-1071-501","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054527","type":"LOCAL"},{"code":"876977","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054527 = Hospital System Supply Identifier | 876977 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X13MM","code_information":[{"code":"Sx00-1071-501","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054523","type":"LOCAL"},{"code":"876973","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054523 = Hospital System Supply Identifier | 876973 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X12MM","code_information":[{"code":"Sx00-1071-501","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054522","type":"LOCAL"},{"code":"876972","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054522 = Hospital System Supply Identifier | 876972 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X11MM","code_information":[{"code":"Sx00-1071-501","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054521","type":"LOCAL"},{"code":"876971","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054521 = Hospital System Supply Identifier | 876971 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X10MM","code_information":[{"code":"Sx00-1071-501","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054520","type":"LOCAL"},{"code":"876970","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054520 = Hospital System Supply Identifier | 876970 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X14MM","code_information":[{"code":"Sx00-1071-501","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054524","type":"LOCAL"},{"code":"876974","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054524 = Hospital System Supply Identifier | 876974 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X26MM","code_information":[{"code":"Sx00-1071-502","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054535","type":"LOCAL"},{"code":"876985","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054535 = Hospital System Supply Identifier | 876985 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X20MM","code_information":[{"code":"Sx00-1071-502","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054530","type":"LOCAL"},{"code":"876980","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054530 = Hospital System Supply Identifier | 876980 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X21MM","code_information":[{"code":"Sx00-1071-502","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054531","type":"LOCAL"},{"code":"876981","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054531 = Hospital System Supply Identifier | 876981 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X22MM","code_information":[{"code":"Sx00-1071-502","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054532","type":"LOCAL"},{"code":"876982","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054532 = Hospital System Supply Identifier | 876982 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X23MM","code_information":[{"code":"Sx00-1071-502","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054533","type":"LOCAL"},{"code":"876983","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054533 = Hospital System Supply Identifier | 876983 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X24MM","code_information":[{"code":"Sx00-1071-502","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054534","type":"LOCAL"},{"code":"876984","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054534 = Hospital System Supply Identifier | 876984 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X28MM","code_information":[{"code":"Sx00-1071-502","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054536","type":"LOCAL"},{"code":"876986","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054536 = Hospital System Supply Identifier | 876986 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X36MM","code_information":[{"code":"Sx00-1071-503","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054540","type":"LOCAL"},{"code":"876990","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054540 = Hospital System Supply Identifier | 876990 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X34MM","code_information":[{"code":"Sx00-1071-503","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054539","type":"LOCAL"},{"code":"876989","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054539 = Hospital System Supply Identifier | 876989 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X38MM","code_information":[{"code":"Sx00-1071-503","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054541","type":"LOCAL"},{"code":"876991","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054541 = Hospital System Supply Identifier | 876991 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X30MM","code_information":[{"code":"Sx00-1071-503","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054537","type":"LOCAL"},{"code":"876987","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054537 = Hospital System Supply Identifier | 876987 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X32MM","code_information":[{"code":"Sx00-1071-503","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054538","type":"LOCAL"},{"code":"876988","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054538 = Hospital System Supply Identifier | 876988 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X40MM","code_information":[{"code":"Sx00-1071-504","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054542","type":"LOCAL"},{"code":"876992","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054542 = Hospital System Supply Identifier | 876992 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X45MM","code_information":[{"code":"Sx00-1071-504","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054543","type":"LOCAL"},{"code":"876993","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054543 = Hospital System Supply Identifier | 876993 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X50MM","code_information":[{"code":"Sx00-1071-505","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054544","type":"LOCAL"},{"code":"876994","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054544 = Hospital System Supply Identifier | 876994 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X18MM","code_information":[{"code":"Sx00-1071-601","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054549","type":"LOCAL"},{"code":"876999","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054549 = Hospital System Supply Identifier | 876999 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X14MM","code_information":[{"code":"Sx00-1071-601","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054547","type":"LOCAL"},{"code":"876997","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054547 = Hospital System Supply Identifier | 876997 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X16MM","code_information":[{"code":"Sx00-1071-601","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054548","type":"LOCAL"},{"code":"876998","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054548 = Hospital System Supply Identifier | 876998 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X10MM","code_information":[{"code":"Sx00-1071-601","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054545","type":"LOCAL"},{"code":"876995","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054545 = Hospital System Supply Identifier | 876995 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X12MM","code_information":[{"code":"Sx00-1071-601","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054546","type":"LOCAL"},{"code":"876996","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054546 = Hospital System Supply Identifier | 876996 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X20MM","code_information":[{"code":"Sx00-1071-602","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054550","type":"LOCAL"},{"code":"877000","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054550 = Hospital System Supply Identifier | 877000 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X22MM","code_information":[{"code":"Sx00-1071-602","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054551","type":"LOCAL"},{"code":"877001","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054551 = Hospital System Supply Identifier | 877001 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X24MM","code_information":[{"code":"Sx00-1071-602","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054552","type":"LOCAL"},{"code":"877002","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054552 = Hospital System Supply Identifier | 877002 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X26MM","code_information":[{"code":"Sx00-1071-602","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054553","type":"LOCAL"},{"code":"877003","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054553 = Hospital System Supply Identifier | 877003 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X28MM","code_information":[{"code":"Sx00-1071-602","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054554","type":"LOCAL"},{"code":"877004","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054554 = Hospital System Supply Identifier | 877004 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X36MM","code_information":[{"code":"Sx00-1071-603","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054559","type":"LOCAL"},{"code":"877009","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054559 = Hospital System Supply Identifier | 877009 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X35MM","code_information":[{"code":"Sx00-1071-603","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054558","type":"LOCAL"},{"code":"877008","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054558 = Hospital System Supply Identifier | 877008 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X38MM","code_information":[{"code":"Sx00-1071-603","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054560","type":"LOCAL"},{"code":"877010","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054560 = Hospital System Supply Identifier | 877010 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X32MM","code_information":[{"code":"Sx00-1071-603","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054556","type":"LOCAL"},{"code":"877006","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054556 = Hospital System Supply Identifier | 877006 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X30MM","code_information":[{"code":"Sx00-1071-603","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054555","type":"LOCAL"},{"code":"877005","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054555 = Hospital System Supply Identifier | 877005 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X34MM","code_information":[{"code":"Sx00-1071-603","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054557","type":"LOCAL"},{"code":"877007","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054557 = Hospital System Supply Identifier | 877007 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X40MM","code_information":[{"code":"Sx00-1071-604","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054561","type":"LOCAL"},{"code":"877011","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054561 = Hospital System Supply Identifier | 877011 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X42MM","code_information":[{"code":"Sx00-1071-604","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054562","type":"LOCAL"},{"code":"877012","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054562 = Hospital System Supply Identifier | 877012 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X44MM","code_information":[{"code":"Sx00-1071-604","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054563","type":"LOCAL"},{"code":"877013","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054563 = Hospital System Supply Identifier | 877013 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X45MM","code_information":[{"code":"Sx00-1071-604","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054564","type":"LOCAL"},{"code":"877014","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054564 = Hospital System Supply Identifier | 877014 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X46MM","code_information":[{"code":"Sx00-1071-604","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054565","type":"LOCAL"},{"code":"877015","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054565 = Hospital System Supply Identifier | 877015 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X48MM","code_information":[{"code":"Sx00-1071-604","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054566","type":"LOCAL"},{"code":"877016","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054566 = Hospital System Supply Identifier | 877016 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X50MM","code_information":[{"code":"Sx00-1071-605","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054567","type":"LOCAL"},{"code":"877017","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054567 = Hospital System Supply Identifier | 877017 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X55MM","code_information":[{"code":"Sx00-1071-605","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054568","type":"LOCAL"},{"code":"877018","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054568 = Hospital System Supply Identifier | 877018 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X60MM","code_information":[{"code":"Sx00-1071-606","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054569","type":"LOCAL"},{"code":"877019","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054569 = Hospital System Supply Identifier | 877019 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X30MM","code_information":[{"code":"Sx00-1071-703","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054570","type":"LOCAL"},{"code":"877020","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054570 = Hospital System Supply Identifier | 877020 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X32MM","code_information":[{"code":"Sx00-1071-703","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054571","type":"LOCAL"},{"code":"877021","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054571 = Hospital System Supply Identifier | 877021 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X34MM","code_information":[{"code":"Sx00-1071-703","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054572","type":"LOCAL"},{"code":"877022","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054572 = Hospital System Supply Identifier | 877022 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X36MM","code_information":[{"code":"Sx00-1071-703","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054573","type":"LOCAL"},{"code":"877023","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054573 = Hospital System Supply Identifier | 877023 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X38MM","code_information":[{"code":"Sx00-1071-703","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054574","type":"LOCAL"},{"code":"877024","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054574 = Hospital System Supply Identifier | 877024 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X40MM","code_information":[{"code":"Sx00-1071-704","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054575","type":"LOCAL"},{"code":"877025","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054575 = Hospital System Supply Identifier | 877025 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X42MM","code_information":[{"code":"Sx00-1071-704","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054576","type":"LOCAL"},{"code":"877026","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054576 = Hospital System Supply Identifier | 877026 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X44MM","code_information":[{"code":"Sx00-1071-704","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054577","type":"LOCAL"},{"code":"877027","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054577 = Hospital System Supply Identifier | 877027 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X46MM","code_information":[{"code":"Sx00-1071-704","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054578","type":"LOCAL"},{"code":"877028","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054578 = Hospital System Supply Identifier | 877028 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X48MM","code_information":[{"code":"Sx00-1071-704","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054579","type":"LOCAL"},{"code":"877029","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054579 = Hospital System Supply Identifier | 877029 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X50MM","code_information":[{"code":"Sx00-1071-705","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054580","type":"LOCAL"},{"code":"877030","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054580 = Hospital System Supply Identifier | 877030 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X55MM","code_information":[{"code":"Sx00-1071-705","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054581","type":"LOCAL"},{"code":"877031","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054581 = Hospital System Supply Identifier | 877031 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X60MM","code_information":[{"code":"Sx00-1071-706","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054582","type":"LOCAL"},{"code":"877032","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054582 = Hospital System Supply Identifier | 877032 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X10MM","code_information":[{"code":"Sx00-1071-821","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054583","type":"LOCAL"},{"code":"877033","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054583 = Hospital System Supply Identifier | 877033 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X12MM","code_information":[{"code":"Sx00-1071-821","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054584","type":"LOCAL"},{"code":"877034","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054584 = Hospital System Supply Identifier | 877034 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X14MM","code_information":[{"code":"Sx00-1071-821","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054585","type":"LOCAL"},{"code":"877035","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054585 = Hospital System Supply Identifier | 877035 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X16MM","code_information":[{"code":"Sx00-1071-821","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054586","type":"LOCAL"},{"code":"877036","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054586 = Hospital System Supply Identifier | 877036 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X18MM","code_information":[{"code":"Sx00-1071-821","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054587","type":"LOCAL"},{"code":"877037","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054587 = Hospital System Supply Identifier | 877037 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X26MM","code_information":[{"code":"Sx00-1071-822","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054591","type":"LOCAL"},{"code":"877041","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054591 = Hospital System Supply Identifier | 877041 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X24MM","code_information":[{"code":"Sx00-1071-822","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054590","type":"LOCAL"},{"code":"877040","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054590 = Hospital System Supply Identifier | 877040 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X28MM","code_information":[{"code":"Sx00-1071-822","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054592","type":"LOCAL"},{"code":"877042","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054592 = Hospital System Supply Identifier | 877042 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X20MM","code_information":[{"code":"Sx00-1071-822","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054588","type":"LOCAL"},{"code":"877038","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054588 = Hospital System Supply Identifier | 877038 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X22MM","code_information":[{"code":"Sx00-1071-822","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054589","type":"LOCAL"},{"code":"877039","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054589 = Hospital System Supply Identifier | 877039 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X30MM","code_information":[{"code":"Sx00-1071-823","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054593","type":"LOCAL"},{"code":"877043","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054593 = Hospital System Supply Identifier | 877043 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X32MM","code_information":[{"code":"Sx00-1071-823","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054594","type":"LOCAL"},{"code":"877044","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054594 = Hospital System Supply Identifier | 877044 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X34MM","code_information":[{"code":"Sx00-1071-823","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054595","type":"LOCAL"},{"code":"877045","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054595 = Hospital System Supply Identifier | 877045 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X36MM","code_information":[{"code":"Sx00-1071-823","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054596","type":"LOCAL"},{"code":"877046","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054596 = Hospital System Supply Identifier | 877046 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X38MM","code_information":[{"code":"Sx00-1071-823","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054597","type":"LOCAL"},{"code":"877047","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054597 = Hospital System Supply Identifier | 877047 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X46MM","code_information":[{"code":"Sx00-1071-824","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054601","type":"LOCAL"},{"code":"877051","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054601 = Hospital System Supply Identifier | 877051 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X40MM","code_information":[{"code":"Sx00-1071-824","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054598","type":"LOCAL"},{"code":"877048","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054598 = Hospital System Supply Identifier | 877048 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X42MM","code_information":[{"code":"Sx00-1071-824","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054599","type":"LOCAL"},{"code":"877049","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054599 = Hospital System Supply Identifier | 877049 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X44MM","code_information":[{"code":"Sx00-1071-824","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054600","type":"LOCAL"},{"code":"877050","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054600 = Hospital System Supply Identifier | 877050 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X48MM","code_information":[{"code":"Sx00-1071-824","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054602","type":"LOCAL"},{"code":"877052","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054602 = Hospital System Supply Identifier | 877052 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X55MM","code_information":[{"code":"Sx00-1071-825","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054604","type":"LOCAL"},{"code":"877054","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054604 = Hospital System Supply Identifier | 877054 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X50MM","code_information":[{"code":"Sx00-1071-825","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054603","type":"LOCAL"},{"code":"877053","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054603 = Hospital System Supply Identifier | 877053 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X60MM","code_information":[{"code":"Sx00-1071-826","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054605","type":"LOCAL"},{"code":"877055","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054605 = Hospital System Supply Identifier | 877055 = Lawson ID"}]},{"description":"CEM BONE DOUGH-TYPE 40/20","code_information":[{"code":"Sx00-1102-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"34976","type":"LOCAL"},{"code":"100111","type":"LOCAL"}],"standard_charges":[{"gross_charge":198.94,"discounted_cash":149.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 34976 = Hospital System Supply Identifier | 100111 = Lawson ID"}]},{"description":"OFF CONTRACT USE 702836 - CEM BONE PALACOS-R/G 40GM","code_information":[{"code":"Sx00-1113-140","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"20122","type":"LOCAL"},{"code":"238388","type":"LOCAL"}],"standard_charges":[{"gross_charge":556.7,"discounted_cash":417.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 20122 = Hospital System Supply Identifier | 238388 = Lawson ID"}]},{"description":"CEM BONE PALACOS-LV 40GM","code_information":[{"code":"Sx00-1118-140","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"176736","type":"LOCAL"},{"code":"308782","type":"LOCAL"}],"standard_charges":[{"gross_charge":161.15,"discounted_cash":120.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 176736 = Hospital System Supply Identifier | 308782 = Lawson ID"}]},{"description":"CEM BONE PALACOS-LV/G 40GM","code_information":[{"code":"Sx00-1119-140","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"176737","type":"LOCAL"},{"code":"308783","type":"LOCAL"}],"standard_charges":[{"gross_charge":556.7,"discounted_cash":417.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 176737 = Hospital System Supply Identifier | 308783 = Lawson ID"}]},{"description":"INST DRIVER SCRW MINI MAGNA","code_information":[{"code":"Sx00-1142-002","type":"CDM"},{"code":"272","type":"RC"},{"code":"149709","type":"LOCAL"},{"code":"237164","type":"LOCAL"}],"standard_charges":[{"gross_charge":772.59,"discounted_cash":579.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 149709 = Hospital System Supply Identifier | 237164 = Lawson ID"}]},{"description":"DISC - DRILL CANNUL 3.5","code_information":[{"code":"Sx00-1142-011","type":"CDM"},{"code":"272","type":"RC"},{"code":"166679","type":"LOCAL"},{"code":"148674","type":"LOCAL"}],"standard_charges":[{"gross_charge":498.1,"discounted_cash":373.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 166679 = Hospital System Supply Identifier | 148674 = Lawson ID"}]},{"description":"SCREW CANN F/T 4.0X44MM","code_information":[{"code":"Sx00-1142-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"148465","type":"LOCAL"},{"code":"235492","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.47,"discounted_cash":351.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 148465 = Hospital System Supply Identifier | 235492 = Lawson ID"}]},{"description":"SCREW CANN F/T 4.0X65MM","code_information":[{"code":"Sx00-1142-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408714","type":"LOCAL"},{"code":"339432","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.47,"discounted_cash":351.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408714 = Hospital System Supply Identifier | 339432 = Lawson ID"}]},{"description":"SCREW CANN F/T 4.0X32MM","code_information":[{"code":"Sx00-1142-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408713","type":"LOCAL"},{"code":"339431","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.47,"discounted_cash":351.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408713 = Hospital System Supply Identifier | 339431 = Lawson ID"}]},{"description":"SCREW CANN F/T 4.0X28MM","code_information":[{"code":"Sx00-1142-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408712","type":"LOCAL"},{"code":"339430","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.47,"discounted_cash":351.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408712 = Hospital System Supply Identifier | 339430 = Lawson ID"}]},{"description":"SCREW CANN F/T 4.0X36MM","code_information":[{"code":"Sx00-1142-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"148463","type":"LOCAL"},{"code":"235490","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.47,"discounted_cash":351.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 148463 = Hospital System Supply Identifier | 235490 = Lawson ID"}]},{"description":"SCREW CANN F/T 4.0X55MM","code_information":[{"code":"Sx00-1142-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"148466","type":"LOCAL"},{"code":"235493","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.47,"discounted_cash":351.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 148466 = Hospital System Supply Identifier | 235493 = Lawson ID"}]},{"description":"SCREW CANN F/T 4.0X40MM","code_information":[{"code":"Sx00-1142-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"148464","type":"LOCAL"},{"code":"235491","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.47,"discounted_cash":351.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 148464 = Hospital System Supply Identifier | 235491 = Lawson ID"}]},{"description":"SCREW CANN F/T 4.0X48MM","code_information":[{"code":"Sx00-1142-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408416","type":"LOCAL"},{"code":"323779","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.47,"discounted_cash":351.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408416 = Hospital System Supply Identifier | 323779 = Lawson ID"}]},{"description":"SCREW CANN P/T 4X60MM","code_information":[{"code":"Sx00-1142-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408718","type":"LOCAL"},{"code":"339437","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.47,"discounted_cash":351.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408718 = Hospital System Supply Identifier | 339437 = Lawson ID"}]},{"description":"SCREW CANN P/T 4X30MM","code_information":[{"code":"Sx00-1142-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408715","type":"LOCAL"},{"code":"339434","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.47,"discounted_cash":351.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408715 = Hospital System Supply Identifier | 339434 = Lawson ID"}]},{"description":"SCREW CANN P/T 4X55MM","code_information":[{"code":"Sx00-1142-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"148477","type":"LOCAL"},{"code":"235504","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.47,"discounted_cash":351.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 148477 = Hospital System Supply Identifier | 235504 = Lawson ID"}]},{"description":"SCREW CANN P/T 4X48MM","code_information":[{"code":"Sx00-1142-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408717","type":"LOCAL"},{"code":"339436","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.47,"discounted_cash":351.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408717 = Hospital System Supply Identifier | 339436 = Lawson ID"}]},{"description":"SCREW CANN P/T 4X36MM","code_information":[{"code":"Sx00-1142-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408716","type":"LOCAL"},{"code":"339435","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.47,"discounted_cash":351.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408716 = Hospital System Supply Identifier | 339435 = Lawson ID"}]},{"description":"SCREW CANN P/T 4X50MM","code_information":[{"code":"Sx00-1142-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"148476","type":"LOCAL"},{"code":"235503","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.47,"discounted_cash":351.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 148476 = Hospital System Supply Identifier | 235503 = Lawson ID"}]},{"description":"SCREW CANN P/T 4X40MM","code_information":[{"code":"Sx00-1142-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"148472","type":"LOCAL"},{"code":"235499","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.47,"discounted_cash":351.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 148472 = Hospital System Supply Identifier | 235499 = Lawson ID"}]},{"description":"SCREW CANN P/T 4X44MM","code_information":[{"code":"Sx00-1142-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"148474","type":"LOCAL"},{"code":"235501","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.47,"discounted_cash":351.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 148474 = Hospital System Supply Identifier | 235501 = Lawson ID"}]},{"description":"SCREW CANN P/T 4X42MM","code_information":[{"code":"Sx00-1142-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"148473","type":"LOCAL"},{"code":"235500","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.47,"discounted_cash":351.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 148473 = Hospital System Supply Identifier | 235500 = Lawson ID"}]},{"description":"SCREW CANN P/T 4X38MM","code_information":[{"code":"Sx00-1142-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"148471","type":"LOCAL"},{"code":"235498","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.47,"discounted_cash":351.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 148471 = Hospital System Supply Identifier | 235498 = Lawson ID"}]},{"description":"SCREW CANN P/T 4X34MM","code_information":[{"code":"Sx00-1142-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"148470","type":"LOCAL"},{"code":"235497","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.47,"discounted_cash":351.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 148470 = Hospital System Supply Identifier | 235497 = Lawson ID"}]},{"description":"SCREW CANN P/T 4X32MM","code_information":[{"code":"Sx00-1142-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"148469","type":"LOCAL"},{"code":"235496","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.47,"discounted_cash":351.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 148469 = Hospital System Supply Identifier | 235496 = Lawson ID"}]},{"description":"SCREW CANN P/T 4X46MM","code_information":[{"code":"Sx00-1142-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"148475","type":"LOCAL"},{"code":"235502","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.47,"discounted_cash":351.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 148475 = Hospital System Supply Identifier | 235502 = Lawson ID"}]},{"description":"SCREW CANN F/T 5.0X44MM","code_information":[{"code":"Sx00-1142-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"148495","type":"LOCAL"},{"code":"235526","type":"LOCAL"}],"standard_charges":[{"gross_charge":476.12,"discounted_cash":357.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 148495 = Hospital System Supply Identifier | 235526 = Lawson ID"}]},{"description":"SCREW CANN F/T 5.0X48MM","code_information":[{"code":"Sx00-1142-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"148496","type":"LOCAL"},{"code":"235527","type":"LOCAL"}],"standard_charges":[{"gross_charge":476.12,"discounted_cash":357.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 148496 = Hospital System Supply Identifier | 235527 = Lawson ID"}]},{"description":"SCREW CANN F/T 5.0X55MM","code_information":[{"code":"Sx00-1142-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"148497","type":"LOCAL"},{"code":"235528","type":"LOCAL"}],"standard_charges":[{"gross_charge":476.12,"discounted_cash":357.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 148497 = Hospital System Supply Identifier | 235528 = Lawson ID"}]},{"description":"SCREW CANN F/T 5.0X12MM","code_information":[{"code":"Sx00-1142-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408719","type":"LOCAL"},{"code":"339439","type":"LOCAL"}],"standard_charges":[{"gross_charge":476.12,"discounted_cash":357.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408719 = Hospital System Supply Identifier | 339439 = Lawson ID"}]},{"description":"SCREW CANN F/T 5.0X16MM","code_information":[{"code":"Sx00-1142-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408720","type":"LOCAL"},{"code":"339440","type":"LOCAL"}],"standard_charges":[{"gross_charge":476.12,"discounted_cash":357.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408720 = Hospital System Supply Identifier | 339440 = Lawson ID"}]},{"description":"SCREW CANN F/T 5.0X65MM","code_information":[{"code":"Sx00-1142-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408721","type":"LOCAL"},{"code":"339443","type":"LOCAL"}],"standard_charges":[{"gross_charge":476.12,"discounted_cash":357.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408721 = Hospital System Supply Identifier | 339443 = Lawson ID"}]},{"description":"SCREW CANN MINI MAGNA-FX 5X65","code_information":[{"code":"Sx00-1142-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"35086","type":"LOCAL"},{"code":"116086","type":"LOCAL"}],"standard_charges":[{"gross_charge":476.12,"discounted_cash":357.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 35086 = Hospital System Supply Identifier | 116086 = Lawson ID"}]},{"description":"SCREW CANN MINI MAGNA-FX 5X60","code_information":[{"code":"Sx00-1142-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"35085","type":"LOCAL"},{"code":"116084","type":"LOCAL"}],"standard_charges":[{"gross_charge":476.12,"discounted_cash":357.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 35085 = Hospital System Supply Identifier | 116084 = Lawson ID"}]},{"description":"SCREW CANN MINI MAGNA-FX 5X50","code_information":[{"code":"Sx00-1142-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"35083","type":"LOCAL"},{"code":"116082","type":"LOCAL"}],"standard_charges":[{"gross_charge":476.12,"discounted_cash":357.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 35083 = Hospital System Supply Identifier | 116082 = Lawson ID"}]},{"description":"SCREW CANN MINI MAGNA-FX 5X48","code_information":[{"code":"Sx00-1142-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"35082","type":"LOCAL"},{"code":"116081","type":"LOCAL"}],"standard_charges":[{"gross_charge":476.12,"discounted_cash":357.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 35082 = Hospital System Supply Identifier | 116081 = Lawson ID"}]},{"description":"SCREW CANN MINI MAGNA-FX 5X55","code_information":[{"code":"Sx00-1142-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"35084","type":"LOCAL"},{"code":"116083","type":"LOCAL"}],"standard_charges":[{"gross_charge":476.12,"discounted_cash":357.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 35084 = Hospital System Supply Identifier | 116083 = Lawson ID"}]},{"description":"SCREW CANN MINI MAGNA-FX 5X40","code_information":[{"code":"Sx00-1142-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"35078","type":"LOCAL"},{"code":"116076","type":"LOCAL"}],"standard_charges":[{"gross_charge":362.14,"discounted_cash":271.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 35078 = Hospital System Supply Identifier | 116076 = Lawson ID"}]},{"description":"SCREW CANN MINI MAGNA-FX 5X36","code_information":[{"code":"Sx00-1142-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"35076","type":"LOCAL"},{"code":"116074","type":"LOCAL"}],"standard_charges":[{"gross_charge":331.09,"discounted_cash":248.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 35076 = Hospital System Supply Identifier | 116074 = Lawson ID"}]},{"description":"SCREW CANN MINI MAGNA-FX 5X44","code_information":[{"code":"Sx00-1142-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"35080","type":"LOCAL"},{"code":"116079","type":"LOCAL"}],"standard_charges":[{"gross_charge":376.62,"discounted_cash":282.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 35080 = Hospital System Supply Identifier | 116079 = Lawson ID"}]},{"description":"SCREW CANN MINI MAGNA-FX 5X34","code_information":[{"code":"Sx00-1142-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"35075","type":"LOCAL"},{"code":"116073","type":"LOCAL"}],"standard_charges":[{"gross_charge":476.12,"discounted_cash":357.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 35075 = Hospital System Supply Identifier | 116073 = Lawson ID"}]},{"description":"SCREW CANN MINI MAGNA-FX 5X30","code_information":[{"code":"Sx00-1142-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"35073","type":"LOCAL"},{"code":"116071","type":"LOCAL"}],"standard_charges":[{"gross_charge":476.12,"discounted_cash":357.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 35073 = Hospital System Supply Identifier | 116071 = Lawson ID"}]},{"description":"DISC - TAP SURG CANN CHS SCRW 7MM","code_information":[{"code":"Sx00-1146-007","type":"CDM"},{"code":"272","type":"RC"},{"code":"407535","type":"LOCAL"},{"code":"202373","type":"LOCAL"}],"standard_charges":[{"gross_charge":1128.0,"discounted_cash":846.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407535 = Hospital System Supply Identifier | 202373 = Lawson ID"}]},{"description":"SCREW CANN MAGNA-FX 16MM 7X30","code_information":[{"code":"Sx00-1146-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407529","type":"LOCAL"},{"code":"201497","type":"LOCAL"}],"standard_charges":[{"gross_charge":581.14,"discounted_cash":435.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407529 = Hospital System Supply Identifier | 201497 = Lawson ID"}]},{"description":"SCREW CANN MAGNA-FX 32MM 7X55","code_information":[{"code":"Sx00-1146-055","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407550","type":"LOCAL"},{"code":"205031","type":"LOCAL"}],"standard_charges":[{"gross_charge":581.14,"discounted_cash":435.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407550 = Hospital System Supply Identifier | 205031 = Lawson ID"}]},{"description":"SCREW CANN MAGNA-FX 32MM 7X75","code_information":[{"code":"Sx00-1146-075","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407512","type":"LOCAL"},{"code":"201197","type":"LOCAL"}],"standard_charges":[{"gross_charge":581.14,"discounted_cash":435.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407512 = Hospital System Supply Identifier | 201197 = Lawson ID"}]},{"description":"SCREW CANN MAGNA-FX 32MM 7X80","code_information":[{"code":"Sx00-1146-080","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407517","type":"LOCAL"},{"code":"201359","type":"LOCAL"}],"standard_charges":[{"gross_charge":581.14,"discounted_cash":435.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407517 = Hospital System Supply Identifier | 201359 = Lawson ID"}]},{"description":"SCREW CANN MAGNA-FX F/T 7X80","code_information":[{"code":"Sx00-1146-080","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408763","type":"LOCAL"},{"code":"339795","type":"LOCAL"}],"standard_charges":[{"gross_charge":581.14,"discounted_cash":435.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408763 = Hospital System Supply Identifier | 339795 = Lawson ID"}]},{"description":"SCREW CANN MAGNA-FX 16MM 7X80","code_information":[{"code":"Sx00-1146-080","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"53570","type":"LOCAL"},{"code":"116091","type":"LOCAL"}],"standard_charges":[{"gross_charge":581.14,"discounted_cash":435.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 53570 = Hospital System Supply Identifier | 116091 = Lawson ID"}]},{"description":"SCREW CANN MAGNA-FX 16MM 7X85","code_information":[{"code":"Sx00-1146-085","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"53571","type":"LOCAL"},{"code":"116092","type":"LOCAL"}],"standard_charges":[{"gross_charge":581.14,"discounted_cash":435.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 53571 = Hospital System Supply Identifier | 116092 = Lawson ID"}]},{"description":"SCREW CANN MAGNA-FX 32MM 7X85","code_information":[{"code":"Sx00-1146-085","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407513","type":"LOCAL"},{"code":"201198","type":"LOCAL"}],"standard_charges":[{"gross_charge":581.14,"discounted_cash":435.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407513 = Hospital System Supply Identifier | 201198 = Lawson ID"}]},{"description":"SCREW CANN MAGNA-FX F/T 7X85","code_information":[{"code":"Sx00-1146-085","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408764","type":"LOCAL"},{"code":"339796","type":"LOCAL"}],"standard_charges":[{"gross_charge":581.14,"discounted_cash":435.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408764 = Hospital System Supply Identifier | 339796 = Lawson ID"}]},{"description":"SCREW CANN MAGNA-FX 16MM 7X90","code_information":[{"code":"Sx00-1146-090","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"53572","type":"LOCAL"},{"code":"116093","type":"LOCAL"}],"standard_charges":[{"gross_charge":442.43,"discounted_cash":331.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 53572 = Hospital System Supply Identifier | 116093 = Lawson ID"}]},{"description":"SCREW CANN MAGNA-FX 32MM 7X90","code_information":[{"code":"Sx00-1146-090","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407515","type":"LOCAL"},{"code":"201293","type":"LOCAL"}],"standard_charges":[{"gross_charge":581.14,"discounted_cash":435.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407515 = Hospital System Supply Identifier | 201293 = Lawson ID"}]},{"description":"SCREW CANN MAGNA-FX F/T 7X90","code_information":[{"code":"Sx00-1146-090","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408765","type":"LOCAL"},{"code":"339797","type":"LOCAL"}],"standard_charges":[{"gross_charge":581.14,"discounted_cash":435.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408765 = Hospital System Supply Identifier | 339797 = Lawson ID"}]},{"description":"SCREW CANN MAGNA-FX 16MM 7X95","code_information":[{"code":"Sx00-1146-095","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"53573","type":"LOCAL"},{"code":"116094","type":"LOCAL"}],"standard_charges":[{"gross_charge":404.34,"discounted_cash":303.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 53573 = Hospital System Supply Identifier | 116094 = Lawson ID"}]},{"description":"SCREW CANN MAGNA-FX 32MM 7X95","code_information":[{"code":"Sx00-1146-095","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407516","type":"LOCAL"},{"code":"201358","type":"LOCAL"}],"standard_charges":[{"gross_charge":581.14,"discounted_cash":435.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407516 = Hospital System Supply Identifier | 201358 = Lawson ID"}]},{"description":"SCREW CANN MAGNA-FX F/T 7X100","code_information":[{"code":"Sx00-1146-100","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408766","type":"LOCAL"},{"code":"339799","type":"LOCAL"}],"standard_charges":[{"gross_charge":581.14,"discounted_cash":435.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408766 = Hospital System Supply Identifier | 339799 = Lawson ID"}]},{"description":"SCREW CANN MAGNA-FX 16MM 7X100","code_information":[{"code":"Sx00-1146-100","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"53574","type":"LOCAL"},{"code":"116095","type":"LOCAL"}],"standard_charges":[{"gross_charge":473.92,"discounted_cash":355.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 53574 = Hospital System Supply Identifier | 116095 = Lawson ID"}]},{"description":"SCREW CANN MAGNA-FX F/T 7X105","code_information":[{"code":"Sx00-1146-105","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408767","type":"LOCAL"},{"code":"339800","type":"LOCAL"}],"standard_charges":[{"gross_charge":581.14,"discounted_cash":435.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408767 = Hospital System Supply Identifier | 339800 = Lawson ID"}]},{"description":"SCREW CANN MAGNA-FX F/T 7X110","code_information":[{"code":"Sx00-1146-110","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408768","type":"LOCAL"},{"code":"339801","type":"LOCAL"}],"standard_charges":[{"gross_charge":581.14,"discounted_cash":435.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408768 = Hospital System Supply Identifier | 339801 = Lawson ID"}]},{"description":"DUP USE 815633 - PIN GUIDE 1.6MM","code_information":[{"code":"Sx00-1147-006","type":"CDM"},{"code":"272","type":"RC"},{"code":"408926","type":"LOCAL"},{"code":"343898","type":"LOCAL"}],"standard_charges":[{"gross_charge":888.84,"discounted_cash":666.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408926 = Hospital System Supply Identifier | 343898 = Lawson ID"}]},{"description":"DUP USE 815634 - PIN GUIDE 3.2MM","code_information":[{"code":"Sx00-1147-009","type":"CDM"},{"code":"272","type":"RC"},{"code":"408945","type":"LOCAL"},{"code":"343919","type":"LOCAL"}],"standard_charges":[{"gross_charge":888.84,"discounted_cash":666.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408945 = Hospital System Supply Identifier | 343919 = Lawson ID"}]},{"description":"DRILL CANN Q/C 2.3MM","code_information":[{"code":"Sx00-1147-024","type":"CDM"},{"code":"272","type":"RC"},{"code":"195901","type":"LOCAL"},{"code":"395445","type":"LOCAL"}],"standard_charges":[{"gross_charge":713.61,"discounted_cash":535.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 195901 = Hospital System Supply Identifier | 395445 = Lawson ID"}]},{"description":"BIT DRILL CANN Q/C 2.7MM","code_information":[{"code":"Sx00-1147-026","type":"CDM"},{"code":"272","type":"RC"},{"code":"193566","type":"LOCAL"},{"code":"314877","type":"LOCAL"}],"standard_charges":[{"gross_charge":730.33,"discounted_cash":547.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 193566 = Hospital System Supply Identifier | 314877 = Lawson ID"}]},{"description":"DRILL CANN Q/C 3.2MM","code_information":[{"code":"Sx00-1147-027","type":"CDM"},{"code":"272","type":"RC"},{"code":"195829","type":"LOCAL"},{"code":"393263","type":"LOCAL"}],"standard_charges":[{"gross_charge":1016.21,"discounted_cash":762.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 195829 = Hospital System Supply Identifier | 393263 = Lawson ID"}]},{"description":"BIT DRILL CANN Q/C 4.5MM","code_information":[{"code":"Sx00-1147-028","type":"CDM"},{"code":"272","type":"RC"},{"code":"408769","type":"LOCAL"},{"code":"339806","type":"LOCAL"}],"standard_charges":[{"gross_charge":1016.21,"discounted_cash":762.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408769 = Hospital System Supply Identifier | 339806 = Lawson ID"}]},{"description":"DRILL CANN Q/C 4.5MM","code_information":[{"code":"Sx00-1147-029","type":"CDM"},{"code":"272","type":"RC"},{"code":"409110","type":"LOCAL"},{"code":"387535","type":"LOCAL"}],"standard_charges":[{"gross_charge":1016.21,"discounted_cash":762.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 409110 = Hospital System Supply Identifier | 387535 = Lawson ID"}]},{"description":"BIT DRILL CANN Q/C 5.0MM","code_information":[{"code":"Sx00-1147-030","type":"CDM"},{"code":"272","type":"RC"},{"code":"408395","type":"LOCAL"},{"code":"314162","type":"LOCAL"}],"standard_charges":[{"gross_charge":1016.21,"discounted_cash":762.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408395 = Hospital System Supply Identifier | 314162 = Lawson ID"}]},{"description":"TAP SURG CANN Q/C 4.0MM","code_information":[{"code":"Sx00-1147-038","type":"CDM"},{"code":"272","type":"RC"},{"code":"408923","type":"LOCAL"},{"code":"343895","type":"LOCAL"}],"standard_charges":[{"gross_charge":1016.21,"discounted_cash":762.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408923 = Hospital System Supply Identifier | 343895 = Lawson ID"}]},{"description":"TAP SURG CANN Q/C 6.5MM","code_information":[{"code":"Sx00-1147-041","type":"CDM"},{"code":"272","type":"RC"},{"code":"411228","type":"LOCAL"},{"code":"461757","type":"LOCAL"}],"standard_charges":[{"gross_charge":1016.21,"discounted_cash":762.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 411228 = Hospital System Supply Identifier | 461757 = Lawson ID"}]},{"description":"PIN GDE CLUS","code_information":[{"code":"Sx00-1147-061","type":"CDM"},{"code":"272","type":"RC"},{"code":"408949","type":"LOCAL"},{"code":"343924","type":"LOCAL"}],"standard_charges":[{"gross_charge":2990.94,"discounted_cash":2243.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408949 = Hospital System Supply Identifier | 343924 = Lawson ID"}]},{"description":"FCP SCREW HLDING","code_information":[{"code":"Sx00-1147-080","type":"CDM"},{"code":"272","type":"RC"},{"code":"408924","type":"LOCAL"},{"code":"343896","type":"LOCAL"}],"standard_charges":[{"gross_charge":788.77,"discounted_cash":591.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408924 = Hospital System Supply Identifier | 343896 = Lawson ID"}]},{"description":"WASHER CANN SCR 5.5-7.5MM 1.2","code_information":[{"code":"Sx00-1147-099","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"721296","type":"LOCAL"},{"code":"732743","type":"LOCAL"}],"standard_charges":[{"gross_charge":94.5,"discounted_cash":70.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 721296 = Hospital System Supply Identifier | 732743 = Lawson ID"}]},{"description":"SCREW CANN MINI HERB 2.5X16MM","code_information":[{"code":"Sx00-1150-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"151048","type":"LOCAL"},{"code":"250825","type":"LOCAL"}],"standard_charges":[{"gross_charge":1044.81,"discounted_cash":783.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 151048 = Hospital System Supply Identifier | 250825 = Lawson ID"}]},{"description":"SCREW CANN HERB/WHIPPLE 12MM","code_information":[{"code":"Sx00-1152-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"15450","type":"LOCAL"},{"code":"114304","type":"LOCAL"}],"standard_charges":[{"gross_charge":987.22,"discounted_cash":740.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 15450 = Hospital System Supply Identifier | 114304 = Lawson ID"}]},{"description":"SCREW CANN HERB/WHIPPLE 14MM","code_information":[{"code":"Sx00-1152-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"15451","type":"LOCAL"},{"code":"114305","type":"LOCAL"}],"standard_charges":[{"gross_charge":987.22,"discounted_cash":740.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 15451 = Hospital System Supply Identifier | 114305 = Lawson ID"}]},{"description":"DRILL TIP HERBERT DISP","code_information":[{"code":"Sx00-1152-015","type":"CDM"},{"code":"272","type":"RC"},{"code":"17319","type":"LOCAL"},{"code":"145717","type":"LOCAL"}],"standard_charges":[{"gross_charge":470.41,"discounted_cash":352.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 17319 = Hospital System Supply Identifier | 145717 = Lawson ID"}]},{"description":"SCREW CANN HERB/WHIPPLE 16MM","code_information":[{"code":"Sx00-1152-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"15452","type":"LOCAL"},{"code":"114306","type":"LOCAL"}],"standard_charges":[{"gross_charge":987.22,"discounted_cash":740.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 15452 = Hospital System Supply Identifier | 114306 = Lawson ID"}]},{"description":"SCREW CANN HERB/WHIPPLE 18MM","code_information":[{"code":"Sx00-1152-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"15849","type":"LOCAL"},{"code":"124103","type":"LOCAL"}],"standard_charges":[{"gross_charge":1196.58,"discounted_cash":897.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 15849 = Hospital System Supply Identifier | 124103 = Lawson ID"}]},{"description":"SCREW CANN HERB/WHIPPLE 20MM","code_information":[{"code":"Sx00-1152-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"15453","type":"LOCAL"},{"code":"114307","type":"LOCAL"}],"standard_charges":[{"gross_charge":987.22,"discounted_cash":740.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 15453 = Hospital System Supply Identifier | 114307 = Lawson ID"}]},{"description":"SCREW CANN HERB/WHIPPLE 22MM","code_information":[{"code":"Sx00-1152-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"17599","type":"LOCAL"},{"code":"154038","type":"LOCAL"}],"standard_charges":[{"gross_charge":987.22,"discounted_cash":740.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 17599 = Hospital System Supply Identifier | 154038 = Lawson ID"}]},{"description":"SCREW CANN HERB/WHIPPLE 24MM","code_information":[{"code":"Sx00-1152-024","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"15454","type":"LOCAL"},{"code":"114309","type":"LOCAL"}],"standard_charges":[{"gross_charge":987.22,"discounted_cash":740.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 15454 = Hospital System Supply Identifier | 114309 = Lawson ID"}]},{"description":"SCREW CANN HERB/WHIPPLE 26MM","code_information":[{"code":"Sx00-1152-026","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"15455","type":"LOCAL"},{"code":"114310","type":"LOCAL"}],"standard_charges":[{"gross_charge":987.22,"discounted_cash":740.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 15455 = Hospital System Supply Identifier | 114310 = Lawson ID"}]},{"description":"SCREW CANN HERB/WHIPPLE 28MM","code_information":[{"code":"Sx00-1152-028","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"15456","type":"LOCAL"},{"code":"114311","type":"LOCAL"}],"standard_charges":[{"gross_charge":987.22,"discounted_cash":740.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 15456 = Hospital System Supply Identifier | 114311 = Lawson ID"}]},{"description":"SCREW CANN HERB/WHIPPLE 30MM","code_information":[{"code":"Sx00-1152-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"15457","type":"LOCAL"},{"code":"114312","type":"LOCAL"}],"standard_charges":[{"gross_charge":987.22,"discounted_cash":740.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 15457 = Hospital System Supply Identifier | 114312 = Lawson ID"}]},{"description":"PLATE RECON STR 2.7 24H","code_information":[{"code":"Sx00-1179-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408782","type":"LOCAL"},{"code":"339884","type":"LOCAL"}],"standard_charges":[{"gross_charge":1273.06,"discounted_cash":954.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408782 = Hospital System Supply Identifier | 339884 = Lawson ID"}]},{"description":"PLATE RECON STR 2.7 22H","code_information":[{"code":"Sx00-1179-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408781","type":"LOCAL"},{"code":"339883","type":"LOCAL"}],"standard_charges":[{"gross_charge":1135.64,"discounted_cash":851.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408781 = Hospital System Supply Identifier | 339883 = Lawson ID"}]},{"description":"PLATE RECON STR 2.7 20H","code_information":[{"code":"Sx00-1179-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408780","type":"LOCAL"},{"code":"339882","type":"LOCAL"}],"standard_charges":[{"gross_charge":979.97,"discounted_cash":734.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408780 = Hospital System Supply Identifier | 339882 = Lawson ID"}]},{"description":"PLATE RECON STR 2.7 18H","code_information":[{"code":"Sx00-1179-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408779","type":"LOCAL"},{"code":"339881","type":"LOCAL"}],"standard_charges":[{"gross_charge":914.62,"discounted_cash":685.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408779 = Hospital System Supply Identifier | 339881 = Lawson ID"}]},{"description":"PLATE RECON STR 2.7 16H","code_information":[{"code":"Sx00-1179-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408778","type":"LOCAL"},{"code":"339880","type":"LOCAL"}],"standard_charges":[{"gross_charge":740.41,"discounted_cash":555.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408778 = Hospital System Supply Identifier | 339880 = Lawson ID"}]},{"description":"PLATE RECON STR 2.7 14H","code_information":[{"code":"Sx00-1179-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408777","type":"LOCAL"},{"code":"339879","type":"LOCAL"}],"standard_charges":[{"gross_charge":721.98,"discounted_cash":541.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408777 = Hospital System Supply Identifier | 339879 = Lawson ID"}]},{"description":"PLATE RECON STR 2.7 12H","code_information":[{"code":"Sx00-1179-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408776","type":"LOCAL"},{"code":"339878","type":"LOCAL"}],"standard_charges":[{"gross_charge":721.98,"discounted_cash":541.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408776 = Hospital System Supply Identifier | 339878 = Lawson ID"}]},{"description":"PLATE RECON STR 2.7 10H","code_information":[{"code":"Sx00-1179-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408775","type":"LOCAL"},{"code":"339877","type":"LOCAL"}],"standard_charges":[{"gross_charge":721.98,"discounted_cash":541.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408775 = Hospital System Supply Identifier | 339877 = Lawson ID"}]},{"description":"PLATE RECON STR 2.7 8H","code_information":[{"code":"Sx00-1179-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408774","type":"LOCAL"},{"code":"339876","type":"LOCAL"}],"standard_charges":[{"gross_charge":721.98,"discounted_cash":541.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408774 = Hospital System Supply Identifier | 339876 = Lawson ID"}]},{"description":"PLATE RECON STR 2.7 6H","code_information":[{"code":"Sx00-1179-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408773","type":"LOCAL"},{"code":"339875","type":"LOCAL"}],"standard_charges":[{"gross_charge":721.98,"discounted_cash":541.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408773 = Hospital System Supply Identifier | 339875 = Lawson ID"}]},{"description":"PLATE TUBE 130 1181-130-03","code_information":[{"code":"Sx00-1181-130","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407518","type":"LOCAL"},{"code":"201370","type":"LOCAL"}],"standard_charges":[{"gross_charge":1068.27,"discounted_cash":801.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407518 = Hospital System Supply Identifier | 201370 = Lawson ID"}]},{"description":"PLATE TUBE 130 1181-130-02","code_information":[{"code":"Sx00-1181-130","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407531","type":"LOCAL"},{"code":"201833","type":"LOCAL"}],"standard_charges":[{"gross_charge":1068.27,"discounted_cash":801.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407531 = Hospital System Supply Identifier | 201833 = Lawson ID"}]},{"description":"PLATE TUBE 135 1181-135-03","code_information":[{"code":"Sx00-1181-135","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407509","type":"LOCAL"},{"code":"200695","type":"LOCAL"}],"standard_charges":[{"gross_charge":1068.27,"discounted_cash":801.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407509 = Hospital System Supply Identifier | 200695 = Lawson ID"}]},{"description":"PLATE TUBE 135 1181-135-02","code_information":[{"code":"Sx00-1181-135","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407542","type":"LOCAL"},{"code":"203357","type":"LOCAL"}],"standard_charges":[{"gross_charge":1068.27,"discounted_cash":801.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407542 = Hospital System Supply Identifier | 203357 = Lawson ID"}]},{"description":"PLATE TUBE 140 1181-140-02","code_information":[{"code":"Sx00-1181-140","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407543","type":"LOCAL"},{"code":"203361","type":"LOCAL"}],"standard_charges":[{"gross_charge":1068.27,"discounted_cash":801.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407543 = Hospital System Supply Identifier | 203361 = Lawson ID"}]},{"description":"PLATE TUBE 140 1181-140-03","code_information":[{"code":"Sx00-1181-140","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407510","type":"LOCAL"},{"code":"201155","type":"LOCAL"}],"standard_charges":[{"gross_charge":1068.27,"discounted_cash":801.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407510 = Hospital System Supply Identifier | 201155 = Lawson ID"}]},{"description":"PLATE TUBE 145 1181-145-03","code_information":[{"code":"Sx00-1181-145","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407511","type":"LOCAL"},{"code":"201175","type":"LOCAL"}],"standard_charges":[{"gross_charge":1068.27,"discounted_cash":801.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407511 = Hospital System Supply Identifier | 201175 = Lawson ID"}]},{"description":"PLATE TUBE 145 1181-145-02","code_information":[{"code":"Sx00-1181-145","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407545","type":"LOCAL"},{"code":"204507","type":"LOCAL"}],"standard_charges":[{"gross_charge":1068.27,"discounted_cash":801.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407545 = Hospital System Supply Identifier | 204507 = Lawson ID"}]},{"description":"PLATE SUPCNDYL TB 150 2H","code_information":[{"code":"Sx00-1181-150","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407530","type":"LOCAL"},{"code":"201531","type":"LOCAL"}],"standard_charges":[{"gross_charge":1068.27,"discounted_cash":801.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407530 = Hospital System Supply Identifier | 201531 = Lawson ID"}]},{"description":"PLATE TUBE 150 1181-150-03","code_information":[{"code":"Sx00-1181-150","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407546","type":"LOCAL"},{"code":"204516","type":"LOCAL"}],"standard_charges":[{"gross_charge":1068.27,"discounted_cash":801.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407546 = Hospital System Supply Identifier | 204516 = Lawson ID"}]},{"description":"WIRE SUT ORTH BEAD 18GA","code_information":[{"code":"Sx00-1191-038","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"20912","type":"LOCAL"},{"code":"103817","type":"LOCAL"}],"standard_charges":[{"gross_charge":31.5,"discounted_cash":23.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 20912 = Hospital System Supply Identifier | 103817 = Lawson ID"}]},{"description":"WIRE SUT ORTH BEAD 16GA","code_information":[{"code":"Sx00-1191-048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"16374","type":"LOCAL"},{"code":"131618","type":"LOCAL"}],"standard_charges":[{"gross_charge":31.5,"discounted_cash":23.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 16374 = Hospital System Supply Identifier | 131618 = Lawson ID"}]},{"description":"PLATE DHS VRSAFX2 95D 16H","code_information":[{"code":"Sx00-1193-095","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410141","type":"LOCAL"},{"code":"410379","type":"LOCAL"}],"standard_charges":[{"gross_charge":1585.68,"discounted_cash":1189.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410141 = Hospital System Supply Identifier | 410379 = Lawson ID"}]},{"description":"DISC - PUNCH ORTH TRAB","code_information":[{"code":"Sx00-1197-010","type":"CDM"},{"code":"272","type":"RC"},{"code":"744077","type":"LOCAL"},{"code":"421234","type":"LOCAL"}],"standard_charges":[{"gross_charge":665.05,"discounted_cash":498.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 744077 = Hospital System Supply Identifier | 421234 = Lawson ID"}]},{"description":"ROD ORTH TRABCLR OSTNECROSIS","code_information":[{"code":"Sx00-1197-080","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408707","type":"LOCAL"},{"code":"339245","type":"LOCAL"}],"standard_charges":[{"gross_charge":10705.04,"discounted_cash":8028.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408707 = Hospital System Supply Identifier | 339245 = Lawson ID"}]},{"description":"IMP HIP OSTEONECROSIS 10X90MM","code_information":[{"code":"Sx00-1197-090","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"171788","type":"LOCAL"},{"code":"439191","type":"LOCAL"}],"standard_charges":[{"gross_charge":10705.04,"discounted_cash":8028.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 171788 = Hospital System Supply Identifier | 439191 = Lawson ID"}]},{"description":"IMP OSTEONECROSIS 10 X 95MM","code_information":[{"code":"Sx00-1197-095","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"411206","type":"LOCAL"},{"code":"454951","type":"LOCAL"}],"standard_charges":[{"gross_charge":10705.04,"discounted_cash":8028.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 411206 = Hospital System Supply Identifier | 454951 = Lawson ID"}]},{"description":"PLATE BLD CANN INF 90D 25X5X3H","code_information":[{"code":"Sx00-1200-100","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054606","type":"LOCAL"},{"code":"877056","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054606 = Hospital System Supply Identifier | 877056 = Lawson ID"}]},{"description":"PLATE BLD CANN INF 90D 30X5X3H","code_information":[{"code":"Sx00-1200-100","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054607","type":"LOCAL"},{"code":"877057","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054607 = Hospital System Supply Identifier | 877057 = Lawson ID"}]},{"description":"PLATE BLD CANN INF 90D 35X5X3H","code_information":[{"code":"Sx00-1200-100","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054608","type":"LOCAL"},{"code":"877058","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054608 = Hospital System Supply Identifier | 877058 = Lawson ID"}]},{"description":"PLATE BLD CANN INF 90 25X12X3H","code_information":[{"code":"Sx00-1200-110","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054609","type":"LOCAL"},{"code":"877059","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054609 = Hospital System Supply Identifier | 877059 = Lawson ID"}]},{"description":"PLATE BLD CANN INF 90 30X12X3H","code_information":[{"code":"Sx00-1200-110","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054610","type":"LOCAL"},{"code":"877060","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054610 = Hospital System Supply Identifier | 877060 = Lawson ID"}]},{"description":"PLATE BLD CANN INF 90 35X12X3H","code_information":[{"code":"Sx00-1200-110","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054611","type":"LOCAL"},{"code":"877061","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054611 = Hospital System Supply Identifier | 877061 = Lawson ID"}]},{"description":"PLATE BLD CANN INF 90D 35X5X2H","code_information":[{"code":"Sx00-1200-200","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054613","type":"LOCAL"},{"code":"877063","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054613 = Hospital System Supply Identifier | 877063 = Lawson ID"}]},{"description":"BLADE PLATE 5MM X25MM 2H 90-DE","code_information":[{"code":"Sx00-1200-200","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"813192","type":"LOCAL"},{"code":"S298353","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 813192 = Hospital System Supply Identifier | S298353 = Lawson ID"}]},{"description":"PLATE BLD CANN INF 90D 30X5X2H","code_information":[{"code":"Sx00-1200-200","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054612","type":"LOCAL"},{"code":"877062","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054612 = Hospital System Supply Identifier | 877062 = Lawson ID"}]},{"description":"PLATE BLD CANN INF 130 25X5X3H","code_information":[{"code":"Sx00-1200-250","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054614","type":"LOCAL"},{"code":"877064","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054614 = Hospital System Supply Identifier | 877064 = Lawson ID"}]},{"description":"PLATE BLD CANN INF 130 30X5X3H","code_information":[{"code":"Sx00-1200-250","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054615","type":"LOCAL"},{"code":"877065","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054615 = Hospital System Supply Identifier | 877065 = Lawson ID"}]},{"description":"PLATE BLD CANN INF 130 35X5X3H","code_information":[{"code":"Sx00-1200-250","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054616","type":"LOCAL"},{"code":"877066","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054616 = Hospital System Supply Identifier | 877066 = Lawson ID"}]},{"description":"PLATE BLD CANN INF 130 40X5X3H","code_information":[{"code":"Sx00-1200-250","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054617","type":"LOCAL"},{"code":"877067","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054617 = Hospital System Supply Identifier | 877067 = Lawson ID"}]},{"description":"PLATE BLD CANN INF 130 45X5X3H","code_information":[{"code":"Sx00-1200-250","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054618","type":"LOCAL"},{"code":"877068","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054618 = Hospital System Supply Identifier | 877068 = Lawson ID"}]},{"description":"PLATE BLD CANN INF 130 50X5X3H","code_information":[{"code":"Sx00-1200-250","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054619","type":"LOCAL"},{"code":"877069","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054619 = Hospital System Supply Identifier | 877069 = Lawson ID"}]},{"description":"PLATE BLD CANN INF 130 55X5X3H","code_information":[{"code":"Sx00-1200-250","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054620","type":"LOCAL"},{"code":"877070","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054620 = Hospital System Supply Identifier | 877070 = Lawson ID"}]},{"description":"PLATE BLD CANN INF 130 60X5X3H","code_information":[{"code":"Sx00-1200-250","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054621","type":"LOCAL"},{"code":"877071","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054621 = Hospital System Supply Identifier | 877071 = Lawson ID"}]},{"description":"PLATE BONE CANNULATED CHILD OSTEOTOMY 90 DEGREE 0012003005 6X50MM","code_information":[{"code":"Sx00-1200-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356811","type":"LOCAL"},{"code":"1082556","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356811 = Hospital System Supply Identifier | 1082556 = Lawson ID"}]},{"description":"PLATE BLD CANN CHD 90 40X10X3H","code_information":[{"code":"Sx00-1200-350","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054630","type":"LOCAL"},{"code":"877080","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054630 = Hospital System Supply Identifier | 877080 = Lawson ID"}]},{"description":"PLATE BLD CANN CHD 90 35X10X3H","code_information":[{"code":"Sx00-1200-350","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054629","type":"LOCAL"},{"code":"877079","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054629 = Hospital System Supply Identifier | 877079 = Lawson ID"}]},{"description":"PLATE BLD CANN CHD 90 30X10X3H","code_information":[{"code":"Sx00-1200-350","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054628","type":"LOCAL"},{"code":"877078","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054628 = Hospital System Supply Identifier | 877078 = Lawson ID"}]},{"description":"PLATE BLD CANN CHD 90 25X10X3H","code_information":[{"code":"Sx00-1200-350","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054627","type":"LOCAL"},{"code":"877077","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054627 = Hospital System Supply Identifier | 877077 = Lawson ID"}]},{"description":"PLATE BLD CANN CHLD 90 50X6X3H","code_information":[{"code":"Sx00-1200-350","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054626","type":"LOCAL"},{"code":"877076","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054626 = Hospital System Supply Identifier | 877076 = Lawson ID"}]},{"description":"PLATE 90DEG 40X6MM","code_information":[{"code":"Sx00-1200-350","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"918407","type":"LOCAL"},{"code":"711670","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 918407 = Hospital System Supply Identifier | 711670 = Lawson ID"}]},{"description":"PLATE BLD CANN CHLD 90 35X6X3H","code_information":[{"code":"Sx00-1200-350","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054624","type":"LOCAL"},{"code":"877074","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054624 = Hospital System Supply Identifier | 877074 = Lawson ID"}]},{"description":"PLATE BLD CANN CHLD 90 30X6X3H","code_information":[{"code":"Sx00-1200-350","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054623","type":"LOCAL"},{"code":"877073","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054623 = Hospital System Supply Identifier | 877073 = Lawson ID"}]},{"description":"PLATE BLD CANN CHLD 90 25X6X3H","code_information":[{"code":"Sx00-1200-350","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054622","type":"LOCAL"},{"code":"877072","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054622 = Hospital System Supply Identifier | 877072 = Lawson ID"}]},{"description":"PLATE BLD CANN CHLD 90 45X6X3H","code_information":[{"code":"Sx00-1200-350","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054625","type":"LOCAL"},{"code":"877075","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054625 = Hospital System Supply Identifier | 877075 = Lawson ID"}]},{"description":"PLATE BLD CANN CHD 90 50X10X3H","code_information":[{"code":"Sx00-1200-351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054632","type":"LOCAL"},{"code":"877082","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054632 = Hospital System Supply Identifier | 877082 = Lawson ID"}]},{"description":"PLATE BLD CANN CHD 90 45X10X3H","code_information":[{"code":"Sx00-1200-351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054631","type":"LOCAL"},{"code":"877081","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054631 = Hospital System Supply Identifier | 877081 = Lawson ID"}]},{"description":"PLATE BLD CANN CHD 100 30X6X3H","code_information":[{"code":"Sx00-1200-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054633","type":"LOCAL"},{"code":"877083","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054633 = Hospital System Supply Identifier | 877083 = Lawson ID"}]},{"description":"PLATE BLD CANN CHD 100 35X6X3H","code_information":[{"code":"Sx00-1200-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054634","type":"LOCAL"},{"code":"877084","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054634 = Hospital System Supply Identifier | 877084 = Lawson ID"}]},{"description":"PLATE BLD CANN CHD 100 40X6X3H","code_information":[{"code":"Sx00-1200-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054635","type":"LOCAL"},{"code":"877085","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054635 = Hospital System Supply Identifier | 877085 = Lawson ID"}]},{"description":"PLATE BLD CANN CHD 100 45X6X3H","code_information":[{"code":"Sx00-1200-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054636","type":"LOCAL"},{"code":"877086","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054636 = Hospital System Supply Identifier | 877086 = Lawson ID"}]},{"description":"PLATE BLD CANN CHD 100 50X6X3H","code_information":[{"code":"Sx00-1200-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054637","type":"LOCAL"},{"code":"877087","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054637 = Hospital System Supply Identifier | 877087 = Lawson ID"}]},{"description":"PLATE BONE 25MM 100-DEG 3-HOLE","code_information":[{"code":"Sx00-1200-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"801298","type":"LOCAL"},{"code":"S299349","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 801298 = Hospital System Supply Identifier | S299349 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL 90 40X6X4H","code_information":[{"code":"Sx00-1200-450","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054638","type":"LOCAL"},{"code":"877088","type":"LOCAL"}],"standard_charges":[{"gross_charge":4530.92,"discounted_cash":3398.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054638 = Hospital System Supply Identifier | 877088 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL 90 45X6X4H","code_information":[{"code":"Sx00-1200-450","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054639","type":"LOCAL"},{"code":"877089","type":"LOCAL"}],"standard_charges":[{"gross_charge":4530.92,"discounted_cash":3398.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054639 = Hospital System Supply Identifier | 877089 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL 90 50X6X4H","code_information":[{"code":"Sx00-1200-450","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054640","type":"LOCAL"},{"code":"877090","type":"LOCAL"}],"standard_charges":[{"gross_charge":4530.92,"discounted_cash":3398.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054640 = Hospital System Supply Identifier | 877090 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL 90 55X6X4H","code_information":[{"code":"Sx00-1200-450","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054641","type":"LOCAL"},{"code":"877091","type":"LOCAL"}],"standard_charges":[{"gross_charge":4530.92,"discounted_cash":3398.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054641 = Hospital System Supply Identifier | 877091 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL 90 60X6X4H","code_information":[{"code":"Sx00-1200-450","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054642","type":"LOCAL"},{"code":"877092","type":"LOCAL"}],"standard_charges":[{"gross_charge":4530.92,"discounted_cash":3398.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054642 = Hospital System Supply Identifier | 877092 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL 90 65X6X4H","code_information":[{"code":"Sx00-1200-450","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054643","type":"LOCAL"},{"code":"877093","type":"LOCAL"}],"standard_charges":[{"gross_charge":4530.92,"discounted_cash":3398.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054643 = Hospital System Supply Identifier | 877093 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL 90 70X6X4H","code_information":[{"code":"Sx00-1200-450","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054644","type":"LOCAL"},{"code":"877094","type":"LOCAL"}],"standard_charges":[{"gross_charge":4530.92,"discounted_cash":3398.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054644 = Hospital System Supply Identifier | 877094 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL90 60X14X4H","code_information":[{"code":"Sx00-1200-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054649","type":"LOCAL"},{"code":"877099","type":"LOCAL"}],"standard_charges":[{"gross_charge":4530.92,"discounted_cash":3398.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054649 = Hospital System Supply Identifier | 877099 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL90 55X14X4H","code_information":[{"code":"Sx00-1200-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054648","type":"LOCAL"},{"code":"877098","type":"LOCAL"}],"standard_charges":[{"gross_charge":4530.92,"discounted_cash":3398.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054648 = Hospital System Supply Identifier | 877098 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL90 65X14X4H","code_information":[{"code":"Sx00-1200-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054650","type":"LOCAL"},{"code":"877100","type":"LOCAL"}],"standard_charges":[{"gross_charge":4530.92,"discounted_cash":3398.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054650 = Hospital System Supply Identifier | 877100 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL90 45X14X4H","code_information":[{"code":"Sx00-1200-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054646","type":"LOCAL"},{"code":"877096","type":"LOCAL"}],"standard_charges":[{"gross_charge":4530.92,"discounted_cash":3398.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054646 = Hospital System Supply Identifier | 877096 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL90 40X14X4H","code_information":[{"code":"Sx00-1200-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054645","type":"LOCAL"},{"code":"877095","type":"LOCAL"}],"standard_charges":[{"gross_charge":4530.92,"discounted_cash":3398.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054645 = Hospital System Supply Identifier | 877095 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL90 50X14X4H","code_information":[{"code":"Sx00-1200-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054647","type":"LOCAL"},{"code":"877097","type":"LOCAL"}],"standard_charges":[{"gross_charge":4530.92,"discounted_cash":3398.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054647 = Hospital System Supply Identifier | 877097 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL90 70X14X4H","code_information":[{"code":"Sx00-1200-452","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054651","type":"LOCAL"},{"code":"877101","type":"LOCAL"}],"standard_charges":[{"gross_charge":4530.92,"discounted_cash":3398.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054651 = Hospital System Supply Identifier | 877101 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL 90 25X6X4H","code_information":[{"code":"Sx00-1200-454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054652","type":"LOCAL"},{"code":"877102","type":"LOCAL"}],"standard_charges":[{"gross_charge":4840.0,"discounted_cash":3630.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054652 = Hospital System Supply Identifier | 877102 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL 90 30X6X4H","code_information":[{"code":"Sx00-1200-454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054653","type":"LOCAL"},{"code":"877103","type":"LOCAL"}],"standard_charges":[{"gross_charge":4840.0,"discounted_cash":3630.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054653 = Hospital System Supply Identifier | 877103 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL 90 35X6X4H","code_information":[{"code":"Sx00-1200-454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054654","type":"LOCAL"},{"code":"877104","type":"LOCAL"}],"standard_charges":[{"gross_charge":4840.0,"discounted_cash":3630.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054654 = Hospital System Supply Identifier | 877104 = Lawson ID"}]},{"description":"PLATE BLD CANN CHD 130 60X0 4H","code_information":[{"code":"Sx00-1200-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054659","type":"LOCAL"},{"code":"877109","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054659 = Hospital System Supply Identifier | 877109 = Lawson ID"}]},{"description":"PLATE BLD CANN CHD 130 50X0 4H","code_information":[{"code":"Sx00-1200-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054657","type":"LOCAL"},{"code":"877107","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054657 = Hospital System Supply Identifier | 877107 = Lawson ID"}]},{"description":"PLATE BLD CANN CHD 130 55X0 4H","code_information":[{"code":"Sx00-1200-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054658","type":"LOCAL"},{"code":"877108","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054658 = Hospital System Supply Identifier | 877108 = Lawson ID"}]},{"description":"PLATE BLD CANN CHD 130 40X0 4H","code_information":[{"code":"Sx00-1200-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054655","type":"LOCAL"},{"code":"877105","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054655 = Hospital System Supply Identifier | 877105 = Lawson ID"}]},{"description":"PLATE BLD CANN CHD 130 45X0 4H","code_information":[{"code":"Sx00-1200-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054656","type":"LOCAL"},{"code":"877106","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054656 = Hospital System Supply Identifier | 877106 = Lawson ID"}]},{"description":"PLATE BONE BLADE LOCKING ADOLESCENT 4 HOLE OSTEOTOMY 0012006003 6X55MM","code_information":[{"code":"Sx00-1200-600","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356879","type":"LOCAL"},{"code":"1082448","type":"LOCAL"}],"standard_charges":[{"gross_charge":4530.92,"discounted_cash":3398.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356879 = Hospital System Supply Identifier | 1082448 = Lawson ID"}]},{"description":"PLATE BONE BLADE LOCKING ADOLESCENT 4 HOLE OSTEOTOMY 0012006004 6X60MM","code_information":[{"code":"Sx00-1200-600","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356428","type":"LOCAL"},{"code":"1082464","type":"LOCAL"}],"standard_charges":[{"gross_charge":4530.92,"discounted_cash":3398.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356428 = Hospital System Supply Identifier | 1082464 = Lawson ID"}]},{"description":"PLATE BONE BLADE LOCKING ADOLESCENT 4 HOLE OSTEOTOMY 0012006002 6X50MM","code_information":[{"code":"Sx00-1200-600","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356947","type":"LOCAL"},{"code":"1082483","type":"LOCAL"}],"standard_charges":[{"gross_charge":4530.92,"discounted_cash":3398.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356947 = Hospital System Supply Identifier | 1082483 = Lawson ID"}]},{"description":"PLATE BONE BLADE LOCKING ADOLESCENT 4 HOLE OSTEOTOMY 0012006006 6X70MM","code_information":[{"code":"Sx00-1200-600","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357050","type":"LOCAL"},{"code":"1082534","type":"LOCAL"}],"standard_charges":[{"gross_charge":4530.92,"discounted_cash":3398.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357050 = Hospital System Supply Identifier | 1082534 = Lawson ID"}]},{"description":"PLATE BONE BLADE LOCKING ADOLESCENT 4 HOLE OSTEOTOMY 0012006005 6X65MM","code_information":[{"code":"Sx00-1200-600","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356584","type":"LOCAL"},{"code":"1082547","type":"LOCAL"}],"standard_charges":[{"gross_charge":4530.92,"discounted_cash":3398.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356584 = Hospital System Supply Identifier | 1082547 = Lawson ID"}]},{"description":"PLATE BONE BLADE LOCKING ADOLESCENT 4 HOLE OSTEOTOMY 0012006001 6X45MM","code_information":[{"code":"Sx00-1200-600","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356812","type":"LOCAL"},{"code":"1082571","type":"LOCAL"}],"standard_charges":[{"gross_charge":4530.92,"discounted_cash":3398.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356812 = Hospital System Supply Identifier | 1082571 = Lawson ID"}]},{"description":"PLATE BONE BLADE LOCKING ADOLESCENT 4 HOLE OSTEOTOMY 0012006000 6X40MM","code_information":[{"code":"Sx00-1200-600","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356813","type":"LOCAL"},{"code":"1082574","type":"LOCAL"}],"standard_charges":[{"gross_charge":4530.92,"discounted_cash":3398.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356813 = Hospital System Supply Identifier | 1082574 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL130 70X0X4H","code_information":[{"code":"Sx00-1200-700","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054665","type":"LOCAL"},{"code":"877115","type":"LOCAL"}],"standard_charges":[{"gross_charge":4530.92,"discounted_cash":3398.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054665 = Hospital System Supply Identifier | 877115 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL130 80X0X4H","code_information":[{"code":"Sx00-1200-700","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054667","type":"LOCAL"},{"code":"877117","type":"LOCAL"}],"standard_charges":[{"gross_charge":4530.92,"discounted_cash":3398.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054667 = Hospital System Supply Identifier | 877117 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL130 65X0X4H","code_information":[{"code":"Sx00-1200-700","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054664","type":"LOCAL"},{"code":"877114","type":"LOCAL"}],"standard_charges":[{"gross_charge":4530.92,"discounted_cash":3398.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054664 = Hospital System Supply Identifier | 877114 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL130 75X0X4H","code_information":[{"code":"Sx00-1200-700","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054666","type":"LOCAL"},{"code":"877116","type":"LOCAL"}],"standard_charges":[{"gross_charge":4530.92,"discounted_cash":3398.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054666 = Hospital System Supply Identifier | 877116 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL130 55X0X4H","code_information":[{"code":"Sx00-1200-700","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054662","type":"LOCAL"},{"code":"877112","type":"LOCAL"}],"standard_charges":[{"gross_charge":4530.92,"discounted_cash":3398.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054662 = Hospital System Supply Identifier | 877112 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL130 50X0X4H","code_information":[{"code":"Sx00-1200-700","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054661","type":"LOCAL"},{"code":"877111","type":"LOCAL"}],"standard_charges":[{"gross_charge":4530.92,"discounted_cash":3398.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054661 = Hospital System Supply Identifier | 877111 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL130 60X0X4H","code_information":[{"code":"Sx00-1200-700","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054663","type":"LOCAL"},{"code":"877113","type":"LOCAL"}],"standard_charges":[{"gross_charge":4530.92,"discounted_cash":3398.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054663 = Hospital System Supply Identifier | 877113 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL130 45X0X4H","code_information":[{"code":"Sx00-1200-700","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054660","type":"LOCAL"},{"code":"877110","type":"LOCAL"}],"standard_charges":[{"gross_charge":4530.92,"discounted_cash":3398.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054660 = Hospital System Supply Identifier | 877110 = Lawson ID"}]},{"description":"PLATE BLD CANN ADO110 60X10 4H","code_information":[{"code":"Sx00-1200-804","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054672","type":"LOCAL"},{"code":"877122","type":"LOCAL"}],"standard_charges":[{"gross_charge":4840.0,"discounted_cash":3630.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054672 = Hospital System Supply Identifier | 877122 = Lawson ID"}]},{"description":"PLATE BLD CANN ADO110 55X10 4H","code_information":[{"code":"Sx00-1200-804","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054671","type":"LOCAL"},{"code":"877121","type":"LOCAL"}],"standard_charges":[{"gross_charge":4840.0,"discounted_cash":3630.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054671 = Hospital System Supply Identifier | 877121 = Lawson ID"}]},{"description":"PLATE BLD CANN ADO110 65X10 4H","code_information":[{"code":"Sx00-1200-804","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054673","type":"LOCAL"},{"code":"877123","type":"LOCAL"}],"standard_charges":[{"gross_charge":4840.0,"discounted_cash":3630.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054673 = Hospital System Supply Identifier | 877123 = Lawson ID"}]},{"description":"PLATE BLD CANN ADO110 45X10 4H","code_information":[{"code":"Sx00-1200-804","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054669","type":"LOCAL"},{"code":"877119","type":"LOCAL"}],"standard_charges":[{"gross_charge":4840.0,"discounted_cash":3630.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054669 = Hospital System Supply Identifier | 877119 = Lawson ID"}]},{"description":"PLATE BLD CANN ADO110 40X10 4H","code_information":[{"code":"Sx00-1200-804","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054668","type":"LOCAL"},{"code":"877118","type":"LOCAL"}],"standard_charges":[{"gross_charge":4840.0,"discounted_cash":3630.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054668 = Hospital System Supply Identifier | 877118 = Lawson ID"}]},{"description":"PLATE BLD CANN ADO110 50X10 4H","code_information":[{"code":"Sx00-1200-804","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054670","type":"LOCAL"},{"code":"877120","type":"LOCAL"}],"standard_charges":[{"gross_charge":4840.0,"discounted_cash":3630.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054670 = Hospital System Supply Identifier | 877120 = Lawson ID"}]},{"description":"PLATE BLD CANN ADO110 70X10 4H","code_information":[{"code":"Sx00-1200-805","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054674","type":"LOCAL"},{"code":"877124","type":"LOCAL"}],"standard_charges":[{"gross_charge":4840.0,"discounted_cash":3630.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054674 = Hospital System Supply Identifier | 877124 = Lawson ID"}]},{"description":"SPLINT THOMAS LEG LG 45X9IN","code_information":[{"code":"Sx00-1232-004","type":"CDM"},{"code":"272","type":"RC"},{"code":"393041","type":"LOCAL"},{"code":"449215","type":"LOCAL"}],"standard_charges":[{"gross_charge":465.4,"discounted_cash":349.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 393041 = Hospital System Supply Identifier | 449215 = Lawson ID"}]},{"description":"SPLINT THOMAS RADLUC LG","code_information":[{"code":"Sx00-1232-008","type":"CDM"},{"code":"272","type":"RC"},{"code":"393042","type":"LOCAL"},{"code":"449216","type":"LOCAL"}],"standard_charges":[{"gross_charge":1217.11,"discounted_cash":912.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 393042 = Hospital System Supply Identifier | 449216 = Lawson ID"}]},{"description":"SPLINT PEARSON ATTACH LG 29IN","code_information":[{"code":"Sx00-1232-014","type":"CDM"},{"code":"272","type":"RC"},{"code":"393039","type":"LOCAL"},{"code":"449213","type":"LOCAL"}],"standard_charges":[{"gross_charge":220.33,"discounted_cash":165.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 393039 = Hospital System Supply Identifier | 449213 = Lawson ID"}]},{"description":"BIT DRILL FIXATION LONG 6.4MM","code_information":[{"code":"Sx00-1291-004","type":"CDM"},{"code":"272","type":"RC"},{"code":"743293","type":"LOCAL"},{"code":"303894","type":"LOCAL"}],"standard_charges":[{"gross_charge":147.23,"discounted_cash":110.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 743293 = Hospital System Supply Identifier | 303894 = Lawson ID"}]},{"description":"BIT DRILIL SHANK 6.4X203MM","code_information":[{"code":"Sx00-1291-004","type":"CDM"},{"code":"272","type":"RC"},{"code":"411112","type":"LOCAL"},{"code":"437851","type":"LOCAL"}],"standard_charges":[{"gross_charge":484.85,"discounted_cash":363.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 411112 = Hospital System Supply Identifier | 437851 = Lawson ID"}]},{"description":"WIRE SPN LUQUE 16GA","code_information":[{"code":"Sx00-1292-061","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"176560","type":"LOCAL"},{"code":"217910","type":"LOCAL"}],"standard_charges":[{"gross_charge":132.3,"discounted_cash":99.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 176560 = Hospital System Supply Identifier | 217910 = Lawson ID"}]},{"description":"DISC - WIRE SPN LUQUE 18GA","code_information":[{"code":"Sx00-1292-063","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"176561","type":"LOCAL"},{"code":"217911","type":"LOCAL"}],"standard_charges":[{"gross_charge":132.3,"discounted_cash":99.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 176561 = Hospital System Supply Identifier | 217911 = Lawson ID"}]},{"description":"SCREW WASHER CANN 2.5/3.0","code_information":[{"code":"Sx00-1400-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054675","type":"LOCAL"},{"code":"877125","type":"LOCAL"}],"standard_charges":[{"gross_charge":72.45,"discounted_cash":54.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054675 = Hospital System Supply Identifier | 877125 = Lawson ID"}]},{"description":"SCREW WASHER CANN 3.5/4.0","code_information":[{"code":"Sx00-1400-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054676","type":"LOCAL"},{"code":"877126","type":"LOCAL"}],"standard_charges":[{"gross_charge":72.45,"discounted_cash":54.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054676 = Hospital System Supply Identifier | 877126 = Lawson ID"}]},{"description":"SCREW WASHER CANN 4.5","code_information":[{"code":"Sx00-1400-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054677","type":"LOCAL"},{"code":"877127","type":"LOCAL"}],"standard_charges":[{"gross_charge":146.5,"discounted_cash":109.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054677 = Hospital System Supply Identifier | 877127 = Lawson ID"}]},{"description":"SCREW WASHER CANN 5.5","code_information":[{"code":"Sx00-1400-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054678","type":"LOCAL"},{"code":"877128","type":"LOCAL"}],"standard_charges":[{"gross_charge":149.43,"discounted_cash":112.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054678 = Hospital System Supply Identifier | 877128 = Lawson ID"}]},{"description":"SCREW CANN F/T 2.5X8MM","code_information":[{"code":"Sx00-1400-250","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054679","type":"LOCAL"},{"code":"877129","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054679 = Hospital System Supply Identifier | 877129 = Lawson ID"}]},{"description":"SCREW CANN F/T 2.5X10MM","code_information":[{"code":"Sx00-1400-251","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054680","type":"LOCAL"},{"code":"877130","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054680 = Hospital System Supply Identifier | 877130 = Lawson ID"}]},{"description":"SCREW CANN F/T 2.5X12MM","code_information":[{"code":"Sx00-1400-251","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054681","type":"LOCAL"},{"code":"877131","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054681 = Hospital System Supply Identifier | 877131 = Lawson ID"}]},{"description":"SCREW CANN F/T 2.5X14MM","code_information":[{"code":"Sx00-1400-251","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054682","type":"LOCAL"},{"code":"877132","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054682 = Hospital System Supply Identifier | 877132 = Lawson ID"}]},{"description":"SCREW CANN F/T 2.5X16MM","code_information":[{"code":"Sx00-1400-251","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054683","type":"LOCAL"},{"code":"877133","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054683 = Hospital System Supply Identifier | 877133 = Lawson ID"}]},{"description":"SCREW CANN F/T 2.5X18MM","code_information":[{"code":"Sx00-1400-251","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054684","type":"LOCAL"},{"code":"877134","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054684 = Hospital System Supply Identifier | 877134 = Lawson ID"}]},{"description":"SCREW CANN F/T 2.5X28MM","code_information":[{"code":"Sx00-1400-252","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054689","type":"LOCAL"},{"code":"877139","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054689 = Hospital System Supply Identifier | 877139 = Lawson ID"}]},{"description":"SCREW CANN F/T 2.5X26MM","code_information":[{"code":"Sx00-1400-252","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054688","type":"LOCAL"},{"code":"877138","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054688 = Hospital System Supply Identifier | 877138 = Lawson ID"}]},{"description":"SCREW CANN F/T 2.5X24MM","code_information":[{"code":"Sx00-1400-252","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054687","type":"LOCAL"},{"code":"877137","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054687 = Hospital System Supply Identifier | 877137 = Lawson ID"}]},{"description":"SCREW CANN F/T 2.5X22MM","code_information":[{"code":"Sx00-1400-252","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054686","type":"LOCAL"},{"code":"877136","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054686 = Hospital System Supply Identifier | 877136 = Lawson ID"}]},{"description":"SCREW CANN F/T 2.5X20MM","code_information":[{"code":"Sx00-1400-252","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054685","type":"LOCAL"},{"code":"877135","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054685 = Hospital System Supply Identifier | 877135 = Lawson ID"}]},{"description":"SCREW CANN F/T 2.5X30MM","code_information":[{"code":"Sx00-1400-253","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054690","type":"LOCAL"},{"code":"877140","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054690 = Hospital System Supply Identifier | 877140 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 2.5X10MM","code_information":[{"code":"Sx00-1400-261","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054691","type":"LOCAL"},{"code":"877141","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054691 = Hospital System Supply Identifier | 877141 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 2.5X12MM","code_information":[{"code":"Sx00-1400-261","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054692","type":"LOCAL"},{"code":"877142","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054692 = Hospital System Supply Identifier | 877142 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 2.5X14MM","code_information":[{"code":"Sx00-1400-261","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054693","type":"LOCAL"},{"code":"877143","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054693 = Hospital System Supply Identifier | 877143 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 2.5X16MM","code_information":[{"code":"Sx00-1400-261","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054694","type":"LOCAL"},{"code":"877144","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054694 = Hospital System Supply Identifier | 877144 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 2.5X18MM","code_information":[{"code":"Sx00-1400-261","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054695","type":"LOCAL"},{"code":"877145","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054695 = Hospital System Supply Identifier | 877145 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 2.5X28MM","code_information":[{"code":"Sx00-1400-262","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054700","type":"LOCAL"},{"code":"877150","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054700 = Hospital System Supply Identifier | 877150 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 2.5X24MM","code_information":[{"code":"Sx00-1400-262","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054698","type":"LOCAL"},{"code":"877148","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054698 = Hospital System Supply Identifier | 877148 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 2.5X26MM","code_information":[{"code":"Sx00-1400-262","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054699","type":"LOCAL"},{"code":"877149","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054699 = Hospital System Supply Identifier | 877149 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 2.5X20MM","code_information":[{"code":"Sx00-1400-262","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054696","type":"LOCAL"},{"code":"877146","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054696 = Hospital System Supply Identifier | 877146 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 2.5X22MM","code_information":[{"code":"Sx00-1400-262","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054697","type":"LOCAL"},{"code":"877147","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054697 = Hospital System Supply Identifier | 877147 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 2.5X30MM","code_information":[{"code":"Sx00-1400-263","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054701","type":"LOCAL"},{"code":"877151","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054701 = Hospital System Supply Identifier | 877151 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 2.5X16MM","code_information":[{"code":"Sx00-1400-271","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054702","type":"LOCAL"},{"code":"877152","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054702 = Hospital System Supply Identifier | 877152 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 2.5X18MM","code_information":[{"code":"Sx00-1400-271","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054703","type":"LOCAL"},{"code":"877153","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054703 = Hospital System Supply Identifier | 877153 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 2.5X26MM","code_information":[{"code":"Sx00-1400-272","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054707","type":"LOCAL"},{"code":"877157","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054707 = Hospital System Supply Identifier | 877157 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 2.5X24MM","code_information":[{"code":"Sx00-1400-272","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054706","type":"LOCAL"},{"code":"877156","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054706 = Hospital System Supply Identifier | 877156 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 2.5X28MM","code_information":[{"code":"Sx00-1400-272","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054708","type":"LOCAL"},{"code":"877158","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054708 = Hospital System Supply Identifier | 877158 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 2.5X20MM","code_information":[{"code":"Sx00-1400-272","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054704","type":"LOCAL"},{"code":"877154","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054704 = Hospital System Supply Identifier | 877154 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 2.5X22MM","code_information":[{"code":"Sx00-1400-272","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054705","type":"LOCAL"},{"code":"877155","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054705 = Hospital System Supply Identifier | 877155 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 2.5X30MM","code_information":[{"code":"Sx00-1400-273","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054709","type":"LOCAL"},{"code":"877159","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054709 = Hospital System Supply Identifier | 877159 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X8MM","code_information":[{"code":"Sx00-1400-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054710","type":"LOCAL"},{"code":"877160","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054710 = Hospital System Supply Identifier | 877160 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X10MM","code_information":[{"code":"Sx00-1400-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054711","type":"LOCAL"},{"code":"877161","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054711 = Hospital System Supply Identifier | 877161 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X12MM","code_information":[{"code":"Sx00-1400-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054712","type":"LOCAL"},{"code":"877162","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054712 = Hospital System Supply Identifier | 877162 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X14MM","code_information":[{"code":"Sx00-1400-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054713","type":"LOCAL"},{"code":"877163","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054713 = Hospital System Supply Identifier | 877163 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X16MM","code_information":[{"code":"Sx00-1400-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054714","type":"LOCAL"},{"code":"877164","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054714 = Hospital System Supply Identifier | 877164 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X18MM","code_information":[{"code":"Sx00-1400-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054715","type":"LOCAL"},{"code":"877165","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054715 = Hospital System Supply Identifier | 877165 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X26MM","code_information":[{"code":"Sx00-1400-302","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054719","type":"LOCAL"},{"code":"877169","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054719 = Hospital System Supply Identifier | 877169 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X24MM","code_information":[{"code":"Sx00-1400-302","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054718","type":"LOCAL"},{"code":"877168","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054718 = Hospital System Supply Identifier | 877168 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X28MM","code_information":[{"code":"Sx00-1400-302","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054720","type":"LOCAL"},{"code":"877170","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054720 = Hospital System Supply Identifier | 877170 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X20MM","code_information":[{"code":"Sx00-1400-302","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054716","type":"LOCAL"},{"code":"877166","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054716 = Hospital System Supply Identifier | 877166 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X22MM","code_information":[{"code":"Sx00-1400-302","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054717","type":"LOCAL"},{"code":"877167","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054717 = Hospital System Supply Identifier | 877167 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X30MM","code_information":[{"code":"Sx00-1400-303","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054721","type":"LOCAL"},{"code":"877171","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054721 = Hospital System Supply Identifier | 877171 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X32MM","code_information":[{"code":"Sx00-1400-303","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054722","type":"LOCAL"},{"code":"877172","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054722 = Hospital System Supply Identifier | 877172 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X34MM","code_information":[{"code":"Sx00-1400-303","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054723","type":"LOCAL"},{"code":"877173","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054723 = Hospital System Supply Identifier | 877173 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X36MM","code_information":[{"code":"Sx00-1400-303","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054724","type":"LOCAL"},{"code":"877174","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054724 = Hospital System Supply Identifier | 877174 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X38MM","code_information":[{"code":"Sx00-1400-303","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054725","type":"LOCAL"},{"code":"877175","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054725 = Hospital System Supply Identifier | 877175 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X40MM","code_information":[{"code":"Sx00-1400-304","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054726","type":"LOCAL"},{"code":"877176","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054726 = Hospital System Supply Identifier | 877176 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X45MM","code_information":[{"code":"Sx00-1400-304","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054727","type":"LOCAL"},{"code":"877177","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054727 = Hospital System Supply Identifier | 877177 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X50MM","code_information":[{"code":"Sx00-1400-305","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054728","type":"LOCAL"},{"code":"877178","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054728 = Hospital System Supply Identifier | 877178 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.0X18MM","code_information":[{"code":"Sx00-1400-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054730","type":"LOCAL"},{"code":"877180","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054730 = Hospital System Supply Identifier | 877180 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.0X16MM","code_information":[{"code":"Sx00-1400-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054729","type":"LOCAL"},{"code":"877179","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054729 = Hospital System Supply Identifier | 877179 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.0X20MM","code_information":[{"code":"Sx00-1400-312","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054731","type":"LOCAL"},{"code":"877181","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054731 = Hospital System Supply Identifier | 877181 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.0X22MM","code_information":[{"code":"Sx00-1400-312","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054732","type":"LOCAL"},{"code":"877182","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054732 = Hospital System Supply Identifier | 877182 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.0X24MM","code_information":[{"code":"Sx00-1400-312","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054733","type":"LOCAL"},{"code":"877183","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054733 = Hospital System Supply Identifier | 877183 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.0X26MM","code_information":[{"code":"Sx00-1400-312","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054734","type":"LOCAL"},{"code":"877184","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054734 = Hospital System Supply Identifier | 877184 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.0X28MM","code_information":[{"code":"Sx00-1400-312","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054735","type":"LOCAL"},{"code":"877185","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054735 = Hospital System Supply Identifier | 877185 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.0X30MM","code_information":[{"code":"Sx00-1400-313","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054736","type":"LOCAL"},{"code":"877186","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054736 = Hospital System Supply Identifier | 877186 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.0X32MM","code_information":[{"code":"Sx00-1400-313","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054737","type":"LOCAL"},{"code":"877187","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054737 = Hospital System Supply Identifier | 877187 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.0X34MM","code_information":[{"code":"Sx00-1400-313","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054738","type":"LOCAL"},{"code":"877188","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054738 = Hospital System Supply Identifier | 877188 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.0X36MM","code_information":[{"code":"Sx00-1400-313","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054739","type":"LOCAL"},{"code":"877189","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054739 = Hospital System Supply Identifier | 877189 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.0X38MM","code_information":[{"code":"Sx00-1400-313","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054740","type":"LOCAL"},{"code":"877190","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054740 = Hospital System Supply Identifier | 877190 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.0X40MM","code_information":[{"code":"Sx00-1400-314","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054741","type":"LOCAL"},{"code":"877191","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054741 = Hospital System Supply Identifier | 877191 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.0X45MM","code_information":[{"code":"Sx00-1400-314","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054742","type":"LOCAL"},{"code":"877192","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054742 = Hospital System Supply Identifier | 877192 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.0X50MM","code_information":[{"code":"Sx00-1400-315","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054743","type":"LOCAL"},{"code":"877193","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054743 = Hospital System Supply Identifier | 877193 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.0X10MM","code_information":[{"code":"Sx00-1400-321","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054744","type":"LOCAL"},{"code":"877194","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054744 = Hospital System Supply Identifier | 877194 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.0X12MM","code_information":[{"code":"Sx00-1400-321","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054745","type":"LOCAL"},{"code":"877195","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054745 = Hospital System Supply Identifier | 877195 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.0X14MM","code_information":[{"code":"Sx00-1400-321","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054746","type":"LOCAL"},{"code":"877196","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054746 = Hospital System Supply Identifier | 877196 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.0X16MM","code_information":[{"code":"Sx00-1400-321","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054747","type":"LOCAL"},{"code":"877197","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054747 = Hospital System Supply Identifier | 877197 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.0X18MM","code_information":[{"code":"Sx00-1400-321","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054748","type":"LOCAL"},{"code":"877198","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054748 = Hospital System Supply Identifier | 877198 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.0X26MM","code_information":[{"code":"Sx00-1400-322","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054752","type":"LOCAL"},{"code":"877202","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054752 = Hospital System Supply Identifier | 877202 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.0X24MM","code_information":[{"code":"Sx00-1400-322","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054751","type":"LOCAL"},{"code":"877201","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054751 = Hospital System Supply Identifier | 877201 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.0X28MM","code_information":[{"code":"Sx00-1400-322","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054753","type":"LOCAL"},{"code":"877203","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054753 = Hospital System Supply Identifier | 877203 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.0X20MM","code_information":[{"code":"Sx00-1400-322","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054749","type":"LOCAL"},{"code":"877199","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054749 = Hospital System Supply Identifier | 877199 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.0X22MM","code_information":[{"code":"Sx00-1400-322","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054750","type":"LOCAL"},{"code":"877200","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054750 = Hospital System Supply Identifier | 877200 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.0X30MM","code_information":[{"code":"Sx00-1400-323","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054754","type":"LOCAL"},{"code":"877204","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054754 = Hospital System Supply Identifier | 877204 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.0X32MM","code_information":[{"code":"Sx00-1400-323","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054755","type":"LOCAL"},{"code":"877205","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054755 = Hospital System Supply Identifier | 877205 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.0X34MM","code_information":[{"code":"Sx00-1400-323","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054756","type":"LOCAL"},{"code":"877206","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054756 = Hospital System Supply Identifier | 877206 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.0X36MM","code_information":[{"code":"Sx00-1400-323","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054757","type":"LOCAL"},{"code":"877207","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054757 = Hospital System Supply Identifier | 877207 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.0X38MM","code_information":[{"code":"Sx00-1400-323","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054758","type":"LOCAL"},{"code":"877208","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054758 = Hospital System Supply Identifier | 877208 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.0X40MM","code_information":[{"code":"Sx00-1400-324","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054759","type":"LOCAL"},{"code":"877209","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054759 = Hospital System Supply Identifier | 877209 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.0X45MM","code_information":[{"code":"Sx00-1400-324","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054760","type":"LOCAL"},{"code":"877210","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054760 = Hospital System Supply Identifier | 877210 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.0X50MM","code_information":[{"code":"Sx00-1400-325","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054761","type":"LOCAL"},{"code":"877211","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054761 = Hospital System Supply Identifier | 877211 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X18MM","code_information":[{"code":"Sx00-1400-351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054766","type":"LOCAL"},{"code":"877216","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054766 = Hospital System Supply Identifier | 877216 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X16MM","code_information":[{"code":"Sx00-1400-351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054765","type":"LOCAL"},{"code":"877215","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054765 = Hospital System Supply Identifier | 877215 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X12MM","code_information":[{"code":"Sx00-1400-351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054763","type":"LOCAL"},{"code":"877213","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054763 = Hospital System Supply Identifier | 877213 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X10MM","code_information":[{"code":"Sx00-1400-351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054762","type":"LOCAL"},{"code":"877212","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054762 = Hospital System Supply Identifier | 877212 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X14MM","code_information":[{"code":"Sx00-1400-351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054764","type":"LOCAL"},{"code":"877214","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054764 = Hospital System Supply Identifier | 877214 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X20MM","code_information":[{"code":"Sx00-1400-352","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054767","type":"LOCAL"},{"code":"877217","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054767 = Hospital System Supply Identifier | 877217 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X22MM","code_information":[{"code":"Sx00-1400-352","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054768","type":"LOCAL"},{"code":"877218","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054768 = Hospital System Supply Identifier | 877218 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X24MM","code_information":[{"code":"Sx00-1400-352","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054769","type":"LOCAL"},{"code":"877219","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054769 = Hospital System Supply Identifier | 877219 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X26MM","code_information":[{"code":"Sx00-1400-352","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054770","type":"LOCAL"},{"code":"877220","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054770 = Hospital System Supply Identifier | 877220 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X28MM","code_information":[{"code":"Sx00-1400-352","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054771","type":"LOCAL"},{"code":"877221","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054771 = Hospital System Supply Identifier | 877221 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X34MM","code_information":[{"code":"Sx00-1400-353","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054774","type":"LOCAL"},{"code":"877224","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054774 = Hospital System Supply Identifier | 877224 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X38MM","code_information":[{"code":"Sx00-1400-353","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054776","type":"LOCAL"},{"code":"877226","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054776 = Hospital System Supply Identifier | 877226 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X36MM","code_information":[{"code":"Sx00-1400-353","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054775","type":"LOCAL"},{"code":"877225","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054775 = Hospital System Supply Identifier | 877225 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X32MM","code_information":[{"code":"Sx00-1400-353","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054773","type":"LOCAL"},{"code":"877223","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054773 = Hospital System Supply Identifier | 877223 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X30MM","code_information":[{"code":"Sx00-1400-353","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054772","type":"LOCAL"},{"code":"877222","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054772 = Hospital System Supply Identifier | 877222 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X40MM","code_information":[{"code":"Sx00-1400-354","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054777","type":"LOCAL"},{"code":"877227","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054777 = Hospital System Supply Identifier | 877227 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X42MM","code_information":[{"code":"Sx00-1400-354","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054778","type":"LOCAL"},{"code":"877228","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054778 = Hospital System Supply Identifier | 877228 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X44MM","code_information":[{"code":"Sx00-1400-354","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054779","type":"LOCAL"},{"code":"877229","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054779 = Hospital System Supply Identifier | 877229 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X46MM","code_information":[{"code":"Sx00-1400-354","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054780","type":"LOCAL"},{"code":"877230","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054780 = Hospital System Supply Identifier | 877230 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X48MM","code_information":[{"code":"Sx00-1400-354","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054781","type":"LOCAL"},{"code":"877231","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054781 = Hospital System Supply Identifier | 877231 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X50MM","code_information":[{"code":"Sx00-1400-355","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054782","type":"LOCAL"},{"code":"877232","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054782 = Hospital System Supply Identifier | 877232 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X55MM","code_information":[{"code":"Sx00-1400-355","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054783","type":"LOCAL"},{"code":"877233","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054783 = Hospital System Supply Identifier | 877233 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X60MM","code_information":[{"code":"Sx00-1400-356","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054784","type":"LOCAL"},{"code":"877234","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054784 = Hospital System Supply Identifier | 877234 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X16MM","code_information":[{"code":"Sx00-1400-361","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054785","type":"LOCAL"},{"code":"877235","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054785 = Hospital System Supply Identifier | 877235 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X18MM","code_information":[{"code":"Sx00-1400-361","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054786","type":"LOCAL"},{"code":"877236","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054786 = Hospital System Supply Identifier | 877236 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X20MM","code_information":[{"code":"Sx00-1400-362","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054787","type":"LOCAL"},{"code":"877237","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054787 = Hospital System Supply Identifier | 877237 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X22MM","code_information":[{"code":"Sx00-1400-362","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054788","type":"LOCAL"},{"code":"877238","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054788 = Hospital System Supply Identifier | 877238 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X24MM","code_information":[{"code":"Sx00-1400-362","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054789","type":"LOCAL"},{"code":"877239","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054789 = Hospital System Supply Identifier | 877239 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X26MM","code_information":[{"code":"Sx00-1400-362","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054790","type":"LOCAL"},{"code":"877240","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054790 = Hospital System Supply Identifier | 877240 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X28MM","code_information":[{"code":"Sx00-1400-362","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054791","type":"LOCAL"},{"code":"877241","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054791 = Hospital System Supply Identifier | 877241 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X38MM","code_information":[{"code":"Sx00-1400-363","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054796","type":"LOCAL"},{"code":"877246","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054796 = Hospital System Supply Identifier | 877246 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X36MM","code_information":[{"code":"Sx00-1400-363","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054795","type":"LOCAL"},{"code":"877245","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054795 = Hospital System Supply Identifier | 877245 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X34MM","code_information":[{"code":"Sx00-1400-363","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054794","type":"LOCAL"},{"code":"877244","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054794 = Hospital System Supply Identifier | 877244 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X32MM","code_information":[{"code":"Sx00-1400-363","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054793","type":"LOCAL"},{"code":"877243","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054793 = Hospital System Supply Identifier | 877243 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X30MM","code_information":[{"code":"Sx00-1400-363","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054792","type":"LOCAL"},{"code":"877242","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054792 = Hospital System Supply Identifier | 877242 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X40MM","code_information":[{"code":"Sx00-1400-364","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054797","type":"LOCAL"},{"code":"877247","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054797 = Hospital System Supply Identifier | 877247 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X42MM","code_information":[{"code":"Sx00-1400-364","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054798","type":"LOCAL"},{"code":"877248","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054798 = Hospital System Supply Identifier | 877248 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X44MM","code_information":[{"code":"Sx00-1400-364","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054799","type":"LOCAL"},{"code":"877249","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054799 = Hospital System Supply Identifier | 877249 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X46MM","code_information":[{"code":"Sx00-1400-364","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054800","type":"LOCAL"},{"code":"877250","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054800 = Hospital System Supply Identifier | 877250 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X48MM","code_information":[{"code":"Sx00-1400-364","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054801","type":"LOCAL"},{"code":"877251","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054801 = Hospital System Supply Identifier | 877251 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X50MM","code_information":[{"code":"Sx00-1400-365","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054802","type":"LOCAL"},{"code":"877252","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054802 = Hospital System Supply Identifier | 877252 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X55MM","code_information":[{"code":"Sx00-1400-365","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054803","type":"LOCAL"},{"code":"877253","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054803 = Hospital System Supply Identifier | 877253 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X60MM","code_information":[{"code":"Sx00-1400-366","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054804","type":"LOCAL"},{"code":"877254","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054804 = Hospital System Supply Identifier | 877254 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X10MM","code_information":[{"code":"Sx00-1400-371","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054805","type":"LOCAL"},{"code":"877255","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054805 = Hospital System Supply Identifier | 877255 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X12MM","code_information":[{"code":"Sx00-1400-371","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054806","type":"LOCAL"},{"code":"877256","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054806 = Hospital System Supply Identifier | 877256 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X14MM","code_information":[{"code":"Sx00-1400-371","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054807","type":"LOCAL"},{"code":"877257","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054807 = Hospital System Supply Identifier | 877257 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X16MM","code_information":[{"code":"Sx00-1400-371","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054808","type":"LOCAL"},{"code":"877258","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054808 = Hospital System Supply Identifier | 877258 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X18MM","code_information":[{"code":"Sx00-1400-371","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054809","type":"LOCAL"},{"code":"877259","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054809 = Hospital System Supply Identifier | 877259 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X26MM","code_information":[{"code":"Sx00-1400-372","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054813","type":"LOCAL"},{"code":"877263","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054813 = Hospital System Supply Identifier | 877263 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X24MM","code_information":[{"code":"Sx00-1400-372","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054812","type":"LOCAL"},{"code":"877262","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054812 = Hospital System Supply Identifier | 877262 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X28MM","code_information":[{"code":"Sx00-1400-372","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054814","type":"LOCAL"},{"code":"877264","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054814 = Hospital System Supply Identifier | 877264 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X20MM","code_information":[{"code":"Sx00-1400-372","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054810","type":"LOCAL"},{"code":"877260","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054810 = Hospital System Supply Identifier | 877260 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X22MM","code_information":[{"code":"Sx00-1400-372","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054811","type":"LOCAL"},{"code":"877261","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054811 = Hospital System Supply Identifier | 877261 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X30MM","code_information":[{"code":"Sx00-1400-373","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054815","type":"LOCAL"},{"code":"877265","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054815 = Hospital System Supply Identifier | 877265 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X32MM","code_information":[{"code":"Sx00-1400-373","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054816","type":"LOCAL"},{"code":"877266","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054816 = Hospital System Supply Identifier | 877266 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X34MM","code_information":[{"code":"Sx00-1400-373","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054817","type":"LOCAL"},{"code":"877267","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054817 = Hospital System Supply Identifier | 877267 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X36MM","code_information":[{"code":"Sx00-1400-373","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054818","type":"LOCAL"},{"code":"877268","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054818 = Hospital System Supply Identifier | 877268 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X38MM","code_information":[{"code":"Sx00-1400-373","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054819","type":"LOCAL"},{"code":"877269","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054819 = Hospital System Supply Identifier | 877269 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X46MM","code_information":[{"code":"Sx00-1400-374","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054823","type":"LOCAL"},{"code":"877273","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054823 = Hospital System Supply Identifier | 877273 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X40MM","code_information":[{"code":"Sx00-1400-374","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054820","type":"LOCAL"},{"code":"877270","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054820 = Hospital System Supply Identifier | 877270 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X42MM","code_information":[{"code":"Sx00-1400-374","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054821","type":"LOCAL"},{"code":"877271","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054821 = Hospital System Supply Identifier | 877271 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X44MM","code_information":[{"code":"Sx00-1400-374","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054822","type":"LOCAL"},{"code":"877272","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054822 = Hospital System Supply Identifier | 877272 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X48MM","code_information":[{"code":"Sx00-1400-374","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054824","type":"LOCAL"},{"code":"877274","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054824 = Hospital System Supply Identifier | 877274 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X55MM","code_information":[{"code":"Sx00-1400-375","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054826","type":"LOCAL"},{"code":"877276","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054826 = Hospital System Supply Identifier | 877276 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X50MM","code_information":[{"code":"Sx00-1400-375","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054825","type":"LOCAL"},{"code":"877275","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054825 = Hospital System Supply Identifier | 877275 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X60MM","code_information":[{"code":"Sx00-1400-376","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054827","type":"LOCAL"},{"code":"877277","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054827 = Hospital System Supply Identifier | 877277 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X10MM","code_information":[{"code":"Sx00-1400-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054828","type":"LOCAL"},{"code":"877278","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054828 = Hospital System Supply Identifier | 877278 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X12MM","code_information":[{"code":"Sx00-1400-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054829","type":"LOCAL"},{"code":"877279","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054829 = Hospital System Supply Identifier | 877279 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X14MM","code_information":[{"code":"Sx00-1400-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054830","type":"LOCAL"},{"code":"877280","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054830 = Hospital System Supply Identifier | 877280 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X16MM","code_information":[{"code":"Sx00-1400-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054831","type":"LOCAL"},{"code":"877281","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054831 = Hospital System Supply Identifier | 877281 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X18MM","code_information":[{"code":"Sx00-1400-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054832","type":"LOCAL"},{"code":"877282","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054832 = Hospital System Supply Identifier | 877282 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X28MM","code_information":[{"code":"Sx00-1400-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054837","type":"LOCAL"},{"code":"877287","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054837 = Hospital System Supply Identifier | 877287 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X26MM","code_information":[{"code":"Sx00-1400-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054836","type":"LOCAL"},{"code":"877286","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054836 = Hospital System Supply Identifier | 877286 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X24MM","code_information":[{"code":"Sx00-1400-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054835","type":"LOCAL"},{"code":"877285","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054835 = Hospital System Supply Identifier | 877285 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X22MM","code_information":[{"code":"Sx00-1400-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054834","type":"LOCAL"},{"code":"877284","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054834 = Hospital System Supply Identifier | 877284 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X20MM","code_information":[{"code":"Sx00-1400-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054833","type":"LOCAL"},{"code":"877283","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054833 = Hospital System Supply Identifier | 877283 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X30MM","code_information":[{"code":"Sx00-1400-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054838","type":"LOCAL"},{"code":"877288","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054838 = Hospital System Supply Identifier | 877288 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X32MM","code_information":[{"code":"Sx00-1400-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054839","type":"LOCAL"},{"code":"877289","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054839 = Hospital System Supply Identifier | 877289 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X34MM","code_information":[{"code":"Sx00-1400-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054840","type":"LOCAL"},{"code":"877290","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054840 = Hospital System Supply Identifier | 877290 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X36MM","code_information":[{"code":"Sx00-1400-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054841","type":"LOCAL"},{"code":"877291","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054841 = Hospital System Supply Identifier | 877291 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X38MM","code_information":[{"code":"Sx00-1400-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054842","type":"LOCAL"},{"code":"877292","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054842 = Hospital System Supply Identifier | 877292 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X48MM","code_information":[{"code":"Sx00-1400-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054847","type":"LOCAL"},{"code":"877297","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054847 = Hospital System Supply Identifier | 877297 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X46MM","code_information":[{"code":"Sx00-1400-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054846","type":"LOCAL"},{"code":"877296","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054846 = Hospital System Supply Identifier | 877296 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X44MM","code_information":[{"code":"Sx00-1400-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054845","type":"LOCAL"},{"code":"877295","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054845 = Hospital System Supply Identifier | 877295 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X42MM","code_information":[{"code":"Sx00-1400-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054844","type":"LOCAL"},{"code":"877294","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054844 = Hospital System Supply Identifier | 877294 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X40MM","code_information":[{"code":"Sx00-1400-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054843","type":"LOCAL"},{"code":"877293","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054843 = Hospital System Supply Identifier | 877293 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X50MM","code_information":[{"code":"Sx00-1400-405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054848","type":"LOCAL"},{"code":"877298","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054848 = Hospital System Supply Identifier | 877298 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X52MM","code_information":[{"code":"Sx00-1400-405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054849","type":"LOCAL"},{"code":"877299","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054849 = Hospital System Supply Identifier | 877299 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X54MM","code_information":[{"code":"Sx00-1400-405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054850","type":"LOCAL"},{"code":"877300","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054850 = Hospital System Supply Identifier | 877300 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X56MM","code_information":[{"code":"Sx00-1400-405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054851","type":"LOCAL"},{"code":"877301","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054851 = Hospital System Supply Identifier | 877301 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X58MM","code_information":[{"code":"Sx00-1400-405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054852","type":"LOCAL"},{"code":"877302","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054852 = Hospital System Supply Identifier | 877302 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X60MM","code_information":[{"code":"Sx00-1400-406","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054853","type":"LOCAL"},{"code":"877303","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054853 = Hospital System Supply Identifier | 877303 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X65MM","code_information":[{"code":"Sx00-1400-406","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054854","type":"LOCAL"},{"code":"877304","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054854 = Hospital System Supply Identifier | 877304 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X70MM","code_information":[{"code":"Sx00-1400-407","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054855","type":"LOCAL"},{"code":"877305","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054855 = Hospital System Supply Identifier | 877305 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X16MM","code_information":[{"code":"Sx00-1400-411","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054856","type":"LOCAL"},{"code":"877306","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054856 = Hospital System Supply Identifier | 877306 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X18MM","code_information":[{"code":"Sx00-1400-411","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054857","type":"LOCAL"},{"code":"877307","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054857 = Hospital System Supply Identifier | 877307 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X20MM","code_information":[{"code":"Sx00-1400-412","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054858","type":"LOCAL"},{"code":"877308","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054858 = Hospital System Supply Identifier | 877308 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X22MM","code_information":[{"code":"Sx00-1400-412","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054859","type":"LOCAL"},{"code":"877309","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054859 = Hospital System Supply Identifier | 877309 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X24MM","code_information":[{"code":"Sx00-1400-412","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054860","type":"LOCAL"},{"code":"877310","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054860 = Hospital System Supply Identifier | 877310 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X26MM","code_information":[{"code":"Sx00-1400-412","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054861","type":"LOCAL"},{"code":"877311","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054861 = Hospital System Supply Identifier | 877311 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X28MM","code_information":[{"code":"Sx00-1400-412","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054862","type":"LOCAL"},{"code":"877312","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054862 = Hospital System Supply Identifier | 877312 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X38MM","code_information":[{"code":"Sx00-1400-413","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054867","type":"LOCAL"},{"code":"877317","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054867 = Hospital System Supply Identifier | 877317 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X34MM","code_information":[{"code":"Sx00-1400-413","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054865","type":"LOCAL"},{"code":"877315","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054865 = Hospital System Supply Identifier | 877315 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X36MM","code_information":[{"code":"Sx00-1400-413","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054866","type":"LOCAL"},{"code":"877316","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054866 = Hospital System Supply Identifier | 877316 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X30MM","code_information":[{"code":"Sx00-1400-413","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054863","type":"LOCAL"},{"code":"877313","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054863 = Hospital System Supply Identifier | 877313 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X32MM","code_information":[{"code":"Sx00-1400-413","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054864","type":"LOCAL"},{"code":"877314","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054864 = Hospital System Supply Identifier | 877314 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X40MM","code_information":[{"code":"Sx00-1400-414","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054868","type":"LOCAL"},{"code":"877318","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054868 = Hospital System Supply Identifier | 877318 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X42MM","code_information":[{"code":"Sx00-1400-414","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054869","type":"LOCAL"},{"code":"877319","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054869 = Hospital System Supply Identifier | 877319 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X44MM","code_information":[{"code":"Sx00-1400-414","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054870","type":"LOCAL"},{"code":"877320","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054870 = Hospital System Supply Identifier | 877320 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X46MM","code_information":[{"code":"Sx00-1400-414","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054871","type":"LOCAL"},{"code":"877321","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054871 = Hospital System Supply Identifier | 877321 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X48MM","code_information":[{"code":"Sx00-1400-414","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054872","type":"LOCAL"},{"code":"877322","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054872 = Hospital System Supply Identifier | 877322 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X56MM","code_information":[{"code":"Sx00-1400-415","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054876","type":"LOCAL"},{"code":"877326","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054876 = Hospital System Supply Identifier | 877326 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X58MM","code_information":[{"code":"Sx00-1400-415","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054877","type":"LOCAL"},{"code":"877327","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054877 = Hospital System Supply Identifier | 877327 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X52MM","code_information":[{"code":"Sx00-1400-415","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054874","type":"LOCAL"},{"code":"877324","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054874 = Hospital System Supply Identifier | 877324 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X50MM","code_information":[{"code":"Sx00-1400-415","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054873","type":"LOCAL"},{"code":"877323","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054873 = Hospital System Supply Identifier | 877323 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X54MM","code_information":[{"code":"Sx00-1400-415","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054875","type":"LOCAL"},{"code":"877325","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054875 = Hospital System Supply Identifier | 877325 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X60MM","code_information":[{"code":"Sx00-1400-416","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054878","type":"LOCAL"},{"code":"877328","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054878 = Hospital System Supply Identifier | 877328 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X65MM","code_information":[{"code":"Sx00-1400-416","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054879","type":"LOCAL"},{"code":"877329","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054879 = Hospital System Supply Identifier | 877329 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X70MM","code_information":[{"code":"Sx00-1400-417","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054880","type":"LOCAL"},{"code":"877330","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054880 = Hospital System Supply Identifier | 877330 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X16MM","code_information":[{"code":"Sx00-1400-421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054883","type":"LOCAL"},{"code":"877333","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054883 = Hospital System Supply Identifier | 877333 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X12MM","code_information":[{"code":"Sx00-1400-421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054882","type":"LOCAL"},{"code":"877332","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054882 = Hospital System Supply Identifier | 877332 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X18MM","code_information":[{"code":"Sx00-1400-421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054884","type":"LOCAL"},{"code":"877334","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054884 = Hospital System Supply Identifier | 877334 = Lawson ID"}]},{"description":"SCREW-BONE CANNULATED SHORT-THREAD STERILE","code_information":[{"code":"Sx00-1400-421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357223","type":"LOCAL"},{"code":"1083674","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357223 = Hospital System Supply Identifier | 1083674 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X10MM","code_information":[{"code":"Sx00-1400-421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054881","type":"LOCAL"},{"code":"877331","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054881 = Hospital System Supply Identifier | 877331 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X28MM","code_information":[{"code":"Sx00-1400-422","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054889","type":"LOCAL"},{"code":"877339","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054889 = Hospital System Supply Identifier | 877339 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X26MM","code_information":[{"code":"Sx00-1400-422","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054888","type":"LOCAL"},{"code":"877338","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054888 = Hospital System Supply Identifier | 877338 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X20MM","code_information":[{"code":"Sx00-1400-422","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054885","type":"LOCAL"},{"code":"877335","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054885 = Hospital System Supply Identifier | 877335 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X22MM","code_information":[{"code":"Sx00-1400-422","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054886","type":"LOCAL"},{"code":"877336","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054886 = Hospital System Supply Identifier | 877336 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X24MM","code_information":[{"code":"Sx00-1400-422","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054887","type":"LOCAL"},{"code":"877337","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054887 = Hospital System Supply Identifier | 877337 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X30MM","code_information":[{"code":"Sx00-1400-423","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054890","type":"LOCAL"},{"code":"877340","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054890 = Hospital System Supply Identifier | 877340 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X32MM","code_information":[{"code":"Sx00-1400-423","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054891","type":"LOCAL"},{"code":"877341","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054891 = Hospital System Supply Identifier | 877341 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X34MM","code_information":[{"code":"Sx00-1400-423","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054892","type":"LOCAL"},{"code":"877342","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054892 = Hospital System Supply Identifier | 877342 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X36MM","code_information":[{"code":"Sx00-1400-423","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054893","type":"LOCAL"},{"code":"877343","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054893 = Hospital System Supply Identifier | 877343 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X38MM","code_information":[{"code":"Sx00-1400-423","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054894","type":"LOCAL"},{"code":"877344","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054894 = Hospital System Supply Identifier | 877344 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X48MM","code_information":[{"code":"Sx00-1400-424","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054899","type":"LOCAL"},{"code":"877349","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054899 = Hospital System Supply Identifier | 877349 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X46MM","code_information":[{"code":"Sx00-1400-424","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054898","type":"LOCAL"},{"code":"877348","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054898 = Hospital System Supply Identifier | 877348 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X42MM","code_information":[{"code":"Sx00-1400-424","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054896","type":"LOCAL"},{"code":"877346","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054896 = Hospital System Supply Identifier | 877346 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X40MM","code_information":[{"code":"Sx00-1400-424","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054895","type":"LOCAL"},{"code":"877345","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054895 = Hospital System Supply Identifier | 877345 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X44MM","code_information":[{"code":"Sx00-1400-424","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054897","type":"LOCAL"},{"code":"877347","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054897 = Hospital System Supply Identifier | 877347 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X56MM","code_information":[{"code":"Sx00-1400-425","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054903","type":"LOCAL"},{"code":"877353","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054903 = Hospital System Supply Identifier | 877353 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X50MM","code_information":[{"code":"Sx00-1400-425","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054900","type":"LOCAL"},{"code":"877350","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054900 = Hospital System Supply Identifier | 877350 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X52MM","code_information":[{"code":"Sx00-1400-425","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054901","type":"LOCAL"},{"code":"877351","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054901 = Hospital System Supply Identifier | 877351 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X54MM","code_information":[{"code":"Sx00-1400-425","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054902","type":"LOCAL"},{"code":"877352","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054902 = Hospital System Supply Identifier | 877352 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X58MM","code_information":[{"code":"Sx00-1400-425","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054904","type":"LOCAL"},{"code":"877354","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054904 = Hospital System Supply Identifier | 877354 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X60MM","code_information":[{"code":"Sx00-1400-426","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054905","type":"LOCAL"},{"code":"877355","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054905 = Hospital System Supply Identifier | 877355 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X65MM","code_information":[{"code":"Sx00-1400-426","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054906","type":"LOCAL"},{"code":"877356","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054906 = Hospital System Supply Identifier | 877356 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X70MM","code_information":[{"code":"Sx00-1400-427","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054907","type":"LOCAL"},{"code":"877357","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054907 = Hospital System Supply Identifier | 877357 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X16MM","code_information":[{"code":"Sx00-1400-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054909","type":"LOCAL"},{"code":"877359","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054909 = Hospital System Supply Identifier | 877359 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X18MM","code_information":[{"code":"Sx00-1400-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054910","type":"LOCAL"},{"code":"877360","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054910 = Hospital System Supply Identifier | 877360 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X14MM","code_information":[{"code":"Sx00-1400-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054908","type":"LOCAL"},{"code":"877358","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054908 = Hospital System Supply Identifier | 877358 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X20MM","code_information":[{"code":"Sx00-1400-452","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054911","type":"LOCAL"},{"code":"877361","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054911 = Hospital System Supply Identifier | 877361 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X22MM","code_information":[{"code":"Sx00-1400-452","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054912","type":"LOCAL"},{"code":"877362","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054912 = Hospital System Supply Identifier | 877362 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X24MM","code_information":[{"code":"Sx00-1400-452","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054913","type":"LOCAL"},{"code":"877363","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054913 = Hospital System Supply Identifier | 877363 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X26MM","code_information":[{"code":"Sx00-1400-452","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054914","type":"LOCAL"},{"code":"877364","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054914 = Hospital System Supply Identifier | 877364 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X28MM","code_information":[{"code":"Sx00-1400-452","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054915","type":"LOCAL"},{"code":"877365","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054915 = Hospital System Supply Identifier | 877365 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X38MM","code_information":[{"code":"Sx00-1400-453","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054920","type":"LOCAL"},{"code":"877370","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054920 = Hospital System Supply Identifier | 877370 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X36MM","code_information":[{"code":"Sx00-1400-453","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054919","type":"LOCAL"},{"code":"877369","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054919 = Hospital System Supply Identifier | 877369 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X34MM","code_information":[{"code":"Sx00-1400-453","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054918","type":"LOCAL"},{"code":"877368","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054918 = Hospital System Supply Identifier | 877368 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X32MM","code_information":[{"code":"Sx00-1400-453","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054917","type":"LOCAL"},{"code":"877367","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054917 = Hospital System Supply Identifier | 877367 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X30MM","code_information":[{"code":"Sx00-1400-453","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054916","type":"LOCAL"},{"code":"877366","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054916 = Hospital System Supply Identifier | 877366 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X40MM","code_information":[{"code":"Sx00-1400-454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054921","type":"LOCAL"},{"code":"877371","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054921 = Hospital System Supply Identifier | 877371 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X42MM","code_information":[{"code":"Sx00-1400-454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054922","type":"LOCAL"},{"code":"877372","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054922 = Hospital System Supply Identifier | 877372 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X44MM","code_information":[{"code":"Sx00-1400-454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054923","type":"LOCAL"},{"code":"877373","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054923 = Hospital System Supply Identifier | 877373 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X46MM","code_information":[{"code":"Sx00-1400-454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054924","type":"LOCAL"},{"code":"877374","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054924 = Hospital System Supply Identifier | 877374 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X48MM","code_information":[{"code":"Sx00-1400-454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054925","type":"LOCAL"},{"code":"877375","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054925 = Hospital System Supply Identifier | 877375 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X56MM","code_information":[{"code":"Sx00-1400-455","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054929","type":"LOCAL"},{"code":"877379","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054929 = Hospital System Supply Identifier | 877379 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X54MM","code_information":[{"code":"Sx00-1400-455","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054928","type":"LOCAL"},{"code":"877378","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054928 = Hospital System Supply Identifier | 877378 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X58MM","code_information":[{"code":"Sx00-1400-455","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054930","type":"LOCAL"},{"code":"877380","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054930 = Hospital System Supply Identifier | 877380 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X50MM","code_information":[{"code":"Sx00-1400-455","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054926","type":"LOCAL"},{"code":"877376","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054926 = Hospital System Supply Identifier | 877376 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X52MM","code_information":[{"code":"Sx00-1400-455","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054927","type":"LOCAL"},{"code":"877377","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054927 = Hospital System Supply Identifier | 877377 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X60MM","code_information":[{"code":"Sx00-1400-456","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054931","type":"LOCAL"},{"code":"877381","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054931 = Hospital System Supply Identifier | 877381 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X65MM","code_information":[{"code":"Sx00-1400-456","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054932","type":"LOCAL"},{"code":"877382","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054932 = Hospital System Supply Identifier | 877382 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X70MM","code_information":[{"code":"Sx00-1400-457","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054933","type":"LOCAL"},{"code":"877383","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054933 = Hospital System Supply Identifier | 877383 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X75MM","code_information":[{"code":"Sx00-1400-457","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054934","type":"LOCAL"},{"code":"877384","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054934 = Hospital System Supply Identifier | 877384 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X80MM","code_information":[{"code":"Sx00-1400-458","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054935","type":"LOCAL"},{"code":"877385","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054935 = Hospital System Supply Identifier | 877385 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X24MM","code_information":[{"code":"Sx00-1400-462","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054936","type":"LOCAL"},{"code":"877386","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054936 = Hospital System Supply Identifier | 877386 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X26MM","code_information":[{"code":"Sx00-1400-462","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054937","type":"LOCAL"},{"code":"877387","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054937 = Hospital System Supply Identifier | 877387 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X28MM","code_information":[{"code":"Sx00-1400-462","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054938","type":"LOCAL"},{"code":"877388","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054938 = Hospital System Supply Identifier | 877388 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X38MM","code_information":[{"code":"Sx00-1400-463","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054943","type":"LOCAL"},{"code":"877393","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054943 = Hospital System Supply Identifier | 877393 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X36MM","code_information":[{"code":"Sx00-1400-463","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054942","type":"LOCAL"},{"code":"877392","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054942 = Hospital System Supply Identifier | 877392 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X30MM","code_information":[{"code":"Sx00-1400-463","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054939","type":"LOCAL"},{"code":"877389","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054939 = Hospital System Supply Identifier | 877389 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X32MM","code_information":[{"code":"Sx00-1400-463","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054940","type":"LOCAL"},{"code":"877390","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054940 = Hospital System Supply Identifier | 877390 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X34MM","code_information":[{"code":"Sx00-1400-463","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054941","type":"LOCAL"},{"code":"877391","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054941 = Hospital System Supply Identifier | 877391 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X40MM","code_information":[{"code":"Sx00-1400-464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054944","type":"LOCAL"},{"code":"877394","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054944 = Hospital System Supply Identifier | 877394 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X42MM","code_information":[{"code":"Sx00-1400-464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054945","type":"LOCAL"},{"code":"877395","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054945 = Hospital System Supply Identifier | 877395 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X44MM","code_information":[{"code":"Sx00-1400-464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054946","type":"LOCAL"},{"code":"877396","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054946 = Hospital System Supply Identifier | 877396 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X46MM","code_information":[{"code":"Sx00-1400-464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054947","type":"LOCAL"},{"code":"877397","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054947 = Hospital System Supply Identifier | 877397 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X48MM","code_information":[{"code":"Sx00-1400-464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054948","type":"LOCAL"},{"code":"877398","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054948 = Hospital System Supply Identifier | 877398 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X58MM","code_information":[{"code":"Sx00-1400-465","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054953","type":"LOCAL"},{"code":"877403","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054953 = Hospital System Supply Identifier | 877403 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X56MM","code_information":[{"code":"Sx00-1400-465","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054952","type":"LOCAL"},{"code":"877402","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054952 = Hospital System Supply Identifier | 877402 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X54MM","code_information":[{"code":"Sx00-1400-465","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054951","type":"LOCAL"},{"code":"877401","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054951 = Hospital System Supply Identifier | 877401 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X52MM","code_information":[{"code":"Sx00-1400-465","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054950","type":"LOCAL"},{"code":"877400","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054950 = Hospital System Supply Identifier | 877400 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X50MM","code_information":[{"code":"Sx00-1400-465","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054949","type":"LOCAL"},{"code":"877399","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054949 = Hospital System Supply Identifier | 877399 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X60MM","code_information":[{"code":"Sx00-1400-466","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054954","type":"LOCAL"},{"code":"877404","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054954 = Hospital System Supply Identifier | 877404 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X65MM","code_information":[{"code":"Sx00-1400-466","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054955","type":"LOCAL"},{"code":"877405","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054955 = Hospital System Supply Identifier | 877405 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X70MM","code_information":[{"code":"Sx00-1400-467","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054956","type":"LOCAL"},{"code":"877406","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054956 = Hospital System Supply Identifier | 877406 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X75MM","code_information":[{"code":"Sx00-1400-467","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054957","type":"LOCAL"},{"code":"877407","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054957 = Hospital System Supply Identifier | 877407 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X80MM","code_information":[{"code":"Sx00-1400-468","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054958","type":"LOCAL"},{"code":"877408","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054958 = Hospital System Supply Identifier | 877408 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X16MM","code_information":[{"code":"Sx00-1400-471","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054959","type":"LOCAL"},{"code":"877409","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054959 = Hospital System Supply Identifier | 877409 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X18MM","code_information":[{"code":"Sx00-1400-471","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054960","type":"LOCAL"},{"code":"877410","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054960 = Hospital System Supply Identifier | 877410 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X28MM","code_information":[{"code":"Sx00-1400-472","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054965","type":"LOCAL"},{"code":"877415","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054965 = Hospital System Supply Identifier | 877415 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X26MM","code_information":[{"code":"Sx00-1400-472","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054964","type":"LOCAL"},{"code":"877414","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054964 = Hospital System Supply Identifier | 877414 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X22MM","code_information":[{"code":"Sx00-1400-472","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054962","type":"LOCAL"},{"code":"877412","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054962 = Hospital System Supply Identifier | 877412 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X20MM","code_information":[{"code":"Sx00-1400-472","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054961","type":"LOCAL"},{"code":"877411","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054961 = Hospital System Supply Identifier | 877411 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X24MM","code_information":[{"code":"Sx00-1400-472","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054963","type":"LOCAL"},{"code":"877413","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054963 = Hospital System Supply Identifier | 877413 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X30MM","code_information":[{"code":"Sx00-1400-473","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054966","type":"LOCAL"},{"code":"877416","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054966 = Hospital System Supply Identifier | 877416 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X32MM","code_information":[{"code":"Sx00-1400-473","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054967","type":"LOCAL"},{"code":"877417","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054967 = Hospital System Supply Identifier | 877417 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X34MM","code_information":[{"code":"Sx00-1400-473","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054968","type":"LOCAL"},{"code":"877418","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054968 = Hospital System Supply Identifier | 877418 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X36MM","code_information":[{"code":"Sx00-1400-473","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054969","type":"LOCAL"},{"code":"877419","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054969 = Hospital System Supply Identifier | 877419 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X38MM","code_information":[{"code":"Sx00-1400-473","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054970","type":"LOCAL"},{"code":"877420","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054970 = Hospital System Supply Identifier | 877420 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X48MM","code_information":[{"code":"Sx00-1400-474","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054975","type":"LOCAL"},{"code":"877425","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054975 = Hospital System Supply Identifier | 877425 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X46MM","code_information":[{"code":"Sx00-1400-474","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054974","type":"LOCAL"},{"code":"877424","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054974 = Hospital System Supply Identifier | 877424 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X42MM","code_information":[{"code":"Sx00-1400-474","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054972","type":"LOCAL"},{"code":"877422","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054972 = Hospital System Supply Identifier | 877422 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X40MM","code_information":[{"code":"Sx00-1400-474","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054971","type":"LOCAL"},{"code":"877421","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054971 = Hospital System Supply Identifier | 877421 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X44MM","code_information":[{"code":"Sx00-1400-474","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054973","type":"LOCAL"},{"code":"877423","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054973 = Hospital System Supply Identifier | 877423 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X50MM","code_information":[{"code":"Sx00-1400-475","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054976","type":"LOCAL"},{"code":"877426","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054976 = Hospital System Supply Identifier | 877426 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X52MM","code_information":[{"code":"Sx00-1400-475","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054977","type":"LOCAL"},{"code":"877427","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054977 = Hospital System Supply Identifier | 877427 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X54MM","code_information":[{"code":"Sx00-1400-475","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054978","type":"LOCAL"},{"code":"877428","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054978 = Hospital System Supply Identifier | 877428 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X56MM","code_information":[{"code":"Sx00-1400-475","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054979","type":"LOCAL"},{"code":"877429","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054979 = Hospital System Supply Identifier | 877429 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X58MM","code_information":[{"code":"Sx00-1400-475","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054980","type":"LOCAL"},{"code":"877430","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054980 = Hospital System Supply Identifier | 877430 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X65MM","code_information":[{"code":"Sx00-1400-476","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054982","type":"LOCAL"},{"code":"877432","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054982 = Hospital System Supply Identifier | 877432 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X60MM","code_information":[{"code":"Sx00-1400-476","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054981","type":"LOCAL"},{"code":"877431","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054981 = Hospital System Supply Identifier | 877431 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X75MM","code_information":[{"code":"Sx00-1400-477","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054984","type":"LOCAL"},{"code":"877434","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054984 = Hospital System Supply Identifier | 877434 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X70MM","code_information":[{"code":"Sx00-1400-477","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054983","type":"LOCAL"},{"code":"877433","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054983 = Hospital System Supply Identifier | 877433 = Lawson ID"}]},{"description":"SCREW CANN P/T 4.5X80MM","code_information":[{"code":"Sx00-1400-478","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054985","type":"LOCAL"},{"code":"877435","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054985 = Hospital System Supply Identifier | 877435 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X20MM","code_information":[{"code":"Sx00-1400-542","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054986","type":"LOCAL"},{"code":"877436","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054986 = Hospital System Supply Identifier | 877436 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X22MM","code_information":[{"code":"Sx00-1400-542","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054987","type":"LOCAL"},{"code":"877437","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054987 = Hospital System Supply Identifier | 877437 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X24MM","code_information":[{"code":"Sx00-1400-542","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054988","type":"LOCAL"},{"code":"877438","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054988 = Hospital System Supply Identifier | 877438 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X26MM","code_information":[{"code":"Sx00-1400-542","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054989","type":"LOCAL"},{"code":"877439","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054989 = Hospital System Supply Identifier | 877439 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X28MM","code_information":[{"code":"Sx00-1400-542","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054990","type":"LOCAL"},{"code":"877440","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054990 = Hospital System Supply Identifier | 877440 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X38MM","code_information":[{"code":"Sx00-1400-543","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054995","type":"LOCAL"},{"code":"877445","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054995 = Hospital System Supply Identifier | 877445 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X36MM","code_information":[{"code":"Sx00-1400-543","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054994","type":"LOCAL"},{"code":"877444","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054994 = Hospital System Supply Identifier | 877444 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X32MM","code_information":[{"code":"Sx00-1400-543","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054992","type":"LOCAL"},{"code":"877442","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054992 = Hospital System Supply Identifier | 877442 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X34MM","code_information":[{"code":"Sx00-1400-543","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054993","type":"LOCAL"},{"code":"877443","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054993 = Hospital System Supply Identifier | 877443 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X30MM","code_information":[{"code":"Sx00-1400-543","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054991","type":"LOCAL"},{"code":"877441","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054991 = Hospital System Supply Identifier | 877441 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X40MM","code_information":[{"code":"Sx00-1400-544","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054996","type":"LOCAL"},{"code":"877446","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054996 = Hospital System Supply Identifier | 877446 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X42MM","code_information":[{"code":"Sx00-1400-544","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054997","type":"LOCAL"},{"code":"877447","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054997 = Hospital System Supply Identifier | 877447 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X44MM","code_information":[{"code":"Sx00-1400-544","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054998","type":"LOCAL"},{"code":"877448","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054998 = Hospital System Supply Identifier | 877448 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X46MM","code_information":[{"code":"Sx00-1400-544","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054999","type":"LOCAL"},{"code":"877449","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1054999 = Hospital System Supply Identifier | 877449 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X48MM","code_information":[{"code":"Sx00-1400-544","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055000","type":"LOCAL"},{"code":"877450","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055000 = Hospital System Supply Identifier | 877450 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X50MM","code_information":[{"code":"Sx00-1400-545","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055001","type":"LOCAL"},{"code":"877451","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055001 = Hospital System Supply Identifier | 877451 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X55MM","code_information":[{"code":"Sx00-1400-545","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055002","type":"LOCAL"},{"code":"877452","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055002 = Hospital System Supply Identifier | 877452 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X65MM","code_information":[{"code":"Sx00-1400-546","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055004","type":"LOCAL"},{"code":"877454","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055004 = Hospital System Supply Identifier | 877454 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X60MM","code_information":[{"code":"Sx00-1400-546","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055003","type":"LOCAL"},{"code":"877453","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055003 = Hospital System Supply Identifier | 877453 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X70MM","code_information":[{"code":"Sx00-1400-547","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055005","type":"LOCAL"},{"code":"877455","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055005 = Hospital System Supply Identifier | 877455 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X75MM","code_information":[{"code":"Sx00-1400-547","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055006","type":"LOCAL"},{"code":"877456","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055006 = Hospital System Supply Identifier | 877456 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X80MM","code_information":[{"code":"Sx00-1400-548","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055007","type":"LOCAL"},{"code":"877457","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055007 = Hospital System Supply Identifier | 877457 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X85MM","code_information":[{"code":"Sx00-1400-548","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055008","type":"LOCAL"},{"code":"877458","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055008 = Hospital System Supply Identifier | 877458 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X90MM","code_information":[{"code":"Sx00-1400-549","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055009","type":"LOCAL"},{"code":"877459","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055009 = Hospital System Supply Identifier | 877459 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X95MM","code_information":[{"code":"Sx00-1400-549","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055010","type":"LOCAL"},{"code":"877460","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055010 = Hospital System Supply Identifier | 877460 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X100MM","code_information":[{"code":"Sx00-1400-550","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055011","type":"LOCAL"},{"code":"877461","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055011 = Hospital System Supply Identifier | 877461 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 5.5X48MM","code_information":[{"code":"Sx00-1400-564","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055014","type":"LOCAL"},{"code":"877464","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055014 = Hospital System Supply Identifier | 877464 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 5.5X46MM","code_information":[{"code":"Sx00-1400-564","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055013","type":"LOCAL"},{"code":"877463","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055013 = Hospital System Supply Identifier | 877463 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 5.5X44MM","code_information":[{"code":"Sx00-1400-564","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055012","type":"LOCAL"},{"code":"877462","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055012 = Hospital System Supply Identifier | 877462 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 5.5X50MM","code_information":[{"code":"Sx00-1400-565","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055015","type":"LOCAL"},{"code":"877465","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055015 = Hospital System Supply Identifier | 877465 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 5.5X55MM","code_information":[{"code":"Sx00-1400-565","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055016","type":"LOCAL"},{"code":"877466","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055016 = Hospital System Supply Identifier | 877466 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 5.5X60MM","code_information":[{"code":"Sx00-1400-566","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055017","type":"LOCAL"},{"code":"877467","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055017 = Hospital System Supply Identifier | 877467 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 5.5X65MM","code_information":[{"code":"Sx00-1400-566","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055018","type":"LOCAL"},{"code":"877468","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055018 = Hospital System Supply Identifier | 877468 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 5.5X70MM","code_information":[{"code":"Sx00-1400-567","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055019","type":"LOCAL"},{"code":"877469","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055019 = Hospital System Supply Identifier | 877469 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 5.5X75MM","code_information":[{"code":"Sx00-1400-567","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055020","type":"LOCAL"},{"code":"877470","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055020 = Hospital System Supply Identifier | 877470 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 5.5X80MM","code_information":[{"code":"Sx00-1400-568","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055021","type":"LOCAL"},{"code":"877471","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055021 = Hospital System Supply Identifier | 877471 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 5.5X85MM","code_information":[{"code":"Sx00-1400-568","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055022","type":"LOCAL"},{"code":"877472","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055022 = Hospital System Supply Identifier | 877472 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 5.5X95MM","code_information":[{"code":"Sx00-1400-569","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055024","type":"LOCAL"},{"code":"877474","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055024 = Hospital System Supply Identifier | 877474 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 5.5X90MM","code_information":[{"code":"Sx00-1400-569","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055023","type":"LOCAL"},{"code":"877473","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055023 = Hospital System Supply Identifier | 877473 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 5.5X100MM","code_information":[{"code":"Sx00-1400-570","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055025","type":"LOCAL"},{"code":"877475","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055025 = Hospital System Supply Identifier | 877475 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X20MM","code_information":[{"code":"Sx00-1400-582","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055026","type":"LOCAL"},{"code":"877476","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055026 = Hospital System Supply Identifier | 877476 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X22MM","code_information":[{"code":"Sx00-1400-582","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055027","type":"LOCAL"},{"code":"877477","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055027 = Hospital System Supply Identifier | 877477 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X24MM","code_information":[{"code":"Sx00-1400-582","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055028","type":"LOCAL"},{"code":"877478","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055028 = Hospital System Supply Identifier | 877478 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X26MM","code_information":[{"code":"Sx00-1400-582","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055029","type":"LOCAL"},{"code":"877479","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055029 = Hospital System Supply Identifier | 877479 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X28MM","code_information":[{"code":"Sx00-1400-582","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055030","type":"LOCAL"},{"code":"877480","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055030 = Hospital System Supply Identifier | 877480 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X38MM","code_information":[{"code":"Sx00-1400-583","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055035","type":"LOCAL"},{"code":"877485","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055035 = Hospital System Supply Identifier | 877485 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X36MM","code_information":[{"code":"Sx00-1400-583","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055034","type":"LOCAL"},{"code":"877484","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055034 = Hospital System Supply Identifier | 877484 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X34MM","code_information":[{"code":"Sx00-1400-583","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055033","type":"LOCAL"},{"code":"877483","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055033 = Hospital System Supply Identifier | 877483 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X32MM","code_information":[{"code":"Sx00-1400-583","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055032","type":"LOCAL"},{"code":"877482","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055032 = Hospital System Supply Identifier | 877482 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X30MM","code_information":[{"code":"Sx00-1400-583","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055031","type":"LOCAL"},{"code":"877481","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055031 = Hospital System Supply Identifier | 877481 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X40MM","code_information":[{"code":"Sx00-1400-584","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055036","type":"LOCAL"},{"code":"877486","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055036 = Hospital System Supply Identifier | 877486 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X42MM","code_information":[{"code":"Sx00-1400-584","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055037","type":"LOCAL"},{"code":"877487","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055037 = Hospital System Supply Identifier | 877487 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X44MM","code_information":[{"code":"Sx00-1400-584","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055038","type":"LOCAL"},{"code":"877488","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055038 = Hospital System Supply Identifier | 877488 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X46MM","code_information":[{"code":"Sx00-1400-584","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055039","type":"LOCAL"},{"code":"877489","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055039 = Hospital System Supply Identifier | 877489 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X48MM","code_information":[{"code":"Sx00-1400-584","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055040","type":"LOCAL"},{"code":"877490","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055040 = Hospital System Supply Identifier | 877490 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X50MM","code_information":[{"code":"Sx00-1400-585","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055041","type":"LOCAL"},{"code":"877491","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055041 = Hospital System Supply Identifier | 877491 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X55MM","code_information":[{"code":"Sx00-1400-585","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055042","type":"LOCAL"},{"code":"877492","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055042 = Hospital System Supply Identifier | 877492 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X65MM","code_information":[{"code":"Sx00-1400-586","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055044","type":"LOCAL"},{"code":"877494","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055044 = Hospital System Supply Identifier | 877494 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X60MM","code_information":[{"code":"Sx00-1400-586","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055043","type":"LOCAL"},{"code":"877493","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055043 = Hospital System Supply Identifier | 877493 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X70MM","code_information":[{"code":"Sx00-1400-587","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055045","type":"LOCAL"},{"code":"877495","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055045 = Hospital System Supply Identifier | 877495 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X75MM","code_information":[{"code":"Sx00-1400-587","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055046","type":"LOCAL"},{"code":"877496","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055046 = Hospital System Supply Identifier | 877496 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X80MM","code_information":[{"code":"Sx00-1400-588","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055047","type":"LOCAL"},{"code":"877497","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055047 = Hospital System Supply Identifier | 877497 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X85MM","code_information":[{"code":"Sx00-1400-588","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055048","type":"LOCAL"},{"code":"877498","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055048 = Hospital System Supply Identifier | 877498 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X90MM","code_information":[{"code":"Sx00-1400-589","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055049","type":"LOCAL"},{"code":"877499","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055049 = Hospital System Supply Identifier | 877499 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X95MM","code_information":[{"code":"Sx00-1400-589","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055050","type":"LOCAL"},{"code":"877500","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055050 = Hospital System Supply Identifier | 877500 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X100MM","code_information":[{"code":"Sx00-1400-590","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055051","type":"LOCAL"},{"code":"877501","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055051 = Hospital System Supply Identifier | 877501 = Lawson ID"}]},{"description":"SCREW-WASHER CANN 6.5/7.3MM","code_information":[{"code":"Sx00-1402-100","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055052","type":"LOCAL"},{"code":"877502","type":"LOCAL"}],"standard_charges":[{"gross_charge":141.75,"discounted_cash":106.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055052 = Hospital System Supply Identifier | 877502 = Lawson ID"}]},{"description":"SCREW CANN 16 SHRT THRD 7.3X35","code_information":[{"code":"Sx00-1402-103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055054","type":"LOCAL"},{"code":"877504","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055054 = Hospital System Supply Identifier | 877504 = Lawson ID"}]},{"description":"SCREW CANN 16 SHRT THRD 7.3X30","code_information":[{"code":"Sx00-1402-103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055053","type":"LOCAL"},{"code":"877503","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055053 = Hospital System Supply Identifier | 877503 = Lawson ID"}]},{"description":"SCREW CANN 16 SHRT THRD 7.3X40","code_information":[{"code":"Sx00-1402-104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055055","type":"LOCAL"},{"code":"877505","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055055 = Hospital System Supply Identifier | 877505 = Lawson ID"}]},{"description":"SCREW CANN 16 SHRT THRD 7.3X45","code_information":[{"code":"Sx00-1402-104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055056","type":"LOCAL"},{"code":"877506","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055056 = Hospital System Supply Identifier | 877506 = Lawson ID"}]},{"description":"SCREW CANN 16 SHRT THRD 7.3X50","code_information":[{"code":"Sx00-1402-105","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055057","type":"LOCAL"},{"code":"877507","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055057 = Hospital System Supply Identifier | 877507 = Lawson ID"}]},{"description":"SCREW CANN 16 SHRT THRD 7.3X55","code_information":[{"code":"Sx00-1402-105","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055058","type":"LOCAL"},{"code":"877508","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055058 = Hospital System Supply Identifier | 877508 = Lawson ID"}]},{"description":"SCREW CANN 16 SHRT THRD 7.3X60","code_information":[{"code":"Sx00-1402-106","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055059","type":"LOCAL"},{"code":"877509","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055059 = Hospital System Supply Identifier | 877509 = Lawson ID"}]},{"description":"DISC - SCREW CANN 24 MED THRD 7.3X65","code_information":[{"code":"Sx00-1402-106","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055060","type":"LOCAL"},{"code":"877510","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055060 = Hospital System Supply Identifier | 877510 = Lawson ID"}]},{"description":"DISC - SCREW CANN 24 MED THRD 7.3X70","code_information":[{"code":"Sx00-1402-107","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055061","type":"LOCAL"},{"code":"877511","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055061 = Hospital System Supply Identifier | 877511 = Lawson ID"}]},{"description":"DISC - SCREW CANN 24 MED THRD 7.3X75","code_information":[{"code":"Sx00-1402-107","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055062","type":"LOCAL"},{"code":"877512","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055062 = Hospital System Supply Identifier | 877512 = Lawson ID"}]},{"description":"DISC - SCREW CANN 24 MED THRD 7.3X85","code_information":[{"code":"Sx00-1402-108","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055064","type":"LOCAL"},{"code":"877514","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055064 = Hospital System Supply Identifier | 877514 = Lawson ID"}]},{"description":"DISC - SCREW CANN 24 MED THRD 7.3X80","code_information":[{"code":"Sx00-1402-108","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055063","type":"LOCAL"},{"code":"877513","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055063 = Hospital System Supply Identifier | 877513 = Lawson ID"}]},{"description":"DISC - SCREW CANN 24 MED THRD 7.3X90","code_information":[{"code":"Sx00-1402-109","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055065","type":"LOCAL"},{"code":"877515","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055065 = Hospital System Supply Identifier | 877515 = Lawson ID"}]},{"description":"SCREW CANN 32 LNG THRD 7.3X95","code_information":[{"code":"Sx00-1402-109","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055066","type":"LOCAL"},{"code":"877516","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055066 = Hospital System Supply Identifier | 877516 = Lawson ID"}]},{"description":"SCREW CANN 32 LNG THRD 7.3X100","code_information":[{"code":"Sx00-1402-110","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055067","type":"LOCAL"},{"code":"877517","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055067 = Hospital System Supply Identifier | 877517 = Lawson ID"}]},{"description":"SCREW CANN 32 LNG THRD 7.3X105","code_information":[{"code":"Sx00-1402-110","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055068","type":"LOCAL"},{"code":"877518","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055068 = Hospital System Supply Identifier | 877518 = Lawson ID"}]},{"description":"SCREW CANN 32 LNG THRD 7.3X110","code_information":[{"code":"Sx00-1402-111","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055069","type":"LOCAL"},{"code":"877519","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055069 = Hospital System Supply Identifier | 877519 = Lawson ID"}]},{"description":"SCREW CANN 32 LNG THRD 7.3X115","code_information":[{"code":"Sx00-1402-111","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055070","type":"LOCAL"},{"code":"877520","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055070 = Hospital System Supply Identifier | 877520 = Lawson ID"}]},{"description":"SCREW CANN 32 LNG THRD 7.3X125","code_information":[{"code":"Sx00-1402-112","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055072","type":"LOCAL"},{"code":"877522","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055072 = Hospital System Supply Identifier | 877522 = Lawson ID"}]},{"description":"SCREW CANN 32 LNG THRD 7.3X120","code_information":[{"code":"Sx00-1402-112","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055071","type":"LOCAL"},{"code":"877521","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055071 = Hospital System Supply Identifier | 877521 = Lawson ID"}]},{"description":"SCREW CANN 32 LNG THRD 7.3X130","code_information":[{"code":"Sx00-1402-113","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055073","type":"LOCAL"},{"code":"877523","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055073 = Hospital System Supply Identifier | 877523 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X38","code_information":[{"code":"Sx00-1402-203","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055078","type":"LOCAL"},{"code":"877528","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055078 = Hospital System Supply Identifier | 877528 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X36","code_information":[{"code":"Sx00-1402-203","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055077","type":"LOCAL"},{"code":"877527","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055077 = Hospital System Supply Identifier | 877527 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X34","code_information":[{"code":"Sx00-1402-203","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055076","type":"LOCAL"},{"code":"877526","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055076 = Hospital System Supply Identifier | 877526 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X32","code_information":[{"code":"Sx00-1402-203","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055075","type":"LOCAL"},{"code":"877525","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055075 = Hospital System Supply Identifier | 877525 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X30","code_information":[{"code":"Sx00-1402-203","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055074","type":"LOCAL"},{"code":"877524","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055074 = Hospital System Supply Identifier | 877524 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X40","code_information":[{"code":"Sx00-1402-204","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055079","type":"LOCAL"},{"code":"877529","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055079 = Hospital System Supply Identifier | 877529 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X42","code_information":[{"code":"Sx00-1402-204","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055080","type":"LOCAL"},{"code":"877530","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055080 = Hospital System Supply Identifier | 877530 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X44","code_information":[{"code":"Sx00-1402-204","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055081","type":"LOCAL"},{"code":"877531","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055081 = Hospital System Supply Identifier | 877531 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X46","code_information":[{"code":"Sx00-1402-204","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055082","type":"LOCAL"},{"code":"877532","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055082 = Hospital System Supply Identifier | 877532 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X48","code_information":[{"code":"Sx00-1402-204","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055083","type":"LOCAL"},{"code":"877533","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055083 = Hospital System Supply Identifier | 877533 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X58","code_information":[{"code":"Sx00-1402-205","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055088","type":"LOCAL"},{"code":"877538","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055088 = Hospital System Supply Identifier | 877538 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X56","code_information":[{"code":"Sx00-1402-205","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055087","type":"LOCAL"},{"code":"877537","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055087 = Hospital System Supply Identifier | 877537 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X54","code_information":[{"code":"Sx00-1402-205","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055086","type":"LOCAL"},{"code":"877536","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055086 = Hospital System Supply Identifier | 877536 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X52","code_information":[{"code":"Sx00-1402-205","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055085","type":"LOCAL"},{"code":"877535","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055085 = Hospital System Supply Identifier | 877535 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X50","code_information":[{"code":"Sx00-1402-205","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055084","type":"LOCAL"},{"code":"877534","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055084 = Hospital System Supply Identifier | 877534 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X60","code_information":[{"code":"Sx00-1402-206","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055089","type":"LOCAL"},{"code":"877539","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055089 = Hospital System Supply Identifier | 877539 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X62","code_information":[{"code":"Sx00-1402-206","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055090","type":"LOCAL"},{"code":"877540","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055090 = Hospital System Supply Identifier | 877540 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X64","code_information":[{"code":"Sx00-1402-206","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055093","type":"LOCAL"},{"code":"877541","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055093 = Hospital System Supply Identifier | 877541 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X66","code_information":[{"code":"Sx00-1402-206","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055094","type":"LOCAL"},{"code":"877542","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055094 = Hospital System Supply Identifier | 877542 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X68","code_information":[{"code":"Sx00-1402-206","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055095","type":"LOCAL"},{"code":"877543","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055095 = Hospital System Supply Identifier | 877543 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X78","code_information":[{"code":"Sx00-1402-207","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055100","type":"LOCAL"},{"code":"877548","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055100 = Hospital System Supply Identifier | 877548 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X76","code_information":[{"code":"Sx00-1402-207","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055099","type":"LOCAL"},{"code":"877547","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055099 = Hospital System Supply Identifier | 877547 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X74","code_information":[{"code":"Sx00-1402-207","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055098","type":"LOCAL"},{"code":"877546","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055098 = Hospital System Supply Identifier | 877546 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X72","code_information":[{"code":"Sx00-1402-207","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055097","type":"LOCAL"},{"code":"877545","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055097 = Hospital System Supply Identifier | 877545 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X70","code_information":[{"code":"Sx00-1402-207","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055096","type":"LOCAL"},{"code":"877544","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055096 = Hospital System Supply Identifier | 877544 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X80","code_information":[{"code":"Sx00-1402-208","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055101","type":"LOCAL"},{"code":"877549","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055101 = Hospital System Supply Identifier | 877549 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X82","code_information":[{"code":"Sx00-1402-208","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055102","type":"LOCAL"},{"code":"877550","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055102 = Hospital System Supply Identifier | 877550 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X84","code_information":[{"code":"Sx00-1402-208","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055103","type":"LOCAL"},{"code":"877551","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055103 = Hospital System Supply Identifier | 877551 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X86","code_information":[{"code":"Sx00-1402-208","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055104","type":"LOCAL"},{"code":"877552","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055104 = Hospital System Supply Identifier | 877552 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X88","code_information":[{"code":"Sx00-1402-208","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055105","type":"LOCAL"},{"code":"877553","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055105 = Hospital System Supply Identifier | 877553 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X90","code_information":[{"code":"Sx00-1402-209","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055106","type":"LOCAL"},{"code":"877554","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055106 = Hospital System Supply Identifier | 877554 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X95","code_information":[{"code":"Sx00-1402-209","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055107","type":"LOCAL"},{"code":"877555","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055107 = Hospital System Supply Identifier | 877555 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS7.3X105","code_information":[{"code":"Sx00-1402-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055109","type":"LOCAL"},{"code":"877557","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055109 = Hospital System Supply Identifier | 877557 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS7.3X100","code_information":[{"code":"Sx00-1402-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055108","type":"LOCAL"},{"code":"877556","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055108 = Hospital System Supply Identifier | 877556 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS7.3X110","code_information":[{"code":"Sx00-1402-211","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055110","type":"LOCAL"},{"code":"877558","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055110 = Hospital System Supply Identifier | 877558 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS7.3X115","code_information":[{"code":"Sx00-1402-211","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055111","type":"LOCAL"},{"code":"877559","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055111 = Hospital System Supply Identifier | 877559 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS7.3X120","code_information":[{"code":"Sx00-1402-212","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055112","type":"LOCAL"},{"code":"877560","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055112 = Hospital System Supply Identifier | 877560 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS7.3X125","code_information":[{"code":"Sx00-1402-212","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055113","type":"LOCAL"},{"code":"877561","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055113 = Hospital System Supply Identifier | 877561 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS7.3X130","code_information":[{"code":"Sx00-1402-213","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055114","type":"LOCAL"},{"code":"877562","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055114 = Hospital System Supply Identifier | 877562 = Lawson ID"}]},{"description":"SCREW CANN 16 SHRT THRD 6.5X30","code_information":[{"code":"Sx00-1402-503","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055115","type":"LOCAL"},{"code":"877563","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055115 = Hospital System Supply Identifier | 877563 = Lawson ID"}]},{"description":"SCREW CANN 16 SHRT THRD 6.5X35","code_information":[{"code":"Sx00-1402-503","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055116","type":"LOCAL"},{"code":"877564","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055116 = Hospital System Supply Identifier | 877564 = Lawson ID"}]},{"description":"SCREW CANN 16 SHRT THRD 6.5X40","code_information":[{"code":"Sx00-1402-504","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055117","type":"LOCAL"},{"code":"877565","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055117 = Hospital System Supply Identifier | 877565 = Lawson ID"}]},{"description":"SCREW CANN 16 SHRT THRD 6.5X45","code_information":[{"code":"Sx00-1402-504","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055118","type":"LOCAL"},{"code":"877566","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055118 = Hospital System Supply Identifier | 877566 = Lawson ID"}]},{"description":"SCREW CANN 16 SHRT THRD 6.5X55","code_information":[{"code":"Sx00-1402-505","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055120","type":"LOCAL"},{"code":"877568","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055120 = Hospital System Supply Identifier | 877568 = Lawson ID"}]},{"description":"SCREW CANN 16 SHRT THRD 6.5X50","code_information":[{"code":"Sx00-1402-505","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055119","type":"LOCAL"},{"code":"877567","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055119 = Hospital System Supply Identifier | 877567 = Lawson ID"}]},{"description":"SCREW CANN 16 SHRT THRD 6.5X60","code_information":[{"code":"Sx00-1402-506","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055121","type":"LOCAL"},{"code":"877569","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055121 = Hospital System Supply Identifier | 877569 = Lawson ID"}]},{"description":"DISC - SCREW CANN 24 MED THRD 6.5X65","code_information":[{"code":"Sx00-1402-506","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055122","type":"LOCAL"},{"code":"877570","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055122 = Hospital System Supply Identifier | 877570 = Lawson ID"}]},{"description":"DISC - SCREW CANN 24 MED THRD 6.5X70","code_information":[{"code":"Sx00-1402-507","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055123","type":"LOCAL"},{"code":"877571","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055123 = Hospital System Supply Identifier | 877571 = Lawson ID"}]},{"description":"DISC - SCREW CANN 24 MED THRD 6.5X75","code_information":[{"code":"Sx00-1402-507","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055124","type":"LOCAL"},{"code":"877572","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055124 = Hospital System Supply Identifier | 877572 = Lawson ID"}]},{"description":"DISC - SCREW CANN 24 MED THRD 6.5X80","code_information":[{"code":"Sx00-1402-508","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055125","type":"LOCAL"},{"code":"877573","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055125 = Hospital System Supply Identifier | 877573 = Lawson ID"}]},{"description":"DISC - SCREW CANN 24 MED THRD 6.5X85","code_information":[{"code":"Sx00-1402-508","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055126","type":"LOCAL"},{"code":"877574","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055126 = Hospital System Supply Identifier | 877574 = Lawson ID"}]},{"description":"SCREW CANN 32 LNG THRD 6.5X95","code_information":[{"code":"Sx00-1402-509","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055128","type":"LOCAL"},{"code":"877576","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055128 = Hospital System Supply Identifier | 877576 = Lawson ID"}]},{"description":"DISC - SCREW CANN 24 MED THRD 6.5X90","code_information":[{"code":"Sx00-1402-509","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055127","type":"LOCAL"},{"code":"877575","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055127 = Hospital System Supply Identifier | 877575 = Lawson ID"}]},{"description":"SCREW CANN 32 LNG THRD 6.5X100","code_information":[{"code":"Sx00-1402-510","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055129","type":"LOCAL"},{"code":"877577","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055129 = Hospital System Supply Identifier | 877577 = Lawson ID"}]},{"description":"SCREW CANN 32 LNG THRD 6.5X105","code_information":[{"code":"Sx00-1402-510","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055130","type":"LOCAL"},{"code":"877578","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055130 = Hospital System Supply Identifier | 877578 = Lawson ID"}]},{"description":"SCREW CANN 32 LNG THRD 6.5X115","code_information":[{"code":"Sx00-1402-511","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055132","type":"LOCAL"},{"code":"877580","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055132 = Hospital System Supply Identifier | 877580 = Lawson ID"}]},{"description":"SCREW CANN 32 LNG THRD 6.5X110","code_information":[{"code":"Sx00-1402-511","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055131","type":"LOCAL"},{"code":"877579","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055131 = Hospital System Supply Identifier | 877579 = Lawson ID"}]},{"description":"SCREW CANN 32 LNG THRD 6.5X120","code_information":[{"code":"Sx00-1402-512","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055133","type":"LOCAL"},{"code":"877581","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055133 = Hospital System Supply Identifier | 877581 = Lawson ID"}]},{"description":"SCREW CANN 32 LNG THRD 6.5X125","code_information":[{"code":"Sx00-1402-512","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055134","type":"LOCAL"},{"code":"877582","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055134 = Hospital System Supply Identifier | 877582 = Lawson ID"}]},{"description":"SCREW CANN 32 LNG THRD 6.5X130","code_information":[{"code":"Sx00-1402-513","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055135","type":"LOCAL"},{"code":"877583","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055135 = Hospital System Supply Identifier | 877583 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X36","code_information":[{"code":"Sx00-1402-603","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055139","type":"LOCAL"},{"code":"877587","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055139 = Hospital System Supply Identifier | 877587 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X34","code_information":[{"code":"Sx00-1402-603","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055138","type":"LOCAL"},{"code":"877586","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055138 = Hospital System Supply Identifier | 877586 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X38","code_information":[{"code":"Sx00-1402-603","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055140","type":"LOCAL"},{"code":"877588","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055140 = Hospital System Supply Identifier | 877588 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X30","code_information":[{"code":"Sx00-1402-603","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055136","type":"LOCAL"},{"code":"877584","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055136 = Hospital System Supply Identifier | 877584 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X32","code_information":[{"code":"Sx00-1402-603","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055137","type":"LOCAL"},{"code":"877585","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055137 = Hospital System Supply Identifier | 877585 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X48","code_information":[{"code":"Sx00-1402-604","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055145","type":"LOCAL"},{"code":"877593","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055145 = Hospital System Supply Identifier | 877593 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X46","code_information":[{"code":"Sx00-1402-604","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055144","type":"LOCAL"},{"code":"877592","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055144 = Hospital System Supply Identifier | 877592 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X40","code_information":[{"code":"Sx00-1402-604","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055141","type":"LOCAL"},{"code":"877589","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055141 = Hospital System Supply Identifier | 877589 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X42","code_information":[{"code":"Sx00-1402-604","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055142","type":"LOCAL"},{"code":"877590","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055142 = Hospital System Supply Identifier | 877590 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X44","code_information":[{"code":"Sx00-1402-604","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055143","type":"LOCAL"},{"code":"877591","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055143 = Hospital System Supply Identifier | 877591 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X50","code_information":[{"code":"Sx00-1402-605","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055146","type":"LOCAL"},{"code":"877594","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055146 = Hospital System Supply Identifier | 877594 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X52","code_information":[{"code":"Sx00-1402-605","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055147","type":"LOCAL"},{"code":"877595","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055147 = Hospital System Supply Identifier | 877595 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X54","code_information":[{"code":"Sx00-1402-605","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055148","type":"LOCAL"},{"code":"877596","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055148 = Hospital System Supply Identifier | 877596 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X56","code_information":[{"code":"Sx00-1402-605","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055149","type":"LOCAL"},{"code":"877597","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055149 = Hospital System Supply Identifier | 877597 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X58","code_information":[{"code":"Sx00-1402-605","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055150","type":"LOCAL"},{"code":"877598","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055150 = Hospital System Supply Identifier | 877598 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X68","code_information":[{"code":"Sx00-1402-606","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055155","type":"LOCAL"},{"code":"877603","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055155 = Hospital System Supply Identifier | 877603 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X66","code_information":[{"code":"Sx00-1402-606","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055154","type":"LOCAL"},{"code":"877602","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055154 = Hospital System Supply Identifier | 877602 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X62","code_information":[{"code":"Sx00-1402-606","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055152","type":"LOCAL"},{"code":"877600","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055152 = Hospital System Supply Identifier | 877600 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X60","code_information":[{"code":"Sx00-1402-606","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055151","type":"LOCAL"},{"code":"877599","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055151 = Hospital System Supply Identifier | 877599 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X64","code_information":[{"code":"Sx00-1402-606","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055153","type":"LOCAL"},{"code":"877601","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055153 = Hospital System Supply Identifier | 877601 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X76","code_information":[{"code":"Sx00-1402-607","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055159","type":"LOCAL"},{"code":"877607","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055159 = Hospital System Supply Identifier | 877607 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X70","code_information":[{"code":"Sx00-1402-607","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055156","type":"LOCAL"},{"code":"877604","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055156 = Hospital System Supply Identifier | 877604 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X72","code_information":[{"code":"Sx00-1402-607","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055157","type":"LOCAL"},{"code":"877605","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055157 = Hospital System Supply Identifier | 877605 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X74","code_information":[{"code":"Sx00-1402-607","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055158","type":"LOCAL"},{"code":"877606","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055158 = Hospital System Supply Identifier | 877606 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X78","code_information":[{"code":"Sx00-1402-607","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055160","type":"LOCAL"},{"code":"877608","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055160 = Hospital System Supply Identifier | 877608 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X88","code_information":[{"code":"Sx00-1402-608","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055165","type":"LOCAL"},{"code":"877613","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055165 = Hospital System Supply Identifier | 877613 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X86","code_information":[{"code":"Sx00-1402-608","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055164","type":"LOCAL"},{"code":"877612","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055164 = Hospital System Supply Identifier | 877612 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X82","code_information":[{"code":"Sx00-1402-608","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055162","type":"LOCAL"},{"code":"877610","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055162 = Hospital System Supply Identifier | 877610 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X84","code_information":[{"code":"Sx00-1402-608","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055163","type":"LOCAL"},{"code":"877611","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055163 = Hospital System Supply Identifier | 877611 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X80","code_information":[{"code":"Sx00-1402-608","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055161","type":"LOCAL"},{"code":"877609","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055161 = Hospital System Supply Identifier | 877609 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X90","code_information":[{"code":"Sx00-1402-609","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055166","type":"LOCAL"},{"code":"877614","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055166 = Hospital System Supply Identifier | 877614 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X95","code_information":[{"code":"Sx00-1402-609","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055167","type":"LOCAL"},{"code":"877615","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055167 = Hospital System Supply Identifier | 877615 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS6.5X100","code_information":[{"code":"Sx00-1402-610","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055168","type":"LOCAL"},{"code":"877616","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055168 = Hospital System Supply Identifier | 877616 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS6.5X105","code_information":[{"code":"Sx00-1402-610","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055169","type":"LOCAL"},{"code":"877617","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055169 = Hospital System Supply Identifier | 877617 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS6.5X110","code_information":[{"code":"Sx00-1402-611","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055170","type":"LOCAL"},{"code":"877618","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055170 = Hospital System Supply Identifier | 877618 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS6.5X115","code_information":[{"code":"Sx00-1402-611","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055171","type":"LOCAL"},{"code":"877619","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055171 = Hospital System Supply Identifier | 877619 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS6.5X125","code_information":[{"code":"Sx00-1402-612","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055173","type":"LOCAL"},{"code":"877621","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055173 = Hospital System Supply Identifier | 877621 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS6.5X120","code_information":[{"code":"Sx00-1402-612","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055172","type":"LOCAL"},{"code":"877620","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055172 = Hospital System Supply Identifier | 877620 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS6.5X130","code_information":[{"code":"Sx00-1402-613","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055174","type":"LOCAL"},{"code":"877622","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055174 = Hospital System Supply Identifier | 877622 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED LONG THREAD 0014026345 SS 6.5X45MM","code_information":[{"code":"Sx00-1402-634","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357242","type":"LOCAL"},{"code":"1082486","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357242 = Hospital System Supply Identifier | 1082486 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED LONG THREAD 0014026355 SS 6.5X55MM","code_information":[{"code":"Sx00-1402-635","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356332","type":"LOCAL"},{"code":"1082535","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356332 = Hospital System Supply Identifier | 1082535 = Lawson ID"}]},{"description":"SCREW-BONE CANNULATED STAINLESS-STEEL LONG-THREAD FEMUR","code_information":[{"code":"Sx00-1402-635","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356515","type":"LOCAL"},{"code":"1083660","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356515 = Hospital System Supply Identifier | 1083660 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED LONG THREAD 0014026365 SS 6.5X65MM","code_information":[{"code":"Sx00-1402-636","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356734","type":"LOCAL"},{"code":"1082540","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356734 = Hospital System Supply Identifier | 1082540 = Lawson ID"}]},{"description":"SCREW-BONE CANNULATED STAINLESS-STEEL LONG-THREAD FEMUR","code_information":[{"code":"Sx00-1402-636","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356855","type":"LOCAL"},{"code":"1083704","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356855 = Hospital System Supply Identifier | 1083704 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED LONG THREAD 0014026375 SS 6.5X75MM","code_information":[{"code":"Sx00-1402-637","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356629","type":"LOCAL"},{"code":"1082532","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356629 = Hospital System Supply Identifier | 1082532 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED LONG THREAD 0014026370 SS 6.5X70MM","code_information":[{"code":"Sx00-1402-637","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356840","type":"LOCAL"},{"code":"1082597","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356840 = Hospital System Supply Identifier | 1082597 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED LONG THREAD 0014026385 SS 6.5X85MM","code_information":[{"code":"Sx00-1402-638","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356911","type":"LOCAL"},{"code":"1082513","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356911 = Hospital System Supply Identifier | 1082513 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED LONG THREAD 0014026380 SS 6.5X80MM","code_information":[{"code":"Sx00-1402-638","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357051","type":"LOCAL"},{"code":"1082559","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357051 = Hospital System Supply Identifier | 1082559 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED LONG THREAD 0014026390 SS 6.5X90MM","code_information":[{"code":"Sx00-1402-639","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356965","type":"LOCAL"},{"code":"1082507","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356965 = Hospital System Supply Identifier | 1082507 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014027065 SS 7.3X65MM","code_information":[{"code":"Sx00-1402-706","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356731","type":"LOCAL"},{"code":"1082443","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356731 = Hospital System Supply Identifier | 1082443 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014027070 SS 7.3X70MM","code_information":[{"code":"Sx00-1402-707","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356427","type":"LOCAL"},{"code":"1082456","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356427 = Hospital System Supply Identifier | 1082456 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014027075 SS 7.3X75MM","code_information":[{"code":"Sx00-1402-707","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357033","type":"LOCAL"},{"code":"1082521","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357033 = Hospital System Supply Identifier | 1082521 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014027085 SS 7.3X85MM","code_information":[{"code":"Sx00-1402-708","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356967","type":"LOCAL"},{"code":"1082545","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356967 = Hospital System Supply Identifier | 1082545 = Lawson ID"}]},{"description":"SCREW-BONE CANNULATED STAINLESS-STEEL SHORT-THREAD FEMUR","code_information":[{"code":"Sx00-1402-708","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356499","type":"LOCAL"},{"code":"1083619","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356499 = Hospital System Supply Identifier | 1083619 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014027095 SS 7.3X95MM","code_information":[{"code":"Sx00-1402-709","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356612","type":"LOCAL"},{"code":"1082428","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356612 = Hospital System Supply Identifier | 1082428 = Lawson ID"}]},{"description":"SCREW-BONE CANNULATED STAINLESS-STEEL SHORT-THREAD FEMUR","code_information":[{"code":"Sx00-1402-709","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356378","type":"LOCAL"},{"code":"1083550","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356378 = Hospital System Supply Identifier | 1083550 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014027100 SS 7.3X100MM","code_information":[{"code":"Sx00-1402-710","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356636","type":"LOCAL"},{"code":"1082474","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356636 = Hospital System Supply Identifier | 1082474 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014027105 SS 7.3X105MM","code_information":[{"code":"Sx00-1402-710","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356713","type":"LOCAL"},{"code":"1082581","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356713 = Hospital System Supply Identifier | 1082581 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014027115 SS 7.3X115MM","code_information":[{"code":"Sx00-1402-711","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356592","type":"LOCAL"},{"code":"1082543","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356592 = Hospital System Supply Identifier | 1082543 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014027110 SS 7.3X110MM","code_information":[{"code":"Sx00-1402-711","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356555","type":"LOCAL"},{"code":"1082449","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356555 = Hospital System Supply Identifier | 1082449 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014027120 SS 7.3X120MM","code_information":[{"code":"Sx00-1402-712","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356503","type":"LOCAL"},{"code":"1082432","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356503 = Hospital System Supply Identifier | 1082432 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014027125 SS 7.3X125MM","code_information":[{"code":"Sx00-1402-712","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356613","type":"LOCAL"},{"code":"1082445","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356613 = Hospital System Supply Identifier | 1082445 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014027130 SS 7.3X130MM","code_information":[{"code":"Sx00-1402-713","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357080","type":"LOCAL"},{"code":"1082554","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357080 = Hospital System Supply Identifier | 1082554 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED LONG THREAD 0014027345 SS 7.3X45MM","code_information":[{"code":"Sx00-1402-734","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356707","type":"LOCAL"},{"code":"1082530","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356707 = Hospital System Supply Identifier | 1082530 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED LONG THREAD 0014027350 SS 7.3X50MM","code_information":[{"code":"Sx00-1402-735","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357078","type":"LOCAL"},{"code":"1082509","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357078 = Hospital System Supply Identifier | 1082509 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED LONG THREAD 0014027355 SS 7.3X55MM","code_information":[{"code":"Sx00-1402-735","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357111","type":"LOCAL"},{"code":"1082517","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357111 = Hospital System Supply Identifier | 1082517 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED LONG THREAD 0014027365 SS 7.3X65MM","code_information":[{"code":"Sx00-1402-736","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356374","type":"LOCAL"},{"code":"1082476","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356374 = Hospital System Supply Identifier | 1082476 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED LONG THREAD 0014027360 SS 7.3X60MM","code_information":[{"code":"Sx00-1402-736","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356693","type":"LOCAL"},{"code":"1082595","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356693 = Hospital System Supply Identifier | 1082595 = Lawson ID"}]},{"description":"SCREW-BONE CANNULATED STAINLESS-STEEL LONG-THREAD FEMUR","code_information":[{"code":"Sx00-1402-737","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357224","type":"LOCAL"},{"code":"1083728","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357224 = Hospital System Supply Identifier | 1083728 = Lawson ID"}]},{"description":"SCREW-BONE CANNULATED STAINLESS-STEEL LONG-THREAD FEMUR","code_information":[{"code":"Sx00-1402-737","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356846","type":"LOCAL"},{"code":"1083727","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356846 = Hospital System Supply Identifier | 1083727 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED LONG THREAD 0014027385 SS 7.3X85MM","code_information":[{"code":"Sx00-1402-738","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356606","type":"LOCAL"},{"code":"1082504","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356606 = Hospital System Supply Identifier | 1082504 = Lawson ID"}]},{"description":"SCREW-BONE CANNULATED STAINLESS-STEEL LONG-THREAD FEMUR","code_information":[{"code":"Sx00-1402-738","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356746","type":"LOCAL"},{"code":"1083554","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356746 = Hospital System Supply Identifier | 1083554 = Lawson ID"}]},{"description":"SCREW-BONE CANNULATED STAINLESS-STEEL LONG-THREAD FEMUR","code_information":[{"code":"Sx00-1402-739","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356621","type":"LOCAL"},{"code":"1083548","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356621 = Hospital System Supply Identifier | 1083548 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014028065 SS 6.5X65MM","code_information":[{"code":"Sx00-1402-806","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356689","type":"LOCAL"},{"code":"1082566","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356689 = Hospital System Supply Identifier | 1082566 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014028070 SS 6.5X70MM","code_information":[{"code":"Sx00-1402-807","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356571","type":"LOCAL"},{"code":"1082550","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356571 = Hospital System Supply Identifier | 1082550 = Lawson ID"}]},{"description":"SCREW-BONE CANNULATED STAINLESS-STEEL 16MM-SHORT-THREAD FEMUR","code_information":[{"code":"Sx00-1402-807","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356344","type":"LOCAL"},{"code":"1083712","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356344 = Hospital System Supply Identifier | 1083712 = Lawson ID"}]},{"description":"SCREW-BONE CANNULATED STAINLESS-STEEL 16MM-SHORT-THREAD FEMUR","code_information":[{"code":"Sx00-1402-808","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356519","type":"LOCAL"},{"code":"1083556","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356519 = Hospital System Supply Identifier | 1083556 = Lawson ID"}]},{"description":"SCREW-BONE CANNULATED STAINLESS-STEEL 16MM-SHORT-THREAD FEMUR","code_information":[{"code":"Sx00-1402-808","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356488","type":"LOCAL"},{"code":"1083658","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356488 = Hospital System Supply Identifier | 1083658 = Lawson ID"}]},{"description":"SCREW-BONE CANNULATED STAINLESS-STEEL 16MM-SHORT-THREAD FEMUR","code_information":[{"code":"Sx00-1402-809","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356858","type":"LOCAL"},{"code":"1083535","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356858 = Hospital System Supply Identifier | 1083535 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014028095 SS 6.5X95MM","code_information":[{"code":"Sx00-1402-809","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356834","type":"LOCAL"},{"code":"1082480","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356834 = Hospital System Supply Identifier | 1082480 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014028105 SS 6.5X105MM","code_information":[{"code":"Sx00-1402-810","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356992","type":"LOCAL"},{"code":"1082485","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356992 = Hospital System Supply Identifier | 1082485 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014028100 SS 6.5X100MM","code_information":[{"code":"Sx00-1402-810","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356935","type":"LOCAL"},{"code":"1082560","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356935 = Hospital System Supply Identifier | 1082560 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014028110 SS 6.5X110MM","code_information":[{"code":"Sx00-1402-811","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356960","type":"LOCAL"},{"code":"1082441","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356960 = Hospital System Supply Identifier | 1082441 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014028115 SS 6.5X115MM","code_information":[{"code":"Sx00-1402-811","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356984","type":"LOCAL"},{"code":"1082460","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356984 = Hospital System Supply Identifier | 1082460 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014028125 SS 6.5X125MM","code_information":[{"code":"Sx00-1402-812","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356799","type":"LOCAL"},{"code":"1082430","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356799 = Hospital System Supply Identifier | 1082430 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014028120 SS 6.5X120MM","code_information":[{"code":"Sx00-1402-812","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357029","type":"LOCAL"},{"code":"1082431","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357029 = Hospital System Supply Identifier | 1082431 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014028130 SS 6.5X130MM","code_information":[{"code":"Sx00-1402-813","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356672","type":"LOCAL"},{"code":"1082457","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356672 = Hospital System Supply Identifier | 1082457 = Lawson ID"}]},{"description":"TUBING DRN HEMO 1/4X36IN","code_information":[{"code":"Sx00-1500-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"92615","type":"LOCAL"},{"code":"126200","type":"LOCAL"}],"standard_charges":[{"gross_charge":12.09,"discounted_cash":9.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 92615 = Hospital System Supply Identifier | 126200 = Lawson ID"}]},{"description":"CONN DRAIN UNIV","code_information":[{"code":"Sx00-1500-015","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"80491","type":"LOCAL"},{"code":"100204","type":"LOCAL"}],"standard_charges":[{"gross_charge":11.65,"discounted_cash":8.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 80491 = Hospital System Supply Identifier | 100204 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X200MM LT","code_information":[{"code":"Sx00-1501-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055175","type":"LOCAL"},{"code":"877623","type":"LOCAL"}],"standard_charges":[{"gross_charge":11298.0,"discounted_cash":8473.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055175 = Hospital System Supply Identifier | 877623 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X220MM LT","code_information":[{"code":"Sx00-1501-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055176","type":"LOCAL"},{"code":"877624","type":"LOCAL"}],"standard_charges":[{"gross_charge":11298.0,"discounted_cash":8473.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055176 = Hospital System Supply Identifier | 877624 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X240MM LT","code_information":[{"code":"Sx00-1501-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055177","type":"LOCAL"},{"code":"877625","type":"LOCAL"}],"standard_charges":[{"gross_charge":11298.0,"discounted_cash":8473.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055177 = Hospital System Supply Identifier | 877625 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X260MM LT","code_information":[{"code":"Sx00-1501-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055178","type":"LOCAL"},{"code":"877626","type":"LOCAL"}],"standard_charges":[{"gross_charge":11298.0,"discounted_cash":8473.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055178 = Hospital System Supply Identifier | 877626 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X280MM LT","code_information":[{"code":"Sx00-1501-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055179","type":"LOCAL"},{"code":"877627","type":"LOCAL"}],"standard_charges":[{"gross_charge":11298.0,"discounted_cash":8473.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055179 = Hospital System Supply Identifier | 877627 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X380MM LT","code_information":[{"code":"Sx00-1501-073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055184","type":"LOCAL"},{"code":"877632","type":"LOCAL"}],"standard_charges":[{"gross_charge":11298.0,"discounted_cash":8473.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055184 = Hospital System Supply Identifier | 877632 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X340MM LT","code_information":[{"code":"Sx00-1501-073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055182","type":"LOCAL"},{"code":"877630","type":"LOCAL"}],"standard_charges":[{"gross_charge":11298.0,"discounted_cash":8473.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055182 = Hospital System Supply Identifier | 877630 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X360MM LT","code_information":[{"code":"Sx00-1501-073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055183","type":"LOCAL"},{"code":"877631","type":"LOCAL"}],"standard_charges":[{"gross_charge":11298.0,"discounted_cash":8473.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055183 = Hospital System Supply Identifier | 877631 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X300MM LT","code_information":[{"code":"Sx00-1501-073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055180","type":"LOCAL"},{"code":"877628","type":"LOCAL"}],"standard_charges":[{"gross_charge":11298.0,"discounted_cash":8473.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055180 = Hospital System Supply Identifier | 877628 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X320MM LT","code_information":[{"code":"Sx00-1501-073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055181","type":"LOCAL"},{"code":"877629","type":"LOCAL"}],"standard_charges":[{"gross_charge":11298.0,"discounted_cash":8473.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055181 = Hospital System Supply Identifier | 877629 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X240MM LT","code_information":[{"code":"Sx00-1501-082","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055185","type":"LOCAL"},{"code":"877633","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055185 = Hospital System Supply Identifier | 877633 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X260MM LT","code_information":[{"code":"Sx00-1501-082","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055186","type":"LOCAL"},{"code":"877634","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055186 = Hospital System Supply Identifier | 877634 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X280MM LT","code_information":[{"code":"Sx00-1501-082","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055187","type":"LOCAL"},{"code":"877635","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055187 = Hospital System Supply Identifier | 877635 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X360MM LT","code_information":[{"code":"Sx00-1501-083","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055191","type":"LOCAL"},{"code":"877639","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055191 = Hospital System Supply Identifier | 877639 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X300MM LT","code_information":[{"code":"Sx00-1501-083","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055188","type":"LOCAL"},{"code":"877636","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055188 = Hospital System Supply Identifier | 877636 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X320MM LT","code_information":[{"code":"Sx00-1501-083","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055189","type":"LOCAL"},{"code":"877637","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055189 = Hospital System Supply Identifier | 877637 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X340MM LT","code_information":[{"code":"Sx00-1501-083","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055190","type":"LOCAL"},{"code":"877638","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055190 = Hospital System Supply Identifier | 877638 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X380MM LT","code_information":[{"code":"Sx00-1501-083","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055192","type":"LOCAL"},{"code":"877640","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055192 = Hospital System Supply Identifier | 877640 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X420MM LT","code_information":[{"code":"Sx00-1501-084","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055194","type":"LOCAL"},{"code":"877642","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055194 = Hospital System Supply Identifier | 877642 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X400MM LT","code_information":[{"code":"Sx00-1501-084","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055193","type":"LOCAL"},{"code":"877641","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055193 = Hospital System Supply Identifier | 877641 = Lawson ID"}]},{"description":"NAIL PIP CHILD 9X280MM LT","code_information":[{"code":"Sx00-1501-092","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055195","type":"LOCAL"},{"code":"877643","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055195 = Hospital System Supply Identifier | 877643 = Lawson ID"}]},{"description":"NAIL PIP CHILD 9X380MM LT","code_information":[{"code":"Sx00-1501-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055200","type":"LOCAL"},{"code":"877648","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055200 = Hospital System Supply Identifier | 877648 = Lawson ID"}]},{"description":"NAIL PIP CHILD 9X360MM LT","code_information":[{"code":"Sx00-1501-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055199","type":"LOCAL"},{"code":"877647","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055199 = Hospital System Supply Identifier | 877647 = Lawson ID"}]},{"description":"NAIL PIP CHILD 9X300MM LT","code_information":[{"code":"Sx00-1501-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055196","type":"LOCAL"},{"code":"877644","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055196 = Hospital System Supply Identifier | 877644 = Lawson ID"}]},{"description":"NAIL PIP CHILD 9X320MM LT","code_information":[{"code":"Sx00-1501-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055197","type":"LOCAL"},{"code":"877645","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055197 = Hospital System Supply Identifier | 877645 = Lawson ID"}]},{"description":"NAIL PIP CHILD 9X340MM LT","code_information":[{"code":"Sx00-1501-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055198","type":"LOCAL"},{"code":"877646","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055198 = Hospital System Supply Identifier | 877646 = Lawson ID"}]},{"description":"NAIL PIP CHILD 9X400MM LT","code_information":[{"code":"Sx00-1501-094","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055201","type":"LOCAL"},{"code":"877649","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055201 = Hospital System Supply Identifier | 877649 = Lawson ID"}]},{"description":"NAIL PIP CHILD 9X420MM LT","code_information":[{"code":"Sx00-1501-094","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055202","type":"LOCAL"},{"code":"877650","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055202 = Hospital System Supply Identifier | 877650 = Lawson ID"}]},{"description":"END CAP NAIL PIP CHILD 0MM","code_information":[{"code":"Sx00-1501-200","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055203","type":"LOCAL"},{"code":"877651","type":"LOCAL"}],"standard_charges":[{"gross_charge":366.25,"discounted_cash":274.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055203 = Hospital System Supply Identifier | 877651 = Lawson ID"}]},{"description":"END CAP NAIL PIP CHILD 5MM","code_information":[{"code":"Sx00-1501-200","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055204","type":"LOCAL"},{"code":"877652","type":"LOCAL"}],"standard_charges":[{"gross_charge":366.25,"discounted_cash":274.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055204 = Hospital System Supply Identifier | 877652 = Lawson ID"}]},{"description":"END CAP NAIL PIP CHILD 10MM","code_information":[{"code":"Sx00-1501-201","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055205","type":"LOCAL"},{"code":"877653","type":"LOCAL"}],"standard_charges":[{"gross_charge":366.25,"discounted_cash":274.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055205 = Hospital System Supply Identifier | 877653 = Lawson ID"}]},{"description":"END CAP NAIL PIP CHILD 15MM","code_information":[{"code":"Sx00-1501-201","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055206","type":"LOCAL"},{"code":"877654","type":"LOCAL"}],"standard_charges":[{"gross_charge":483.45,"discounted_cash":362.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055206 = Hospital System Supply Identifier | 877654 = Lawson ID"}]},{"description":"END CAP NAIL PIP CHILD 20MM","code_information":[{"code":"Sx00-1501-202","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055207","type":"LOCAL"},{"code":"877655","type":"LOCAL"}],"standard_charges":[{"gross_charge":483.45,"discounted_cash":362.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055207 = Hospital System Supply Identifier | 877655 = Lawson ID"}]},{"description":"IMPLANT-BONE ENDCAP INTRAMEDULLARY-NAIL RETAINING LATEX-FREE","code_information":[{"code":"Sx00-1501-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356506","type":"LOCAL"},{"code":"1083649","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356506 = Hospital System Supply Identifier | 1083649 = Lawson ID"}]},{"description":"IMPLANT-BONE ENDCAP INTRAMEDULLARY-NAIL RETAINING LATEX-FREE","code_information":[{"code":"Sx00-1501-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356557","type":"LOCAL"},{"code":"1083709","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356557 = Hospital System Supply Identifier | 1083709 = Lawson ID"}]},{"description":"IMPLANT-BONE ENDCAP INTRAMEDULLARY-NAIL RETAINING LATEX-FREE","code_information":[{"code":"Sx00-1501-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357038","type":"LOCAL"},{"code":"1083692","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357038 = Hospital System Supply Identifier | 1083692 = Lawson ID"}]},{"description":"IMPLANT-BONE ENDCAP INTRAMEDULLARY-NAIL RETAINING LATEX-FREE","code_information":[{"code":"Sx00-1501-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357184","type":"LOCAL"},{"code":"1083705","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357184 = Hospital System Supply Identifier | 1083705 = Lawson ID"}]},{"description":"IMPLANT-BONE ENDCAP INTRAMEDULLARY-NAIL RETAINING LATEX-FREE","code_information":[{"code":"Sx00-1501-302","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356875","type":"LOCAL"},{"code":"1083573","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356875 = Hospital System Supply Identifier | 1083573 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X260MM RT","code_information":[{"code":"Sx00-1502-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055211","type":"LOCAL"},{"code":"877659","type":"LOCAL"}],"standard_charges":[{"gross_charge":11298.0,"discounted_cash":8473.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055211 = Hospital System Supply Identifier | 877659 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X240MM RT","code_information":[{"code":"Sx00-1502-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055210","type":"LOCAL"},{"code":"877658","type":"LOCAL"}],"standard_charges":[{"gross_charge":11298.0,"discounted_cash":8473.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055210 = Hospital System Supply Identifier | 877658 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X280MM RT","code_information":[{"code":"Sx00-1502-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055212","type":"LOCAL"},{"code":"877660","type":"LOCAL"}],"standard_charges":[{"gross_charge":11298.0,"discounted_cash":8473.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055212 = Hospital System Supply Identifier | 877660 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X200MM RT","code_information":[{"code":"Sx00-1502-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055208","type":"LOCAL"},{"code":"877656","type":"LOCAL"}],"standard_charges":[{"gross_charge":11298.0,"discounted_cash":8473.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055208 = Hospital System Supply Identifier | 877656 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X220MM RT","code_information":[{"code":"Sx00-1502-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055209","type":"LOCAL"},{"code":"877657","type":"LOCAL"}],"standard_charges":[{"gross_charge":11298.0,"discounted_cash":8473.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055209 = Hospital System Supply Identifier | 877657 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X300MM RT","code_information":[{"code":"Sx00-1502-073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055213","type":"LOCAL"},{"code":"877661","type":"LOCAL"}],"standard_charges":[{"gross_charge":11298.0,"discounted_cash":8473.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055213 = Hospital System Supply Identifier | 877661 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X320MM RT","code_information":[{"code":"Sx00-1502-073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055214","type":"LOCAL"},{"code":"877662","type":"LOCAL"}],"standard_charges":[{"gross_charge":11298.0,"discounted_cash":8473.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055214 = Hospital System Supply Identifier | 877662 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X340MM RT","code_information":[{"code":"Sx00-1502-073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055215","type":"LOCAL"},{"code":"877663","type":"LOCAL"}],"standard_charges":[{"gross_charge":11298.0,"discounted_cash":8473.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055215 = Hospital System Supply Identifier | 877663 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X360MM RT","code_information":[{"code":"Sx00-1502-073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055216","type":"LOCAL"},{"code":"877664","type":"LOCAL"}],"standard_charges":[{"gross_charge":11298.0,"discounted_cash":8473.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055216 = Hospital System Supply Identifier | 877664 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X380MM RT","code_information":[{"code":"Sx00-1502-073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055217","type":"LOCAL"},{"code":"877665","type":"LOCAL"}],"standard_charges":[{"gross_charge":11298.0,"discounted_cash":8473.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055217 = Hospital System Supply Identifier | 877665 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X260MM RT","code_information":[{"code":"Sx00-1502-082","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055219","type":"LOCAL"},{"code":"877667","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055219 = Hospital System Supply Identifier | 877667 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X280MM RT","code_information":[{"code":"Sx00-1502-082","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055220","type":"LOCAL"},{"code":"877668","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055220 = Hospital System Supply Identifier | 877668 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X240MM RT","code_information":[{"code":"Sx00-1502-082","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055218","type":"LOCAL"},{"code":"877666","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055218 = Hospital System Supply Identifier | 877666 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X300MM RT","code_information":[{"code":"Sx00-1502-083","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055221","type":"LOCAL"},{"code":"877669","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055221 = Hospital System Supply Identifier | 877669 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X320MM RT","code_information":[{"code":"Sx00-1502-083","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055222","type":"LOCAL"},{"code":"877670","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055222 = Hospital System Supply Identifier | 877670 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X340MM RT","code_information":[{"code":"Sx00-1502-083","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055223","type":"LOCAL"},{"code":"877671","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055223 = Hospital System Supply Identifier | 877671 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X360MM RT","code_information":[{"code":"Sx00-1502-083","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055224","type":"LOCAL"},{"code":"877672","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055224 = Hospital System Supply Identifier | 877672 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X380MM RT","code_information":[{"code":"Sx00-1502-083","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055225","type":"LOCAL"},{"code":"877673","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055225 = Hospital System Supply Identifier | 877673 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X400MM RT","code_information":[{"code":"Sx00-1502-084","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055226","type":"LOCAL"},{"code":"877674","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055226 = Hospital System Supply Identifier | 877674 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X420MM RT","code_information":[{"code":"Sx00-1502-084","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055227","type":"LOCAL"},{"code":"877675","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055227 = Hospital System Supply Identifier | 877675 = Lawson ID"}]},{"description":"NAIL PIP CHILD 9X280MM RT","code_information":[{"code":"Sx00-1502-092","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055228","type":"LOCAL"},{"code":"877676","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055228 = Hospital System Supply Identifier | 877676 = Lawson ID"}]},{"description":"NAIL PIP CHILD 9X360MM RT","code_information":[{"code":"Sx00-1502-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055232","type":"LOCAL"},{"code":"877680","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055232 = Hospital System Supply Identifier | 877680 = Lawson ID"}]},{"description":"NAIL PIP CHILD 9X340MM RT","code_information":[{"code":"Sx00-1502-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055231","type":"LOCAL"},{"code":"877679","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055231 = Hospital System Supply Identifier | 877679 = Lawson ID"}]},{"description":"NAIL PIP CHILD 9X380MM RT","code_information":[{"code":"Sx00-1502-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055233","type":"LOCAL"},{"code":"877681","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055233 = Hospital System Supply Identifier | 877681 = Lawson ID"}]},{"description":"NAIL PIP CHILD 9X300MM RT","code_information":[{"code":"Sx00-1502-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055229","type":"LOCAL"},{"code":"877677","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055229 = Hospital System Supply Identifier | 877677 = Lawson ID"}]},{"description":"NAIL PIP CHILD 9X320MM RT","code_information":[{"code":"Sx00-1502-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055230","type":"LOCAL"},{"code":"877678","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055230 = Hospital System Supply Identifier | 877678 = Lawson ID"}]},{"description":"NAIL PIP CHILD 9X400MM RT","code_information":[{"code":"Sx00-1502-094","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055234","type":"LOCAL"},{"code":"877682","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055234 = Hospital System Supply Identifier | 877682 = Lawson ID"}]},{"description":"NAIL PIP CHILD 9X420MM RT","code_information":[{"code":"Sx00-1502-094","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055235","type":"LOCAL"},{"code":"877683","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055235 = Hospital System Supply Identifier | 877683 = Lawson ID"}]},{"description":"NAIL PIP ADOL 9X280MM LT","code_information":[{"code":"Sx00-1503-092","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055236","type":"LOCAL"},{"code":"877684","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055236 = Hospital System Supply Identifier | 877684 = Lawson ID"}]},{"description":"NAIL PIP ADOL 9X300MM LT","code_information":[{"code":"Sx00-1503-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055237","type":"LOCAL"},{"code":"877685","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055237 = Hospital System Supply Identifier | 877685 = Lawson ID"}]},{"description":"NAIL PIP ADOL 9X320MM LT","code_information":[{"code":"Sx00-1503-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055238","type":"LOCAL"},{"code":"877686","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055238 = Hospital System Supply Identifier | 877686 = Lawson ID"}]},{"description":"NAIL PIP ADOL 9X340MM LT","code_information":[{"code":"Sx00-1503-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055239","type":"LOCAL"},{"code":"877687","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055239 = Hospital System Supply Identifier | 877687 = Lawson ID"}]},{"description":"NAIL PIP ADOL 9X360MM LT","code_information":[{"code":"Sx00-1503-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055240","type":"LOCAL"},{"code":"877688","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055240 = Hospital System Supply Identifier | 877688 = Lawson ID"}]},{"description":"NAIL PIP ADOL 9X380MM LT","code_information":[{"code":"Sx00-1503-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055241","type":"LOCAL"},{"code":"877689","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055241 = Hospital System Supply Identifier | 877689 = Lawson ID"}]},{"description":"NAIL PIP ADOL 9X420MM LT","code_information":[{"code":"Sx00-1503-094","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055243","type":"LOCAL"},{"code":"877691","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055243 = Hospital System Supply Identifier | 877691 = Lawson ID"}]},{"description":"NAIL PIP ADOL 9X400MM LT","code_information":[{"code":"Sx00-1503-094","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055242","type":"LOCAL"},{"code":"877690","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055242 = Hospital System Supply Identifier | 877690 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1503-094","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357264","type":"LOCAL"},{"code":"1083571","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357264 = Hospital System Supply Identifier | 1083571 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1503-094","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356973","type":"LOCAL"},{"code":"1083596","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356973 = Hospital System Supply Identifier | 1083596 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1503-094","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357236","type":"LOCAL"},{"code":"1083657","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357236 = Hospital System Supply Identifier | 1083657 = Lawson ID"}]},{"description":"NAIL PIP ADOL 10X300MM LT","code_information":[{"code":"Sx00-1503-103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055244","type":"LOCAL"},{"code":"877692","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055244 = Hospital System Supply Identifier | 877692 = Lawson ID"}]},{"description":"NAIL PIP ADOL 10X320MM LT","code_information":[{"code":"Sx00-1503-103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055245","type":"LOCAL"},{"code":"877693","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055245 = Hospital System Supply Identifier | 877693 = Lawson ID"}]},{"description":"NAIL PIP ADOL 10X340MM LT","code_information":[{"code":"Sx00-1503-103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055246","type":"LOCAL"},{"code":"877694","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055246 = Hospital System Supply Identifier | 877694 = Lawson ID"}]},{"description":"NAIL PIP ADOL 10X360MM LT","code_information":[{"code":"Sx00-1503-103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055247","type":"LOCAL"},{"code":"877695","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055247 = Hospital System Supply Identifier | 877695 = Lawson ID"}]},{"description":"NAIL PIP ADOL 10X380MM LT","code_information":[{"code":"Sx00-1503-103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055248","type":"LOCAL"},{"code":"877696","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055248 = Hospital System Supply Identifier | 877696 = Lawson ID"}]},{"description":"NAIL PIP ADOL 10X420MM LT","code_information":[{"code":"Sx00-1503-104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055250","type":"LOCAL"},{"code":"877698","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055250 = Hospital System Supply Identifier | 877698 = Lawson ID"}]},{"description":"NAIL PIP ADOL 10X400MM LT","code_information":[{"code":"Sx00-1503-104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055249","type":"LOCAL"},{"code":"877697","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055249 = Hospital System Supply Identifier | 877697 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1503-104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357221","type":"LOCAL"},{"code":"1083647","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357221 = Hospital System Supply Identifier | 1083647 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1503-104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356354","type":"LOCAL"},{"code":"1083680","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356354 = Hospital System Supply Identifier | 1083680 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1503-104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356802","type":"LOCAL"},{"code":"1083713","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356802 = Hospital System Supply Identifier | 1083713 = Lawson ID"}]},{"description":"NAIL PIP ADOL 11X300MM LT","code_information":[{"code":"Sx00-1503-113","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055251","type":"LOCAL"},{"code":"877699","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055251 = Hospital System Supply Identifier | 877699 = Lawson ID"}]},{"description":"NAIL PIP ADOL 11X320MM LT","code_information":[{"code":"Sx00-1503-113","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055252","type":"LOCAL"},{"code":"877700","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055252 = Hospital System Supply Identifier | 877700 = Lawson ID"}]},{"description":"NAIL PIP ADOL 11X340MM LT","code_information":[{"code":"Sx00-1503-113","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055253","type":"LOCAL"},{"code":"877701","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055253 = Hospital System Supply Identifier | 877701 = Lawson ID"}]},{"description":"NAIL PIP ADOL 11X360MM LT","code_information":[{"code":"Sx00-1503-113","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055254","type":"LOCAL"},{"code":"877702","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055254 = Hospital System Supply Identifier | 877702 = Lawson ID"}]},{"description":"NAIL PIP ADOL 11X380MM LT","code_information":[{"code":"Sx00-1503-113","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055255","type":"LOCAL"},{"code":"877703","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055255 = Hospital System Supply Identifier | 877703 = Lawson ID"}]},{"description":"NAIL PIP ADOL 11X420MM LT","code_information":[{"code":"Sx00-1503-114","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055257","type":"LOCAL"},{"code":"877705","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055257 = Hospital System Supply Identifier | 877705 = Lawson ID"}]},{"description":"NAIL PIP ADOL 11X400MM LT","code_information":[{"code":"Sx00-1503-114","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055256","type":"LOCAL"},{"code":"877704","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055256 = Hospital System Supply Identifier | 877704 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1503-114","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356500","type":"LOCAL"},{"code":"1083662","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356500 = Hospital System Supply Identifier | 1083662 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1503-114","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356623","type":"LOCAL"},{"code":"1083577","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356623 = Hospital System Supply Identifier | 1083577 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1503-114","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356725","type":"LOCAL"},{"code":"1083611","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356725 = Hospital System Supply Identifier | 1083611 = Lawson ID"}]},{"description":"NAIL PIP ADOL 12X300MM LT","code_information":[{"code":"Sx00-1503-123","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055258","type":"LOCAL"},{"code":"877706","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055258 = Hospital System Supply Identifier | 877706 = Lawson ID"}]},{"description":"NAIL PIP ADOL 12X320MM LT","code_information":[{"code":"Sx00-1503-123","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055259","type":"LOCAL"},{"code":"877707","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055259 = Hospital System Supply Identifier | 877707 = Lawson ID"}]},{"description":"NAIL PIP ADOL 12X340MM LT","code_information":[{"code":"Sx00-1503-123","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055260","type":"LOCAL"},{"code":"877708","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055260 = Hospital System Supply Identifier | 877708 = Lawson ID"}]},{"description":"NAIL PIP ADOL 12X360MM LT","code_information":[{"code":"Sx00-1503-123","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055261","type":"LOCAL"},{"code":"877709","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055261 = Hospital System Supply Identifier | 877709 = Lawson ID"}]},{"description":"NAIL PIP ADOL 12X380MM LT","code_information":[{"code":"Sx00-1503-123","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055262","type":"LOCAL"},{"code":"877710","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055262 = Hospital System Supply Identifier | 877710 = Lawson ID"}]},{"description":"NAIL PIP ADOL 12X420MM LT","code_information":[{"code":"Sx00-1503-124","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055264","type":"LOCAL"},{"code":"877712","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055264 = Hospital System Supply Identifier | 877712 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1503-124","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357204","type":"LOCAL"},{"code":"1083751","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357204 = Hospital System Supply Identifier | 1083751 = Lawson ID"}]},{"description":"NAIL PIP ADOL 12X400MM LT","code_information":[{"code":"Sx00-1503-124","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055263","type":"LOCAL"},{"code":"877711","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055263 = Hospital System Supply Identifier | 877711 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1503-124","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356697","type":"LOCAL"},{"code":"1083726","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356697 = Hospital System Supply Identifier | 1083726 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1503-124","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356764","type":"LOCAL"},{"code":"1083552","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356764 = Hospital System Supply Identifier | 1083552 = Lawson ID"}]},{"description":"END CAP NAIL PIP ADOL 0MM","code_information":[{"code":"Sx00-1503-200","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055265","type":"LOCAL"},{"code":"877713","type":"LOCAL"}],"standard_charges":[{"gross_charge":483.45,"discounted_cash":362.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055265 = Hospital System Supply Identifier | 877713 = Lawson ID"}]},{"description":"END CAP NAIL PIP ADOL 5MM","code_information":[{"code":"Sx00-1503-200","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055266","type":"LOCAL"},{"code":"877714","type":"LOCAL"}],"standard_charges":[{"gross_charge":483.45,"discounted_cash":362.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055266 = Hospital System Supply Identifier | 877714 = Lawson ID"}]},{"description":"END CAP NAIL PIP ADOL 10MM","code_information":[{"code":"Sx00-1503-201","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055267","type":"LOCAL"},{"code":"877715","type":"LOCAL"}],"standard_charges":[{"gross_charge":483.45,"discounted_cash":362.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055267 = Hospital System Supply Identifier | 877715 = Lawson ID"}]},{"description":"END CAP NAIL PIP ADOL 15MM","code_information":[{"code":"Sx00-1503-201","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055268","type":"LOCAL"},{"code":"877716","type":"LOCAL"}],"standard_charges":[{"gross_charge":483.45,"discounted_cash":362.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055268 = Hospital System Supply Identifier | 877716 = Lawson ID"}]},{"description":"END CAP NAIL PIP ADOL 20MM","code_information":[{"code":"Sx00-1503-202","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055269","type":"LOCAL"},{"code":"877717","type":"LOCAL"}],"standard_charges":[{"gross_charge":483.45,"discounted_cash":362.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055269 = Hospital System Supply Identifier | 877717 = Lawson ID"}]},{"description":"IMPLANT-BONE ENDCAP INTRAMEDULLARY-NAIL RETAINING LATEX-FREE","code_information":[{"code":"Sx00-1503-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356718","type":"LOCAL"},{"code":"1083654","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356718 = Hospital System Supply Identifier | 1083654 = Lawson ID"}]},{"description":"IMPLANT-BONE ENDCAP INTRAMEDULLARY-NAIL RETAINING LATEX-FREE","code_information":[{"code":"Sx00-1503-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356353","type":"LOCAL"},{"code":"1083667","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356353 = Hospital System Supply Identifier | 1083667 = Lawson ID"}]},{"description":"IMPLANT-BONE ENDCAP INTRAMEDULLARY-NAIL RETAINING LATEX-FREE","code_information":[{"code":"Sx00-1503-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357122","type":"LOCAL"},{"code":"1083609","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357122 = Hospital System Supply Identifier | 1083609 = Lawson ID"}]},{"description":"IMPLANT-BONE ENDCAP INTRAMEDULLARY-NAIL RETAINING LATEX-FREE","code_information":[{"code":"Sx00-1503-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356972","type":"LOCAL"},{"code":"1083561","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356972 = Hospital System Supply Identifier | 1083561 = Lawson ID"}]},{"description":"IMPLANT-BONE ENDCAP INTRAMEDULLARY-NAIL RETAINING LATEX-FREE","code_information":[{"code":"Sx00-1503-302","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356626","type":"LOCAL"},{"code":"1083677","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356626 = Hospital System Supply Identifier | 1083677 = Lawson ID"}]},{"description":"NAIL PIP ADOL 9X280MM RT","code_information":[{"code":"Sx00-1504-092","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055270","type":"LOCAL"},{"code":"877718","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055270 = Hospital System Supply Identifier | 877718 = Lawson ID"}]},{"description":"NAIL PIP ADOL 9X300MM RT","code_information":[{"code":"Sx00-1504-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055271","type":"LOCAL"},{"code":"877719","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055271 = Hospital System Supply Identifier | 877719 = Lawson ID"}]},{"description":"NAIL PIP ADOL 9X320MM RT","code_information":[{"code":"Sx00-1504-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055272","type":"LOCAL"},{"code":"877720","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055272 = Hospital System Supply Identifier | 877720 = Lawson ID"}]},{"description":"NAIL PIP ADOL 9X340MM RT","code_information":[{"code":"Sx00-1504-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055273","type":"LOCAL"},{"code":"877721","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055273 = Hospital System Supply Identifier | 877721 = Lawson ID"}]},{"description":"NAIL PIP ADOL 9X360MM RT","code_information":[{"code":"Sx00-1504-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055274","type":"LOCAL"},{"code":"877722","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055274 = Hospital System Supply Identifier | 877722 = Lawson ID"}]},{"description":"NAIL PIP ADOL 9X380MM RT","code_information":[{"code":"Sx00-1504-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055275","type":"LOCAL"},{"code":"877723","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055275 = Hospital System Supply Identifier | 877723 = Lawson ID"}]},{"description":"NAIL PIP ADOL 9X420MM RT","code_information":[{"code":"Sx00-1504-094","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055277","type":"LOCAL"},{"code":"877725","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055277 = Hospital System Supply Identifier | 877725 = Lawson ID"}]},{"description":"NAIL PIP ADOL 9X400MM RT","code_information":[{"code":"Sx00-1504-094","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055276","type":"LOCAL"},{"code":"877724","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055276 = Hospital System Supply Identifier | 877724 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1504-094","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356518","type":"LOCAL"},{"code":"1083574","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356518 = Hospital System Supply Identifier | 1083574 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1504-094","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356513","type":"LOCAL"},{"code":"1083557","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356513 = Hospital System Supply Identifier | 1083557 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1504-094","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356339","type":"LOCAL"},{"code":"1083734","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356339 = Hospital System Supply Identifier | 1083734 = Lawson ID"}]},{"description":"NAIL PIP ADOL 10X300MM RT","code_information":[{"code":"Sx00-1504-103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055278","type":"LOCAL"},{"code":"877726","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055278 = Hospital System Supply Identifier | 877726 = Lawson ID"}]},{"description":"NAIL PIP ADOL 10X320MM RT","code_information":[{"code":"Sx00-1504-103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055279","type":"LOCAL"},{"code":"877727","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055279 = Hospital System Supply Identifier | 877727 = Lawson ID"}]},{"description":"NAIL PIP ADOL 10X340MM RT","code_information":[{"code":"Sx00-1504-103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055280","type":"LOCAL"},{"code":"877728","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055280 = Hospital System Supply Identifier | 877728 = Lawson ID"}]},{"description":"NAIL PIP ADOL 10X360MM RT","code_information":[{"code":"Sx00-1504-103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055281","type":"LOCAL"},{"code":"877729","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055281 = Hospital System Supply Identifier | 877729 = Lawson ID"}]},{"description":"NAIL PIP ADOL 10X380MM RT","code_information":[{"code":"Sx00-1504-103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055282","type":"LOCAL"},{"code":"877730","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055282 = Hospital System Supply Identifier | 877730 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1504-104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356719","type":"LOCAL"},{"code":"1083666","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356719 = Hospital System Supply Identifier | 1083666 = Lawson ID"}]},{"description":"NAIL PIP ADOL 10X420MM RT","code_information":[{"code":"Sx00-1504-104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055284","type":"LOCAL"},{"code":"877732","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055284 = Hospital System Supply Identifier | 877732 = Lawson ID"}]},{"description":"NAIL PIP ADOL 10X400MM RT","code_information":[{"code":"Sx00-1504-104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055283","type":"LOCAL"},{"code":"877731","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055283 = Hospital System Supply Identifier | 877731 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1504-104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356950","type":"LOCAL"},{"code":"1083653","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356950 = Hospital System Supply Identifier | 1083653 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1504-104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356379","type":"LOCAL"},{"code":"1083555","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356379 = Hospital System Supply Identifier | 1083555 = Lawson ID"}]},{"description":"NAIL PIP ADOL 11X300MM RT","code_information":[{"code":"Sx00-1504-113","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055285","type":"LOCAL"},{"code":"877733","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055285 = Hospital System Supply Identifier | 877733 = Lawson ID"}]},{"description":"NAIL PIP ADOL 11X320MM RT","code_information":[{"code":"Sx00-1504-113","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055286","type":"LOCAL"},{"code":"877734","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055286 = Hospital System Supply Identifier | 877734 = Lawson ID"}]},{"description":"NAIL PIP ADOL 11X340MM RT","code_information":[{"code":"Sx00-1504-113","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055287","type":"LOCAL"},{"code":"877735","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055287 = Hospital System Supply Identifier | 877735 = Lawson ID"}]},{"description":"NAIL PIP ADOL 11X360MM RT","code_information":[{"code":"Sx00-1504-113","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055288","type":"LOCAL"},{"code":"877736","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055288 = Hospital System Supply Identifier | 877736 = Lawson ID"}]},{"description":"NAIL PIP ADOL 11X380MM RT","code_information":[{"code":"Sx00-1504-113","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055289","type":"LOCAL"},{"code":"877737","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055289 = Hospital System Supply Identifier | 877737 = Lawson ID"}]},{"description":"NAIL PIP ADOL 11X420MM RT","code_information":[{"code":"Sx00-1504-114","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055291","type":"LOCAL"},{"code":"877739","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055291 = Hospital System Supply Identifier | 877739 = Lawson ID"}]},{"description":"NAIL PIP ADOL 11X400MM RT","code_information":[{"code":"Sx00-1504-114","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055290","type":"LOCAL"},{"code":"877738","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055290 = Hospital System Supply Identifier | 877738 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1504-114","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356971","type":"LOCAL"},{"code":"1083602","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356971 = Hospital System Supply Identifier | 1083602 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1504-114","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356747","type":"LOCAL"},{"code":"1083543","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356747 = Hospital System Supply Identifier | 1083543 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1504-114","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356939","type":"LOCAL"},{"code":"1083722","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356939 = Hospital System Supply Identifier | 1083722 = Lawson ID"}]},{"description":"NAIL PIP ADOL 12X300MM RT","code_information":[{"code":"Sx00-1504-123","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055292","type":"LOCAL"},{"code":"877740","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055292 = Hospital System Supply Identifier | 877740 = Lawson ID"}]},{"description":"NAIL PIP ADOL 12X320MM RT","code_information":[{"code":"Sx00-1504-123","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055293","type":"LOCAL"},{"code":"877741","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055293 = Hospital System Supply Identifier | 877741 = Lawson ID"}]},{"description":"NAIL PIP ADOL 12X340MM RT","code_information":[{"code":"Sx00-1504-123","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055294","type":"LOCAL"},{"code":"877742","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055294 = Hospital System Supply Identifier | 877742 = Lawson ID"}]},{"description":"NAIL PIP ADOL 12X360MM RT","code_information":[{"code":"Sx00-1504-123","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055295","type":"LOCAL"},{"code":"877743","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055295 = Hospital System Supply Identifier | 877743 = Lawson ID"}]},{"description":"NAIL PIP ADOL 12X380MM RT","code_information":[{"code":"Sx00-1504-123","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055296","type":"LOCAL"},{"code":"877744","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055296 = Hospital System Supply Identifier | 877744 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1504-124","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357084","type":"LOCAL"},{"code":"1083750","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357084 = Hospital System Supply Identifier | 1083750 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1504-124","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357120","type":"LOCAL"},{"code":"1083570","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357120 = Hospital System Supply Identifier | 1083570 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1504-124","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356729","type":"LOCAL"},{"code":"1083679","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356729 = Hospital System Supply Identifier | 1083679 = Lawson ID"}]},{"description":"NAIL PIP ADOL 12X400MM RT","code_information":[{"code":"Sx00-1504-124","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055297","type":"LOCAL"},{"code":"877745","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055297 = Hospital System Supply Identifier | 877745 = Lawson ID"}]},{"description":"NAIL PIP ADOL 12X420MM RT","code_information":[{"code":"Sx00-1504-124","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055298","type":"LOCAL"},{"code":"877746","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055298 = Hospital System Supply Identifier | 877746 = Lawson ID"}]},{"description":"PEG UNICORT 3.8X25MM","code_information":[{"code":"Sx00-1506-102","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055299","type":"LOCAL"},{"code":"877747","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055299 = Hospital System Supply Identifier | 877747 = Lawson ID"}]},{"description":"PEG UNICORT 3.8X27.5MM","code_information":[{"code":"Sx00-1506-102","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055300","type":"LOCAL"},{"code":"877748","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055300 = Hospital System Supply Identifier | 877748 = Lawson ID"}]},{"description":"PEG UNICORT 3.8X37.5MM","code_information":[{"code":"Sx00-1506-103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055304","type":"LOCAL"},{"code":"877752","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055304 = Hospital System Supply Identifier | 877752 = Lawson ID"}]},{"description":"PEG UNICORT 3.8X35MM","code_information":[{"code":"Sx00-1506-103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055303","type":"LOCAL"},{"code":"877751","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055303 = Hospital System Supply Identifier | 877751 = Lawson ID"}]},{"description":"PEG UNICORT 3.8X30MM","code_information":[{"code":"Sx00-1506-103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055301","type":"LOCAL"},{"code":"877749","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055301 = Hospital System Supply Identifier | 877749 = Lawson ID"}]},{"description":"PEG UNICORT 3.8X32.5MM","code_information":[{"code":"Sx00-1506-103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055302","type":"LOCAL"},{"code":"877750","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055302 = Hospital System Supply Identifier | 877750 = Lawson ID"}]},{"description":"PEG UNICORT 3.8X47.5MM","code_information":[{"code":"Sx00-1506-104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055308","type":"LOCAL"},{"code":"877756","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055308 = Hospital System Supply Identifier | 877756 = Lawson ID"}]},{"description":"PEG UNICORT 3.8X45MM","code_information":[{"code":"Sx00-1506-104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055307","type":"LOCAL"},{"code":"877755","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055307 = Hospital System Supply Identifier | 877755 = Lawson ID"}]},{"description":"PEG UNICORT 3.8X40MM","code_information":[{"code":"Sx00-1506-104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055305","type":"LOCAL"},{"code":"877753","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055305 = Hospital System Supply Identifier | 877753 = Lawson ID"}]},{"description":"PEG UNICORT 3.8X42.5MM","code_information":[{"code":"Sx00-1506-104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055306","type":"LOCAL"},{"code":"877754","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055306 = Hospital System Supply Identifier | 877754 = Lawson ID"}]},{"description":"PEG UNICORT 3.8X50MM","code_information":[{"code":"Sx00-1506-105","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055309","type":"LOCAL"},{"code":"877757","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055309 = Hospital System Supply Identifier | 877757 = Lawson ID"}]},{"description":"PEG UNICORT 3.8X52.5MM","code_information":[{"code":"Sx00-1506-105","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055310","type":"LOCAL"},{"code":"877758","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055310 = Hospital System Supply Identifier | 877758 = Lawson ID"}]},{"description":"PEG UNICORT 3.8X55MM","code_information":[{"code":"Sx00-1506-105","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055311","type":"LOCAL"},{"code":"877759","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055311 = Hospital System Supply Identifier | 877759 = Lawson ID"}]},{"description":"PEG UNICORT 3.8X57.5MM","code_information":[{"code":"Sx00-1506-105","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055312","type":"LOCAL"},{"code":"877760","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055312 = Hospital System Supply Identifier | 877760 = Lawson ID"}]},{"description":"PEG UNICORT 3.8X60MM","code_information":[{"code":"Sx00-1506-106","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055313","type":"LOCAL"},{"code":"877761","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055313 = Hospital System Supply Identifier | 877761 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-201","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356748","type":"LOCAL"},{"code":"1083546","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356748 = Hospital System Supply Identifier | 1083546 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-201","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356390","type":"LOCAL"},{"code":"1083583","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356390 = Hospital System Supply Identifier | 1083583 = Lawson ID"}]},{"description":"SCREW F/T 4.5X27.5MM","code_information":[{"code":"Sx00-1506-202","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055315","type":"LOCAL"},{"code":"877763","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055315 = Hospital System Supply Identifier | 877763 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-202","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356497","type":"LOCAL"},{"code":"1083562","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356497 = Hospital System Supply Identifier | 1083562 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-202","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356940","type":"LOCAL"},{"code":"1083737","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356940 = Hospital System Supply Identifier | 1083737 = Lawson ID"}]},{"description":"SCREW F/T 4.5X25MM","code_information":[{"code":"Sx00-1506-202","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055314","type":"LOCAL"},{"code":"877762","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055314 = Hospital System Supply Identifier | 877762 = Lawson ID"}]},{"description":"SCREW F/T 4.5X35MM","code_information":[{"code":"Sx00-1506-203","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055318","type":"LOCAL"},{"code":"877766","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055318 = Hospital System Supply Identifier | 877766 = Lawson ID"}]},{"description":"SCREW F/T 4.5X37.5MM","code_information":[{"code":"Sx00-1506-203","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055319","type":"LOCAL"},{"code":"877767","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055319 = Hospital System Supply Identifier | 877767 = Lawson ID"}]},{"description":"SCREW F/T 4.5X30MM","code_information":[{"code":"Sx00-1506-203","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055316","type":"LOCAL"},{"code":"877764","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055316 = Hospital System Supply Identifier | 877764 = Lawson ID"}]},{"description":"SCREW F/T 4.5X32.5MM","code_information":[{"code":"Sx00-1506-203","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055317","type":"LOCAL"},{"code":"877765","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055317 = Hospital System Supply Identifier | 877765 = Lawson ID"}]},{"description":"SCREW F/T 4.5X45MM","code_information":[{"code":"Sx00-1506-204","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055322","type":"LOCAL"},{"code":"877770","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055322 = Hospital System Supply Identifier | 877770 = Lawson ID"}]},{"description":"SCREW F/T 4.5X47.5MM","code_information":[{"code":"Sx00-1506-204","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055323","type":"LOCAL"},{"code":"877771","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055323 = Hospital System Supply Identifier | 877771 = Lawson ID"}]},{"description":"SCREW F/T 4.5X40MM","code_information":[{"code":"Sx00-1506-204","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055320","type":"LOCAL"},{"code":"877768","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055320 = Hospital System Supply Identifier | 877768 = Lawson ID"}]},{"description":"SCREW F/T 4.5X42.5MM","code_information":[{"code":"Sx00-1506-204","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055321","type":"LOCAL"},{"code":"877769","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055321 = Hospital System Supply Identifier | 877769 = Lawson ID"}]},{"description":"SCREW F/T 4.5X55MM","code_information":[{"code":"Sx00-1506-205","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055326","type":"LOCAL"},{"code":"877774","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055326 = Hospital System Supply Identifier | 877774 = Lawson ID"}]},{"description":"SCREW F/T 4.5X57.5MM","code_information":[{"code":"Sx00-1506-205","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055327","type":"LOCAL"},{"code":"877775","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055327 = Hospital System Supply Identifier | 877775 = Lawson ID"}]},{"description":"SCREW F/T 4.5X50MM","code_information":[{"code":"Sx00-1506-205","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055324","type":"LOCAL"},{"code":"877772","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055324 = Hospital System Supply Identifier | 877772 = Lawson ID"}]},{"description":"SCREW F/T 4.5X52.5MM","code_information":[{"code":"Sx00-1506-205","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055325","type":"LOCAL"},{"code":"877773","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055325 = Hospital System Supply Identifier | 877773 = Lawson ID"}]},{"description":"SCREW F/T 4.5X60MM","code_information":[{"code":"Sx00-1506-206","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055328","type":"LOCAL"},{"code":"877776","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055328 = Hospital System Supply Identifier | 877776 = Lawson ID"}]},{"description":"SCREW F/T 4.5X62.5MM","code_information":[{"code":"Sx00-1506-206","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055329","type":"LOCAL"},{"code":"877777","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055329 = Hospital System Supply Identifier | 877777 = Lawson ID"}]},{"description":"SCREW F/T 4.5X65MM","code_information":[{"code":"Sx00-1506-206","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055330","type":"LOCAL"},{"code":"877778","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055330 = Hospital System Supply Identifier | 877778 = Lawson ID"}]},{"description":"SCREW F/T 4.5X67.5MM","code_information":[{"code":"Sx00-1506-206","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055331","type":"LOCAL"},{"code":"877779","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055331 = Hospital System Supply Identifier | 877779 = Lawson ID"}]},{"description":"SCREW F/T 4.5X70MM","code_information":[{"code":"Sx00-1506-207","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055332","type":"LOCAL"},{"code":"877780","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055332 = Hospital System Supply Identifier | 877780 = Lawson ID"}]},{"description":"SCREW F/T 4.5X75MM","code_information":[{"code":"Sx00-1506-207","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055333","type":"LOCAL"},{"code":"877781","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055333 = Hospital System Supply Identifier | 877781 = Lawson ID"}]},{"description":"SCREW F/T 4.5X80MM","code_information":[{"code":"Sx00-1506-208","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055334","type":"LOCAL"},{"code":"877782","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055334 = Hospital System Supply Identifier | 877782 = Lawson ID"}]},{"description":"SCREW F/T 4.5X85MM","code_information":[{"code":"Sx00-1506-208","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055335","type":"LOCAL"},{"code":"877783","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055335 = Hospital System Supply Identifier | 877783 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-209","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357094","type":"LOCAL"},{"code":"1083696","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357094 = Hospital System Supply Identifier | 1083696 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-209","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356504","type":"LOCAL"},{"code":"1083581","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356504 = Hospital System Supply Identifier | 1083581 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356988","type":"LOCAL"},{"code":"1083582","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356988 = Hospital System Supply Identifier | 1083582 = Lawson ID"}]},{"description":"SCREW P/T 4.5X45MM","code_information":[{"code":"Sx00-1506-304","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055336","type":"LOCAL"},{"code":"877784","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055336 = Hospital System Supply Identifier | 877784 = Lawson ID"}]},{"description":"SCREW P/T 4.5X47.5MM","code_information":[{"code":"Sx00-1506-304","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055337","type":"LOCAL"},{"code":"877785","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055337 = Hospital System Supply Identifier | 877785 = Lawson ID"}]},{"description":"SCREW P/T 4.5X50MM","code_information":[{"code":"Sx00-1506-305","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055338","type":"LOCAL"},{"code":"877786","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055338 = Hospital System Supply Identifier | 877786 = Lawson ID"}]},{"description":"SCREW P/T 4.5X52.5MM","code_information":[{"code":"Sx00-1506-305","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055339","type":"LOCAL"},{"code":"877787","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055339 = Hospital System Supply Identifier | 877787 = Lawson ID"}]},{"description":"SCREW P/T 4.5X55MM","code_information":[{"code":"Sx00-1506-305","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055340","type":"LOCAL"},{"code":"877788","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055340 = Hospital System Supply Identifier | 877788 = Lawson ID"}]},{"description":"SCREW P/T 4.5X57.5MM","code_information":[{"code":"Sx00-1506-305","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055341","type":"LOCAL"},{"code":"877789","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055341 = Hospital System Supply Identifier | 877789 = Lawson ID"}]},{"description":"SCREW P/T 4.5X67.5MM","code_information":[{"code":"Sx00-1506-306","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055345","type":"LOCAL"},{"code":"877793","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055345 = Hospital System Supply Identifier | 877793 = Lawson ID"}]},{"description":"SCREW P/T 4.5X65MM","code_information":[{"code":"Sx00-1506-306","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055344","type":"LOCAL"},{"code":"877792","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055344 = Hospital System Supply Identifier | 877792 = Lawson ID"}]},{"description":"SCREW P/T 4.5X60MM","code_information":[{"code":"Sx00-1506-306","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055342","type":"LOCAL"},{"code":"877790","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055342 = Hospital System Supply Identifier | 877790 = Lawson ID"}]},{"description":"SCREW P/T 4.5X62.5MM","code_information":[{"code":"Sx00-1506-306","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055343","type":"LOCAL"},{"code":"877791","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055343 = Hospital System Supply Identifier | 877791 = Lawson ID"}]},{"description":"SCREW P/T 4.5X70MM","code_information":[{"code":"Sx00-1506-307","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055346","type":"LOCAL"},{"code":"877794","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055346 = Hospital System Supply Identifier | 877794 = Lawson ID"}]},{"description":"SCREW P/T 4.5X75MM","code_information":[{"code":"Sx00-1506-307","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055347","type":"LOCAL"},{"code":"877795","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055347 = Hospital System Supply Identifier | 877795 = Lawson ID"}]},{"description":"SCREW P/T 4.5X80MM","code_information":[{"code":"Sx00-1506-308","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055348","type":"LOCAL"},{"code":"877796","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055348 = Hospital System Supply Identifier | 877796 = Lawson ID"}]},{"description":"SCREW P/T 4.5X85MM","code_information":[{"code":"Sx00-1506-308","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055349","type":"LOCAL"},{"code":"877797","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055349 = Hospital System Supply Identifier | 877797 = Lawson ID"}]},{"description":"SCREW P/T 4.5X90MM","code_information":[{"code":"Sx00-1506-309","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055350","type":"LOCAL"},{"code":"877798","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055350 = Hospital System Supply Identifier | 877798 = Lawson ID"}]},{"description":"SCREW P/T 4.5X95MM","code_information":[{"code":"Sx00-1506-309","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055351","type":"LOCAL"},{"code":"877799","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055351 = Hospital System Supply Identifier | 877799 = Lawson ID"}]},{"description":"SCREW P/T 4.5X100MM","code_information":[{"code":"Sx00-1506-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055352","type":"LOCAL"},{"code":"877800","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055352 = Hospital System Supply Identifier | 877800 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL PARTIAL-THREAD","code_information":[{"code":"Sx00-1506-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357228","type":"LOCAL"},{"code":"1083731","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357228 = Hospital System Supply Identifier | 1083731 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL PARTIAL-THREAD","code_information":[{"code":"Sx00-1506-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356758","type":"LOCAL"},{"code":"1083595","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356758 = Hospital System Supply Identifier | 1083595 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL PARTIAL-THREAD","code_information":[{"code":"Sx00-1506-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356485","type":"LOCAL"},{"code":"1083715","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356485 = Hospital System Supply Identifier | 1083715 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL PARTIAL-THREAD","code_information":[{"code":"Sx00-1506-312","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356987","type":"LOCAL"},{"code":"1083540","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356987 = Hospital System Supply Identifier | 1083540 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356974","type":"LOCAL"},{"code":"1083610","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356974 = Hospital System Supply Identifier | 1083610 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357217","type":"LOCAL"},{"code":"1083711","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357217 = Hospital System Supply Identifier | 1083711 = Lawson ID"}]},{"description":"SCREW F/T 5.0X25MM","code_information":[{"code":"Sx00-1506-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055353","type":"LOCAL"},{"code":"877801","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055353 = Hospital System Supply Identifier | 877801 = Lawson ID"}]},{"description":"SCREW F/T 5.0X27.5MM","code_information":[{"code":"Sx00-1506-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055354","type":"LOCAL"},{"code":"877802","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055354 = Hospital System Supply Identifier | 877802 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED FEMORAL PNP FEMUR 0015064023 5.0X22.5MM","code_information":[{"code":"Sx00-1506-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356495","type":"LOCAL"},{"code":"1082572","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356495 = Hospital System Supply Identifier | 1082572 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356720","type":"LOCAL"},{"code":"1083718","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356720 = Hospital System Supply Identifier | 1083718 = Lawson ID"}]},{"description":"SCREW F/T 5.0X32.5MM","code_information":[{"code":"Sx00-1506-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055356","type":"LOCAL"},{"code":"877804","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055356 = Hospital System Supply Identifier | 877804 = Lawson ID"}]},{"description":"SCREW F/T 5.0X37.5MM","code_information":[{"code":"Sx00-1506-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055358","type":"LOCAL"},{"code":"877806","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055358 = Hospital System Supply Identifier | 877806 = Lawson ID"}]},{"description":"SCREW F/T 5.0X35MM","code_information":[{"code":"Sx00-1506-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055357","type":"LOCAL"},{"code":"877805","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055357 = Hospital System Supply Identifier | 877805 = Lawson ID"}]},{"description":"SCREW F/T 5.0X30MM","code_information":[{"code":"Sx00-1506-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055355","type":"LOCAL"},{"code":"877803","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055355 = Hospital System Supply Identifier | 877803 = Lawson ID"}]},{"description":"SCREW F/T 5.0X40MM","code_information":[{"code":"Sx00-1506-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055359","type":"LOCAL"},{"code":"877807","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055359 = Hospital System Supply Identifier | 877807 = Lawson ID"}]},{"description":"SCREW F/T 5.0X42.5MM","code_information":[{"code":"Sx00-1506-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055360","type":"LOCAL"},{"code":"877808","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055360 = Hospital System Supply Identifier | 877808 = Lawson ID"}]},{"description":"SCREW F/T 5.0X45MM","code_information":[{"code":"Sx00-1506-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055361","type":"LOCAL"},{"code":"877809","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055361 = Hospital System Supply Identifier | 877809 = Lawson ID"}]},{"description":"SCREW F/T 5.0X47.5MM","code_information":[{"code":"Sx00-1506-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055362","type":"LOCAL"},{"code":"877810","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055362 = Hospital System Supply Identifier | 877810 = Lawson ID"}]},{"description":"SCREW F/T 5.0X50MM","code_information":[{"code":"Sx00-1506-405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055363","type":"LOCAL"},{"code":"877811","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055363 = Hospital System Supply Identifier | 877811 = Lawson ID"}]},{"description":"SCREW F/T 5.0X52.5MM","code_information":[{"code":"Sx00-1506-405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055364","type":"LOCAL"},{"code":"877812","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055364 = Hospital System Supply Identifier | 877812 = Lawson ID"}]},{"description":"SCREW F/T 5.0X55MM","code_information":[{"code":"Sx00-1506-405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055365","type":"LOCAL"},{"code":"877813","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055365 = Hospital System Supply Identifier | 877813 = Lawson ID"}]},{"description":"SCREW F/T 5.0X57.5MM","code_information":[{"code":"Sx00-1506-405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055366","type":"LOCAL"},{"code":"877814","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055366 = Hospital System Supply Identifier | 877814 = Lawson ID"}]},{"description":"SCREW F/T 5.0X67.5MM","code_information":[{"code":"Sx00-1506-406","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055370","type":"LOCAL"},{"code":"877818","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055370 = Hospital System Supply Identifier | 877818 = Lawson ID"}]},{"description":"SCREW F/T 5.0X65MM","code_information":[{"code":"Sx00-1506-406","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055369","type":"LOCAL"},{"code":"877817","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055369 = Hospital System Supply Identifier | 877817 = Lawson ID"}]},{"description":"SCREW F/T 5.0X62.5MM","code_information":[{"code":"Sx00-1506-406","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055368","type":"LOCAL"},{"code":"877816","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055368 = Hospital System Supply Identifier | 877816 = Lawson ID"}]},{"description":"SCREW F/T 5.0X60MM","code_information":[{"code":"Sx00-1506-406","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055367","type":"LOCAL"},{"code":"877815","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055367 = Hospital System Supply Identifier | 877815 = Lawson ID"}]},{"description":"SCREW F/T 5.0X70MM","code_information":[{"code":"Sx00-1506-407","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055371","type":"LOCAL"},{"code":"877819","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055371 = Hospital System Supply Identifier | 877819 = Lawson ID"}]},{"description":"SCREW F/T 5.0X75MM","code_information":[{"code":"Sx00-1506-407","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055372","type":"LOCAL"},{"code":"877820","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055372 = Hospital System Supply Identifier | 877820 = Lawson ID"}]},{"description":"SCREW F/T 5.0X80MM","code_information":[{"code":"Sx00-1506-408","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055373","type":"LOCAL"},{"code":"877821","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055373 = Hospital System Supply Identifier | 877821 = Lawson ID"}]},{"description":"SCREW F/T 5.0X85MM","code_information":[{"code":"Sx00-1506-408","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055374","type":"LOCAL"},{"code":"877822","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055374 = Hospital System Supply Identifier | 877822 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-409","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357127","type":"LOCAL"},{"code":"1083584","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357127 = Hospital System Supply Identifier | 1083584 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-409","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356478","type":"LOCAL"},{"code":"1083738","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356478 = Hospital System Supply Identifier | 1083738 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-410","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356579","type":"LOCAL"},{"code":"1083720","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356579 = Hospital System Supply Identifier | 1083720 = Lawson ID"}]},{"description":"SCREW P/T 5.0X47.5MM","code_information":[{"code":"Sx00-1506-504","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055376","type":"LOCAL"},{"code":"877824","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055376 = Hospital System Supply Identifier | 877824 = Lawson ID"}]},{"description":"SCREW P/T 5.0X45MM","code_information":[{"code":"Sx00-1506-504","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055375","type":"LOCAL"},{"code":"877823","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055375 = Hospital System Supply Identifier | 877823 = Lawson ID"}]},{"description":"SCREW P/T 5.0X50MM","code_information":[{"code":"Sx00-1506-505","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055377","type":"LOCAL"},{"code":"877825","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055377 = Hospital System Supply Identifier | 877825 = Lawson ID"}]},{"description":"SCREW P/T 5.0X52.5MM","code_information":[{"code":"Sx00-1506-505","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055378","type":"LOCAL"},{"code":"877826","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055378 = Hospital System Supply Identifier | 877826 = Lawson ID"}]},{"description":"SCREW P/T 5.0X55MM","code_information":[{"code":"Sx00-1506-505","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055379","type":"LOCAL"},{"code":"877827","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055379 = Hospital System Supply Identifier | 877827 = Lawson ID"}]},{"description":"SCREW P/T 5.0X57.5MM","code_information":[{"code":"Sx00-1506-505","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055380","type":"LOCAL"},{"code":"877828","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055380 = Hospital System Supply Identifier | 877828 = Lawson ID"}]},{"description":"SCREW P/T 5.0X60MM","code_information":[{"code":"Sx00-1506-506","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055381","type":"LOCAL"},{"code":"877829","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055381 = Hospital System Supply Identifier | 877829 = Lawson ID"}]},{"description":"SCREW P/T 5.0X62.5MM","code_information":[{"code":"Sx00-1506-506","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055382","type":"LOCAL"},{"code":"877830","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055382 = Hospital System Supply Identifier | 877830 = Lawson ID"}]},{"description":"SCREW P/T 5.0X65MM","code_information":[{"code":"Sx00-1506-506","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055383","type":"LOCAL"},{"code":"877831","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055383 = Hospital System Supply Identifier | 877831 = Lawson ID"}]},{"description":"SCREW P/T 5.0X67.5MM","code_information":[{"code":"Sx00-1506-506","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055384","type":"LOCAL"},{"code":"877832","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055384 = Hospital System Supply Identifier | 877832 = Lawson ID"}]},{"description":"SCREW P/T 5.0X75MM","code_information":[{"code":"Sx00-1506-507","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055386","type":"LOCAL"},{"code":"877834","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055386 = Hospital System Supply Identifier | 877834 = Lawson ID"}]},{"description":"SCREW P/T 5.0X70MM","code_information":[{"code":"Sx00-1506-507","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055385","type":"LOCAL"},{"code":"877833","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055385 = Hospital System Supply Identifier | 877833 = Lawson ID"}]},{"description":"SCREW P/T 5.0X80MM","code_information":[{"code":"Sx00-1506-508","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055387","type":"LOCAL"},{"code":"877835","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055387 = Hospital System Supply Identifier | 877835 = Lawson ID"}]},{"description":"SCREW P/T 5.0X85MM","code_information":[{"code":"Sx00-1506-508","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055388","type":"LOCAL"},{"code":"877836","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055388 = Hospital System Supply Identifier | 877836 = Lawson ID"}]},{"description":"SCREW P/T 5.0X90MM","code_information":[{"code":"Sx00-1506-509","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055389","type":"LOCAL"},{"code":"877837","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055389 = Hospital System Supply Identifier | 877837 = Lawson ID"}]},{"description":"SCREW P/T 5.0X95MM","code_information":[{"code":"Sx00-1506-509","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055390","type":"LOCAL"},{"code":"877838","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055390 = Hospital System Supply Identifier | 877838 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-510","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356756","type":"LOCAL"},{"code":"1083665","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356756 = Hospital System Supply Identifier | 1083665 = Lawson ID"}]},{"description":"SCREW P/T 5.0X100MM","code_information":[{"code":"Sx00-1506-510","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055391","type":"LOCAL"},{"code":"877839","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1055391 = Hospital System Supply Identifier | 877839 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-511","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356851","type":"LOCAL"},{"code":"1083622","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356851 = Hospital System Supply Identifier | 1083622 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-511","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357072","type":"LOCAL"},{"code":"1083725","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357072 = Hospital System Supply Identifier | 1083725 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-512","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356388","type":"LOCAL"},{"code":"1083687","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356388 = Hospital System Supply Identifier | 1083687 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-601","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356365","type":"LOCAL"},{"code":"1083695","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356365 = Hospital System Supply Identifier | 1083695 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-601","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356362","type":"LOCAL"},{"code":"1083633","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356362 = Hospital System Supply Identifier | 1083633 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-602","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356750","type":"LOCAL"},{"code":"1083626","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356750 = Hospital System Supply Identifier | 1083626 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-602","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356842","type":"LOCAL"},{"code":"1083632","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356842 = Hospital System Supply Identifier | 1083632 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-602","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356860","type":"LOCAL"},{"code":"1083671","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356860 = Hospital System Supply Identifier | 1083671 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-602","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357237","type":"LOCAL"},{"code":"1083681","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357237 = Hospital System Supply Identifier | 1083681 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-603","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357257","type":"LOCAL"},{"code":"1083551","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357257 = Hospital System Supply Identifier | 1083551 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-603","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356991","type":"LOCAL"},{"code":"1083590","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356991 = Hospital System Supply Identifier | 1083590 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-603","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356843","type":"LOCAL"},{"code":"1083698","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356843 = Hospital System Supply Identifier | 1083698 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-603","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356600","type":"LOCAL"},{"code":"1083703","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356600 = Hospital System Supply Identifier | 1083703 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-604","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356757","type":"LOCAL"},{"code":"1083672","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356757 = Hospital System Supply Identifier | 1083672 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-604","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356760","type":"LOCAL"},{"code":"1083614","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356760 = Hospital System Supply Identifier | 1083614 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-604","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356381","type":"LOCAL"},{"code":"1083605","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356381 = Hospital System Supply Identifier | 1083605 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-604","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357119","type":"LOCAL"},{"code":"1083568","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357119 = Hospital System Supply Identifier | 1083568 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-605","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356752","type":"LOCAL"},{"code":"1083542","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356752 = Hospital System Supply Identifier | 1083542 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-605","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357123","type":"LOCAL"},{"code":"1083618","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357123 = Hospital System Supply Identifier | 1083618 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-605","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356975","type":"LOCAL"},{"code":"1083623","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356975 = Hospital System Supply Identifier | 1083623 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-605","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356836","type":"LOCAL"},{"code":"1083697","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356836 = Hospital System Supply Identifier | 1083697 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-606","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356717","type":"LOCAL"},{"code":"1083651","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356717 = Hospital System Supply Identifier | 1083651 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015107240 TITANIUM 7X240MM","code_information":[{"code":"Sx00-1510-724","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356373","type":"LOCAL"},{"code":"1082473","type":"LOCAL"}],"standard_charges":[{"gross_charge":11240.62,"discounted_cash":8430.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356373 = Hospital System Supply Identifier | 1082473 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015107255 TITANIUM 7X255MM","code_information":[{"code":"Sx00-1510-725","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356867","type":"LOCAL"},{"code":"1082526","type":"LOCAL"}],"standard_charges":[{"gross_charge":11240.62,"discounted_cash":8430.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356867 = Hospital System Supply Identifier | 1082526 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015107270 TITANIUM 7X270MM","code_information":[{"code":"Sx00-1510-727","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357210","type":"LOCAL"},{"code":"1082546","type":"LOCAL"}],"standard_charges":[{"gross_charge":11240.62,"discounted_cash":8430.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357210 = Hospital System Supply Identifier | 1082546 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015107285 TITANIUM 7X285MM","code_information":[{"code":"Sx00-1510-728","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356728","type":"LOCAL"},{"code":"1082429","type":"LOCAL"}],"standard_charges":[{"gross_charge":11240.62,"discounted_cash":8430.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356728 = Hospital System Supply Identifier | 1082429 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015107300 TITANIUM 7X300MM","code_information":[{"code":"Sx00-1510-730","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356706","type":"LOCAL"},{"code":"1082511","type":"LOCAL"}],"standard_charges":[{"gross_charge":11240.62,"discounted_cash":8430.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356706 = Hospital System Supply Identifier | 1082511 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015107315 TITANIUM 7X315MM","code_information":[{"code":"Sx00-1510-731","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356742","type":"LOCAL"},{"code":"1082580","type":"LOCAL"}],"standard_charges":[{"gross_charge":11240.62,"discounted_cash":8430.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356742 = Hospital System Supply Identifier | 1082580 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015107330 TITANIUM 7X330MM","code_information":[{"code":"Sx00-1510-733","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357052","type":"LOCAL"},{"code":"1082569","type":"LOCAL"}],"standard_charges":[{"gross_charge":11240.62,"discounted_cash":8430.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357052 = Hospital System Supply Identifier | 1082569 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015107345 TITANIUM 7X345MM","code_information":[{"code":"Sx00-1510-734","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356554","type":"LOCAL"},{"code":"1082439","type":"LOCAL"}],"standard_charges":[{"gross_charge":11240.62,"discounted_cash":8430.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356554 = Hospital System Supply Identifier | 1082439 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015107360 TITANIUM 7X360MM","code_information":[{"code":"Sx00-1510-736","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356614","type":"LOCAL"},{"code":"1082475","type":"LOCAL"}],"standard_charges":[{"gross_charge":11240.62,"discounted_cash":8430.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356614 = Hospital System Supply Identifier | 1082475 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015107375 TITANIUM 7X375MM","code_information":[{"code":"Sx00-1510-737","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357250","type":"LOCAL"},{"code":"1082549","type":"LOCAL"}],"standard_charges":[{"gross_charge":11240.62,"discounted_cash":8430.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357250 = Hospital System Supply Identifier | 1082549 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015107390 TITANIUM 7X390MM","code_information":[{"code":"Sx00-1510-739","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356831","type":"LOCAL"},{"code":"1082568","type":"LOCAL"}],"standard_charges":[{"gross_charge":11240.62,"discounted_cash":8430.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356831 = Hospital System Supply Identifier | 1082568 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015108240 TITANIUM 8X240MM","code_information":[{"code":"Sx00-1510-824","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356494","type":"LOCAL"},{"code":"1082451","type":"LOCAL"}],"standard_charges":[{"gross_charge":11496.09,"discounted_cash":8622.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356494 = Hospital System Supply Identifier | 1082451 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015108255 TITANIUM 8X255MM","code_information":[{"code":"Sx00-1510-825","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357220","type":"LOCAL"},{"code":"1082593","type":"LOCAL"}],"standard_charges":[{"gross_charge":11496.09,"discounted_cash":8622.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357220 = Hospital System Supply Identifier | 1082593 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015108270 TITANIUM 8X270MM","code_information":[{"code":"Sx00-1510-827","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356368","type":"LOCAL"},{"code":"1082490","type":"LOCAL"}],"standard_charges":[{"gross_charge":11496.09,"discounted_cash":8622.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356368 = Hospital System Supply Identifier | 1082490 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015108285 TITANIUM 8X285MM","code_information":[{"code":"Sx00-1510-828","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356512","type":"LOCAL"},{"code":"1082436","type":"LOCAL"}],"standard_charges":[{"gross_charge":11496.09,"discounted_cash":8622.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356512 = Hospital System Supply Identifier | 1082436 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015108300 TITANIUM 8X300MM","code_information":[{"code":"Sx00-1510-830","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356825","type":"LOCAL"},{"code":"1082563","type":"LOCAL"}],"standard_charges":[{"gross_charge":11496.09,"discounted_cash":8622.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356825 = Hospital System Supply Identifier | 1082563 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015108315 TITANIUM 8X315MM","code_information":[{"code":"Sx00-1510-831","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356859","type":"LOCAL"},{"code":"1082427","type":"LOCAL"}],"standard_charges":[{"gross_charge":11496.09,"discounted_cash":8622.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356859 = Hospital System Supply Identifier | 1082427 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015108330 TITANIUM 8X330MM","code_information":[{"code":"Sx00-1510-833","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357075","type":"LOCAL"},{"code":"1082591","type":"LOCAL"}],"standard_charges":[{"gross_charge":11496.09,"discounted_cash":8622.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357075 = Hospital System Supply Identifier | 1082591 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015108345 TITANIUM 8X345MM","code_information":[{"code":"Sx00-1510-834","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356604","type":"LOCAL"},{"code":"1082437","type":"LOCAL"}],"standard_charges":[{"gross_charge":11496.09,"discounted_cash":8622.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356604 = Hospital System Supply Identifier | 1082437 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015108360 TITANIUM 8X360MM","code_information":[{"code":"Sx00-1510-836","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357195","type":"LOCAL"},{"code":"1082542","type":"LOCAL"}],"standard_charges":[{"gross_charge":11496.09,"discounted_cash":8622.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357195 = Hospital System Supply Identifier | 1082542 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015108375 TITANIUM 8X375MM","code_information":[{"code":"Sx00-1510-837","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356692","type":"LOCAL"},{"code":"1082586","type":"LOCAL"}],"standard_charges":[{"gross_charge":11496.09,"discounted_cash":8622.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356692 = Hospital System Supply Identifier | 1082586 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015108390 TITANIUM 8X390MM","code_information":[{"code":"Sx00-1510-839","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357034","type":"LOCAL"},{"code":"1082525","type":"LOCAL"}],"standard_charges":[{"gross_charge":11496.09,"discounted_cash":8622.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357034 = Hospital System Supply Identifier | 1082525 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015108405 TITANIUM 8X405MM","code_information":[{"code":"Sx00-1510-840","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356739","type":"LOCAL"},{"code":"1082470","type":"LOCAL"}],"standard_charges":[{"gross_charge":11496.09,"discounted_cash":8622.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356739 = Hospital System Supply Identifier | 1082470 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015108420 TITANIUM 8X420MM","code_information":[{"code":"Sx00-1510-842","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356475","type":"LOCAL"},{"code":"1082518","type":"LOCAL"}],"standard_charges":[{"gross_charge":11496.09,"discounted_cash":8622.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356475 = Hospital System Supply Identifier | 1082518 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015109240 TITANIUM 9X240MM","code_information":[{"code":"Sx00-1510-924","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356910","type":"LOCAL"},{"code":"1082484","type":"LOCAL"}],"standard_charges":[{"gross_charge":11763.42,"discounted_cash":8822.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356910 = Hospital System Supply Identifier | 1082484 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015109255 TITANIUM 9X255MM","code_information":[{"code":"Sx00-1510-925","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356511","type":"LOCAL"},{"code":"1082499","type":"LOCAL"}],"standard_charges":[{"gross_charge":11763.42,"discounted_cash":8822.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356511 = Hospital System Supply Identifier | 1082499 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015109270 TITANIUM 9X270MM","code_information":[{"code":"Sx00-1510-927","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356727","type":"LOCAL"},{"code":"1082433","type":"LOCAL"}],"standard_charges":[{"gross_charge":11763.42,"discounted_cash":8822.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356727 = Hospital System Supply Identifier | 1082433 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015109285 TITANIUM 9X285MM","code_information":[{"code":"Sx00-1510-928","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356705","type":"LOCAL"},{"code":"1082500","type":"LOCAL"}],"standard_charges":[{"gross_charge":11763.42,"discounted_cash":8822.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356705 = Hospital System Supply Identifier | 1082500 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015109300 TITANIUM 9X300MM","code_information":[{"code":"Sx00-1510-930","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356389","type":"LOCAL"},{"code":"1082541","type":"LOCAL"}],"standard_charges":[{"gross_charge":11763.42,"discounted_cash":8822.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356389 = Hospital System Supply Identifier | 1082541 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015109315 TITANIUM 9X315MM","code_information":[{"code":"Sx00-1510-931","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356830","type":"LOCAL"},{"code":"1082522","type":"LOCAL"}],"standard_charges":[{"gross_charge":11763.42,"discounted_cash":8822.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356830 = Hospital System Supply Identifier | 1082522 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015109330 TITANIUM 9X330MM","code_information":[{"code":"Sx00-1510-933","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357134","type":"LOCAL"},{"code":"1082537","type":"LOCAL"}],"standard_charges":[{"gross_charge":11763.42,"discounted_cash":8822.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357134 = Hospital System Supply Identifier | 1082537 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015109345 TITANIUM 9X345MM","code_information":[{"code":"Sx00-1510-934","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356490","type":"LOCAL"},{"code":"1082506","type":"LOCAL"}],"standard_charges":[{"gross_charge":11763.42,"discounted_cash":8822.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356490 = Hospital System Supply Identifier | 1082506 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015109360 TITANIUM 9X360MM","code_information":[{"code":"Sx00-1510-936","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356476","type":"LOCAL"},{"code":"1082551","type":"LOCAL"}],"standard_charges":[{"gross_charge":11763.42,"discounted_cash":8822.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356476 = Hospital System Supply Identifier | 1082551 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015109375 TITANIUM 9X375MM","code_information":[{"code":"Sx00-1510-937","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356845","type":"LOCAL"},{"code":"1082527","type":"LOCAL"}],"standard_charges":[{"gross_charge":11763.42,"discounted_cash":8822.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356845 = Hospital System Supply Identifier | 1082527 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015109390 TITANIUM 9X390MM","code_information":[{"code":"Sx00-1510-939","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356491","type":"LOCAL"},{"code":"1082466","type":"LOCAL"}],"standard_charges":[{"gross_charge":11763.42,"discounted_cash":8822.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356491 = Hospital System Supply Identifier | 1082466 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015109405 TITANIUM 9X405MM","code_information":[{"code":"Sx00-1510-940","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356735","type":"LOCAL"},{"code":"1082493","type":"LOCAL"}],"standard_charges":[{"gross_charge":11763.42,"discounted_cash":8822.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356735 = Hospital System Supply Identifier | 1082493 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015109420 TITANIUM 9X420MM","code_information":[{"code":"Sx00-1510-942","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356489","type":"LOCAL"},{"code":"1082447","type":"LOCAL"}],"standard_charges":[{"gross_charge":11763.42,"discounted_cash":8822.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356489 = Hospital System Supply Identifier | 1082447 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015110270 TITANIUM 10X270MM","code_information":[{"code":"Sx00-1511-027","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357174","type":"LOCAL"},{"code":"1082440","type":"LOCAL"}],"standard_charges":[{"gross_charge":11763.42,"discounted_cash":8822.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357174 = Hospital System Supply Identifier | 1082440 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015110285 TITANIUM 10X285MM","code_information":[{"code":"Sx00-1511-028","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356768","type":"LOCAL"},{"code":"1082479","type":"LOCAL"}],"standard_charges":[{"gross_charge":11763.42,"discounted_cash":8822.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356768 = Hospital System Supply Identifier | 1082479 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015110300 TITANIUM 10X300MM","code_information":[{"code":"Sx00-1511-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356978","type":"LOCAL"},{"code":"1082552","type":"LOCAL"}],"standard_charges":[{"gross_charge":11763.42,"discounted_cash":8822.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356978 = Hospital System Supply Identifier | 1082552 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015110315 TITANIUM 10X315MM","code_information":[{"code":"Sx00-1511-031","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357110","type":"LOCAL"},{"code":"1082471","type":"LOCAL"}],"standard_charges":[{"gross_charge":11763.42,"discounted_cash":8822.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357110 = Hospital System Supply Identifier | 1082471 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015110330 TITANIUM 10X330MM","code_information":[{"code":"Sx00-1511-033","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356616","type":"LOCAL"},{"code":"1082458","type":"LOCAL"}],"standard_charges":[{"gross_charge":11763.42,"discounted_cash":8822.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356616 = Hospital System Supply Identifier | 1082458 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015110345 TITANIUM 10X345MM","code_information":[{"code":"Sx00-1511-034","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356357","type":"LOCAL"},{"code":"1082516","type":"LOCAL"}],"standard_charges":[{"gross_charge":11763.42,"discounted_cash":8822.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356357 = Hospital System Supply Identifier | 1082516 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015110360 TITANIUM 10X360MM","code_information":[{"code":"Sx00-1511-036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357177","type":"LOCAL"},{"code":"1082528","type":"LOCAL"}],"standard_charges":[{"gross_charge":11763.42,"discounted_cash":8822.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357177 = Hospital System Supply Identifier | 1082528 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015110375 TITANIUM 10X375MM","code_information":[{"code":"Sx00-1511-037","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356320","type":"LOCAL"},{"code":"1082469","type":"LOCAL"}],"standard_charges":[{"gross_charge":11763.42,"discounted_cash":8822.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356320 = Hospital System Supply Identifier | 1082469 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015110390 TITANIUM 10X390MM","code_information":[{"code":"Sx00-1511-039","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357227","type":"LOCAL"},{"code":"1082598","type":"LOCAL"}],"standard_charges":[{"gross_charge":11763.42,"discounted_cash":8822.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357227 = Hospital System Supply Identifier | 1082598 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015110405 TITANIUM 10X405MM","code_information":[{"code":"Sx00-1511-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356673","type":"LOCAL"},{"code":"1082524","type":"LOCAL"}],"standard_charges":[{"gross_charge":11763.42,"discounted_cash":8822.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356673 = Hospital System Supply Identifier | 1082524 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015110420 TITANIUM 10X420MM","code_information":[{"code":"Sx00-1511-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356959","type":"LOCAL"},{"code":"1082489","type":"LOCAL"}],"standard_charges":[{"gross_charge":11763.42,"discounted_cash":8822.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356959 = Hospital System Supply Identifier | 1082489 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015111270 TITANIUM 11X270MM","code_information":[{"code":"Sx00-1511-127","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356800","type":"LOCAL"},{"code":"1082446","type":"LOCAL"}],"standard_charges":[{"gross_charge":12043.5,"discounted_cash":9032.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356800 = Hospital System Supply Identifier | 1082446 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015111285 TITANIUM 11X285MM","code_information":[{"code":"Sx00-1511-128","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357032","type":"LOCAL"},{"code":"1082498","type":"LOCAL"}],"standard_charges":[{"gross_charge":12043.5,"discounted_cash":9032.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357032 = Hospital System Supply Identifier | 1082498 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015111300 TITANIUM 11X300MM","code_information":[{"code":"Sx00-1511-130","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356583","type":"LOCAL"},{"code":"1082503","type":"LOCAL"}],"standard_charges":[{"gross_charge":12043.5,"discounted_cash":9032.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356583 = Hospital System Supply Identifier | 1082503 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015111315 TITANIUM 11X315MM","code_information":[{"code":"Sx00-1511-131","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356941","type":"LOCAL"},{"code":"1082501","type":"LOCAL"}],"standard_charges":[{"gross_charge":12043.5,"discounted_cash":9032.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356941 = Hospital System Supply Identifier | 1082501 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015111330 TITANIUM 11X330MM","code_information":[{"code":"Sx00-1511-133","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357249","type":"LOCAL"},{"code":"1082538","type":"LOCAL"}],"standard_charges":[{"gross_charge":12043.5,"discounted_cash":9032.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357249 = Hospital System Supply Identifier | 1082538 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015111345 TITANIUM 11X345MM","code_information":[{"code":"Sx00-1511-134","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356429","type":"LOCAL"},{"code":"1082508","type":"LOCAL"}],"standard_charges":[{"gross_charge":12043.5,"discounted_cash":9032.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356429 = Hospital System Supply Identifier | 1082508 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015111360 TITANIUM 11X360MM","code_information":[{"code":"Sx00-1511-136","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357096","type":"LOCAL"},{"code":"1082515","type":"LOCAL"}],"standard_charges":[{"gross_charge":12043.5,"discounted_cash":9032.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357096 = Hospital System Supply Identifier | 1082515 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015111375 TITANIUM 11X375MM","code_information":[{"code":"Sx00-1511-137","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357138","type":"LOCAL"},{"code":"1082557","type":"LOCAL"}],"standard_charges":[{"gross_charge":12043.5,"discounted_cash":9032.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357138 = Hospital System Supply Identifier | 1082557 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015111390 TITANIUM 11X390MM","code_information":[{"code":"Sx00-1511-139","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356605","type":"LOCAL"},{"code":"1082488","type":"LOCAL"}],"standard_charges":[{"gross_charge":12043.5,"discounted_cash":9032.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356605 = Hospital System Supply Identifier | 1082488 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015111405 TITANIUM 11X405MM","code_information":[{"code":"Sx00-1511-140","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356732","type":"LOCAL"},{"code":"1082472","type":"LOCAL"}],"standard_charges":[{"gross_charge":12043.5,"discounted_cash":9032.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356732 = Hospital System Supply Identifier | 1082472 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015111420 TITANIUM 11X420MM","code_information":[{"code":"Sx00-1511-142","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356346","type":"LOCAL"},{"code":"1082544","type":"LOCAL"}],"standard_charges":[{"gross_charge":12043.5,"discounted_cash":9032.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356346 = Hospital System Supply Identifier | 1082544 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015112285 TITANIUM 12X285MM","code_information":[{"code":"Sx00-1511-228","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356319","type":"LOCAL"},{"code":"1082462","type":"LOCAL"}],"standard_charges":[{"gross_charge":12337.25,"discounted_cash":9252.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356319 = Hospital System Supply Identifier | 1082462 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015112300 TITANIUM 12X300MM","code_information":[{"code":"Sx00-1511-230","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357256","type":"LOCAL"},{"code":"1082567","type":"LOCAL"}],"standard_charges":[{"gross_charge":12337.25,"discounted_cash":9252.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357256 = Hospital System Supply Identifier | 1082567 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015112315 TITANIUM 12X315MM","code_information":[{"code":"Sx00-1511-231","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357178","type":"LOCAL"},{"code":"1082520","type":"LOCAL"}],"standard_charges":[{"gross_charge":12337.25,"discounted_cash":9252.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357178 = Hospital System Supply Identifier | 1082520 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015112330 TITANIUM 12X330MM","code_information":[{"code":"Sx00-1511-233","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356738","type":"LOCAL"},{"code":"1082452","type":"LOCAL"}],"standard_charges":[{"gross_charge":12337.25,"discounted_cash":9252.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356738 = Hospital System Supply Identifier | 1082452 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015112345 TITANIUM 12X345MM","code_information":[{"code":"Sx00-1511-234","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356671","type":"LOCAL"},{"code":"1082434","type":"LOCAL"}],"standard_charges":[{"gross_charge":12337.25,"discounted_cash":9252.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356671 = Hospital System Supply Identifier | 1082434 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015112360 TITANIUM 12X360MM","code_information":[{"code":"Sx00-1511-236","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357079","type":"LOCAL"},{"code":"1082533","type":"LOCAL"}],"standard_charges":[{"gross_charge":12337.25,"discounted_cash":9252.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357079 = Hospital System Supply Identifier | 1082533 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015112375 TITANIUM 12X375MM","code_information":[{"code":"Sx00-1511-237","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356556","type":"LOCAL"},{"code":"1082512","type":"LOCAL"}],"standard_charges":[{"gross_charge":12337.25,"discounted_cash":9252.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356556 = Hospital System Supply Identifier | 1082512 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015112390 TITANIUM 12X390MM","code_information":[{"code":"Sx00-1511-239","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356814","type":"LOCAL"},{"code":"1082596","type":"LOCAL"}],"standard_charges":[{"gross_charge":12337.25,"discounted_cash":9252.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356814 = Hospital System Supply Identifier | 1082596 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015112405 TITANIUM 12X405MM","code_information":[{"code":"Sx00-1511-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356801","type":"LOCAL"},{"code":"1082459","type":"LOCAL"}],"standard_charges":[{"gross_charge":12337.25,"discounted_cash":9252.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356801 = Hospital System Supply Identifier | 1082459 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015112420 TITANIUM 12X420MM","code_information":[{"code":"Sx00-1511-242","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356595","type":"LOCAL"},{"code":"1082564","type":"LOCAL"}],"standard_charges":[{"gross_charge":12337.25,"discounted_cash":9252.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356595 = Hospital System Supply Identifier | 1082564 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015240025 4.0X25MM","code_information":[{"code":"Sx00-1524-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356866","type":"LOCAL"},{"code":"1082467","type":"LOCAL"}],"standard_charges":[{"gross_charge":907.49,"discounted_cash":680.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356866 = Hospital System Supply Identifier | 1082467 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015240020 4.0X20MM","code_information":[{"code":"Sx00-1524-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357240","type":"LOCAL"},{"code":"1082497","type":"LOCAL"}],"standard_charges":[{"gross_charge":907.49,"discounted_cash":680.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357240 = Hospital System Supply Identifier | 1082497 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015240035 4.0X35MM","code_information":[{"code":"Sx00-1524-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356321","type":"LOCAL"},{"code":"1082519","type":"LOCAL"}],"standard_charges":[{"gross_charge":907.49,"discounted_cash":680.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356321 = Hospital System Supply Identifier | 1082519 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015240030 4.0X30MM","code_information":[{"code":"Sx00-1524-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356922","type":"LOCAL"},{"code":"1082558","type":"LOCAL"}],"standard_charges":[{"gross_charge":907.49,"discounted_cash":680.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356922 = Hospital System Supply Identifier | 1082558 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015240040 4.0X40MM","code_information":[{"code":"Sx00-1524-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357106","type":"LOCAL"},{"code":"1082455","type":"LOCAL"}],"standard_charges":[{"gross_charge":907.49,"discounted_cash":680.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357106 = Hospital System Supply Identifier | 1082455 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015240045 4.0X45MM","code_information":[{"code":"Sx00-1524-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357214","type":"LOCAL"},{"code":"1082565","type":"LOCAL"}],"standard_charges":[{"gross_charge":907.49,"discounted_cash":680.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357214 = Hospital System Supply Identifier | 1082565 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015240050 4.0X50MM","code_information":[{"code":"Sx00-1524-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357054","type":"LOCAL"},{"code":"1082583","type":"LOCAL"}],"standard_charges":[{"gross_charge":907.49,"discounted_cash":680.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357054 = Hospital System Supply Identifier | 1082583 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015240055 4.0X55MM","code_information":[{"code":"Sx00-1524-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356833","type":"LOCAL"},{"code":"1082444","type":"LOCAL"}],"standard_charges":[{"gross_charge":907.49,"discounted_cash":680.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356833 = Hospital System Supply Identifier | 1082444 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015240060 4.0X60MM","code_information":[{"code":"Sx00-1524-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356688","type":"LOCAL"},{"code":"1082539","type":"LOCAL"}],"standard_charges":[{"gross_charge":907.49,"discounted_cash":680.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356688 = Hospital System Supply Identifier | 1082539 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015240175 4.0X17.5MM","code_information":[{"code":"Sx00-1524-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357176","type":"LOCAL"},{"code":"1082514","type":"LOCAL"}],"standard_charges":[{"gross_charge":907.49,"discounted_cash":680.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357176 = Hospital System Supply Identifier | 1082514 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015240225 4.0X22.5MM","code_information":[{"code":"Sx00-1524-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356994","type":"LOCAL"},{"code":"1082578","type":"LOCAL"}],"standard_charges":[{"gross_charge":907.49,"discounted_cash":680.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356994 = Hospital System Supply Identifier | 1082578 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015240275 4.0X27.5MM","code_information":[{"code":"Sx00-1524-027","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356710","type":"LOCAL"},{"code":"1082465","type":"LOCAL"}],"standard_charges":[{"gross_charge":907.49,"discounted_cash":680.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356710 = Hospital System Supply Identifier | 1082465 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015240325 4.0X32.5MM","code_information":[{"code":"Sx00-1524-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357248","type":"LOCAL"},{"code":"1082494","type":"LOCAL"}],"standard_charges":[{"gross_charge":907.49,"discounted_cash":680.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357248 = Hospital System Supply Identifier | 1082494 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015240375 4.0X37.5MM","code_information":[{"code":"Sx00-1524-037","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356924","type":"LOCAL"},{"code":"1082573","type":"LOCAL"}],"standard_charges":[{"gross_charge":907.49,"discounted_cash":680.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356924 = Hospital System Supply Identifier | 1082573 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015240425 4.0X42.5MM","code_information":[{"code":"Sx00-1524-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356943","type":"LOCAL"},{"code":"1082529","type":"LOCAL"}],"standard_charges":[{"gross_charge":907.49,"discounted_cash":680.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356943 = Hospital System Supply Identifier | 1082529 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015240475 4.0X47.5MM","code_information":[{"code":"Sx00-1524-047","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357175","type":"LOCAL"},{"code":"1082442","type":"LOCAL"}],"standard_charges":[{"gross_charge":907.49,"discounted_cash":680.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357175 = Hospital System Supply Identifier | 1082442 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015240525 4.0X52.5MM","code_information":[{"code":"Sx00-1524-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356803","type":"LOCAL"},{"code":"1082478","type":"LOCAL"}],"standard_charges":[{"gross_charge":907.49,"discounted_cash":680.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356803 = Hospital System Supply Identifier | 1082478 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015240575 4.0X57.5MM","code_information":[{"code":"Sx00-1524-057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357030","type":"LOCAL"},{"code":"1082477","type":"LOCAL"}],"standard_charges":[{"gross_charge":907.49,"discounted_cash":680.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357030 = Hospital System Supply Identifier | 1082477 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245020 4.5X20MM","code_information":[{"code":"Sx00-1524-502","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356733","type":"LOCAL"},{"code":"1082495","type":"LOCAL"}],"standard_charges":[{"gross_charge":1166.6,"discounted_cash":874.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356733 = Hospital System Supply Identifier | 1082495 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245025 4.5X25MM","code_information":[{"code":"Sx00-1524-502","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356572","type":"LOCAL"},{"code":"1082561","type":"LOCAL"}],"standard_charges":[{"gross_charge":1166.6,"discounted_cash":874.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356572 = Hospital System Supply Identifier | 1082561 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245035 4.5X35MM","code_information":[{"code":"Sx00-1524-503","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357089","type":"LOCAL"},{"code":"1082531","type":"LOCAL"}],"standard_charges":[{"gross_charge":1166.6,"discounted_cash":874.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357089 = Hospital System Supply Identifier | 1082531 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245030 4.5X30MM","code_information":[{"code":"Sx00-1524-503","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357055","type":"LOCAL"},{"code":"1082590","type":"LOCAL"}],"standard_charges":[{"gross_charge":1166.6,"discounted_cash":874.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357055 = Hospital System Supply Identifier | 1082590 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245040 4.5X40MM","code_information":[{"code":"Sx00-1524-504","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357031","type":"LOCAL"},{"code":"1082481","type":"LOCAL"}],"standard_charges":[{"gross_charge":1166.6,"discounted_cash":874.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357031 = Hospital System Supply Identifier | 1082481 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245045 4.5X45MM","code_information":[{"code":"Sx00-1524-504","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356465","type":"LOCAL"},{"code":"1082523","type":"LOCAL"}],"standard_charges":[{"gross_charge":1166.6,"discounted_cash":874.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356465 = Hospital System Supply Identifier | 1082523 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245050 4.5X50MM","code_information":[{"code":"Sx00-1524-505","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357261","type":"LOCAL"},{"code":"1082468","type":"LOCAL"}],"standard_charges":[{"gross_charge":1166.6,"discounted_cash":874.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357261 = Hospital System Supply Identifier | 1082468 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245055 4.5X55MM","code_information":[{"code":"Sx00-1524-505","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357082","type":"LOCAL"},{"code":"1082582","type":"LOCAL"}],"standard_charges":[{"gross_charge":1166.6,"discounted_cash":874.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357082 = Hospital System Supply Identifier | 1082582 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245060 4.5X60MM","code_information":[{"code":"Sx00-1524-506","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356832","type":"LOCAL"},{"code":"1082585","type":"LOCAL"}],"standard_charges":[{"gross_charge":1166.6,"discounted_cash":874.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356832 = Hospital System Supply Identifier | 1082585 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245065 4.5X65MM","code_information":[{"code":"Sx00-1524-506","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356586","type":"LOCAL"},{"code":"1082553","type":"LOCAL"}],"standard_charges":[{"gross_charge":1166.6,"discounted_cash":874.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356586 = Hospital System Supply Identifier | 1082553 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245070 4.5X70MM","code_information":[{"code":"Sx00-1524-507","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356371","type":"LOCAL"},{"code":"1082461","type":"LOCAL"}],"standard_charges":[{"gross_charge":1166.6,"discounted_cash":874.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356371 = Hospital System Supply Identifier | 1082461 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245075 4.5X75MM","code_information":[{"code":"Sx00-1524-507","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356573","type":"LOCAL"},{"code":"1082587","type":"LOCAL"}],"standard_charges":[{"gross_charge":1166.6,"discounted_cash":874.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356573 = Hospital System Supply Identifier | 1082587 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245080 4.5X80MM","code_information":[{"code":"Sx00-1524-508","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357137","type":"LOCAL"},{"code":"1082482","type":"LOCAL"}],"standard_charges":[{"gross_charge":1166.6,"discounted_cash":874.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357137 = Hospital System Supply Identifier | 1082482 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245175 4.5X17.5MM","code_information":[{"code":"Sx00-1524-517","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357053","type":"LOCAL"},{"code":"1082576","type":"LOCAL"}],"standard_charges":[{"gross_charge":1166.6,"discounted_cash":874.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357053 = Hospital System Supply Identifier | 1082576 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245225 4.5X22.5MM","code_information":[{"code":"Sx00-1524-522","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356372","type":"LOCAL"},{"code":"1082487","type":"LOCAL"}],"standard_charges":[{"gross_charge":1166.6,"discounted_cash":874.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356372 = Hospital System Supply Identifier | 1082487 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245275 4.5X27.5MM","code_information":[{"code":"Sx00-1524-527","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356426","type":"LOCAL"},{"code":"1082453","type":"LOCAL"}],"standard_charges":[{"gross_charge":1166.6,"discounted_cash":874.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356426 = Hospital System Supply Identifier | 1082453 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245325 4.5X32.5MM","code_information":[{"code":"Sx00-1524-532","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356383","type":"LOCAL"},{"code":"1082575","type":"LOCAL"}],"standard_charges":[{"gross_charge":1166.6,"discounted_cash":874.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356383 = Hospital System Supply Identifier | 1082575 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245375 4.5X37.5MM","code_information":[{"code":"Sx00-1524-537","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356690","type":"LOCAL"},{"code":"1082570","type":"LOCAL"}],"standard_charges":[{"gross_charge":1166.6,"discounted_cash":874.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356690 = Hospital System Supply Identifier | 1082570 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245425 4.5X42.5MM","code_information":[{"code":"Sx00-1524-542","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356691","type":"LOCAL"},{"code":"1082577","type":"LOCAL"}],"standard_charges":[{"gross_charge":1166.6,"discounted_cash":874.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356691 = Hospital System Supply Identifier | 1082577 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245475 4.5X47.5MM","code_information":[{"code":"Sx00-1524-547","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357244","type":"LOCAL"},{"code":"1082450","type":"LOCAL"}],"standard_charges":[{"gross_charge":1166.6,"discounted_cash":874.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357244 = Hospital System Supply Identifier | 1082450 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245525 4.5X52.5MM","code_information":[{"code":"Sx00-1524-552","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356865","type":"LOCAL"},{"code":"1082510","type":"LOCAL"}],"standard_charges":[{"gross_charge":1166.6,"discounted_cash":874.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356865 = Hospital System Supply Identifier | 1082510 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245575 4.5X57.5MM","code_information":[{"code":"Sx00-1524-557","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356945","type":"LOCAL"},{"code":"1082592","type":"LOCAL"}],"standard_charges":[{"gross_charge":1166.6,"discounted_cash":874.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356945 = Hospital System Supply Identifier | 1082592 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245625 4.5X62.5MM","code_information":[{"code":"Sx00-1524-562","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356829","type":"LOCAL"},{"code":"1082502","type":"LOCAL"}],"standard_charges":[{"gross_charge":1166.6,"discounted_cash":874.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356829 = Hospital System Supply Identifier | 1082502 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245675 4.5X67.5MM","code_information":[{"code":"Sx00-1524-567","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357125","type":"LOCAL"},{"code":"1082594","type":"LOCAL"}],"standard_charges":[{"gross_charge":1166.6,"discounted_cash":874.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357125 = Hospital System Supply Identifier | 1082594 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245725 4.5X72.5MM","code_information":[{"code":"Sx00-1524-572","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357081","type":"LOCAL"},{"code":"1082562","type":"LOCAL"}],"standard_charges":[{"gross_charge":1166.6,"discounted_cash":874.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357081 = Hospital System Supply Identifier | 1082562 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245775 4.5X77.5MM","code_information":[{"code":"Sx00-1524-577","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357196","type":"LOCAL"},{"code":"1082589","type":"LOCAL"}],"standard_charges":[{"gross_charge":1166.6,"discounted_cash":874.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357196 = Hospital System Supply Identifier | 1082589 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250020 5.0X20MM","code_information":[{"code":"Sx00-1525-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357270","type":"LOCAL"},{"code":"1082454","type":"LOCAL"}],"standard_charges":[{"gross_charge":1342.32,"discounted_cash":1006.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357270 = Hospital System Supply Identifier | 1082454 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250025 5.0X25MM","code_information":[{"code":"Sx00-1525-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356349","type":"LOCAL"},{"code":"1082463","type":"LOCAL"}],"standard_charges":[{"gross_charge":1342.32,"discounted_cash":1006.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356349 = Hospital System Supply Identifier | 1082463 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250035 5.0X35MM","code_information":[{"code":"Sx00-1525-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356585","type":"LOCAL"},{"code":"1082548","type":"LOCAL"}],"standard_charges":[{"gross_charge":1342.32,"discounted_cash":1006.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356585 = Hospital System Supply Identifier | 1082548 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250030 5.0X30MM","code_information":[{"code":"Sx00-1525-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356961","type":"LOCAL"},{"code":"1082492","type":"LOCAL"}],"standard_charges":[{"gross_charge":1342.32,"discounted_cash":1006.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356961 = Hospital System Supply Identifier | 1082492 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250045 5.0X45MM","code_information":[{"code":"Sx00-1525-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357107","type":"LOCAL"},{"code":"1082491","type":"LOCAL"}],"standard_charges":[{"gross_charge":1342.32,"discounted_cash":1006.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357107 = Hospital System Supply Identifier | 1082491 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250040 5.0X40MM","code_information":[{"code":"Sx00-1525-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356347","type":"LOCAL"},{"code":"1082584","type":"LOCAL"}],"standard_charges":[{"gross_charge":1342.32,"discounted_cash":1006.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356347 = Hospital System Supply Identifier | 1082584 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250055 5.0X55MM","code_information":[{"code":"Sx00-1525-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356958","type":"LOCAL"},{"code":"1082438","type":"LOCAL"}],"standard_charges":[{"gross_charge":1342.32,"discounted_cash":1006.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356958 = Hospital System Supply Identifier | 1082438 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250050 5.0X50MM","code_information":[{"code":"Sx00-1525-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357215","type":"LOCAL"},{"code":"1082579","type":"LOCAL"}],"standard_charges":[{"gross_charge":1342.32,"discounted_cash":1006.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357215 = Hospital System Supply Identifier | 1082579 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250060 5.0X60MM","code_information":[{"code":"Sx00-1525-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356864","type":"LOCAL"},{"code":"1082435","type":"LOCAL"}],"standard_charges":[{"gross_charge":1342.32,"discounted_cash":1006.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356864 = Hospital System Supply Identifier | 1082435 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250065 5.0X65MM","code_information":[{"code":"Sx00-1525-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356923","type":"LOCAL"},{"code":"1082588","type":"LOCAL"}],"standard_charges":[{"gross_charge":1342.32,"discounted_cash":1006.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356923 = Hospital System Supply Identifier | 1082588 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250070 5.0X70MM","code_information":[{"code":"Sx00-1525-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356424","type":"LOCAL"},{"code":"1082818","type":"LOCAL"}],"standard_charges":[{"gross_charge":1342.32,"discounted_cash":1006.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356424 = Hospital System Supply Identifier | 1082818 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250075 5.0X75MM","code_information":[{"code":"Sx00-1525-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356902","type":"LOCAL"},{"code":"1082758","type":"LOCAL"}],"standard_charges":[{"gross_charge":1342.32,"discounted_cash":1006.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356902 = Hospital System Supply Identifier | 1082758 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250080 5.0X80MM","code_information":[{"code":"Sx00-1525-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356443","type":"LOCAL"},{"code":"1082669","type":"LOCAL"}],"standard_charges":[{"gross_charge":1342.32,"discounted_cash":1006.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356443 = Hospital System Supply Identifier | 1082669 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250175 5.0X17.5MM","code_information":[{"code":"Sx00-1525-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357170","type":"LOCAL"},{"code":"1082730","type":"LOCAL"}],"standard_charges":[{"gross_charge":1342.32,"discounted_cash":1006.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357170 = Hospital System Supply Identifier | 1082730 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250225 5.0X22.5MM","code_information":[{"code":"Sx00-1525-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356380","type":"LOCAL"},{"code":"1082805","type":"LOCAL"}],"standard_charges":[{"gross_charge":1342.32,"discounted_cash":1006.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356380 = Hospital System Supply Identifier | 1082805 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250275 5.0X27.5MM","code_information":[{"code":"Sx00-1525-027","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356783","type":"LOCAL"},{"code":"1082831","type":"LOCAL"}],"standard_charges":[{"gross_charge":1342.32,"discounted_cash":1006.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356783 = Hospital System Supply Identifier | 1082831 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250325 5.0X32.5MM","code_information":[{"code":"Sx00-1525-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356314","type":"LOCAL"},{"code":"1082854","type":"LOCAL"}],"standard_charges":[{"gross_charge":1342.32,"discounted_cash":1006.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356314 = Hospital System Supply Identifier | 1082854 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250375 5.0X37.5MM","code_information":[{"code":"Sx00-1525-037","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357207","type":"LOCAL"},{"code":"1082635","type":"LOCAL"}],"standard_charges":[{"gross_charge":1342.32,"discounted_cash":1006.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357207 = Hospital System Supply Identifier | 1082635 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250425 5.0X42.5MM","code_information":[{"code":"Sx00-1525-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356575","type":"LOCAL"},{"code":"1082632","type":"LOCAL"}],"standard_charges":[{"gross_charge":1342.32,"discounted_cash":1006.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356575 = Hospital System Supply Identifier | 1082632 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250475 5.0X47.5MM","code_information":[{"code":"Sx00-1525-047","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356920","type":"LOCAL"},{"code":"1082620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1342.32,"discounted_cash":1006.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356920 = Hospital System Supply Identifier | 1082620 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250525 5.0X52.5MM","code_information":[{"code":"Sx00-1525-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357201","type":"LOCAL"},{"code":"1082697","type":"LOCAL"}],"standard_charges":[{"gross_charge":1342.32,"discounted_cash":1006.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357201 = Hospital System Supply Identifier | 1082697 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250575 5.0X57.5MM","code_information":[{"code":"Sx00-1525-057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356669","type":"LOCAL"},{"code":"1082728","type":"LOCAL"}],"standard_charges":[{"gross_charge":1342.32,"discounted_cash":1006.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356669 = Hospital System Supply Identifier | 1082728 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250625 5.0X62.5MM","code_information":[{"code":"Sx00-1525-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357064","type":"LOCAL"},{"code":"1082651","type":"LOCAL"}],"standard_charges":[{"gross_charge":1342.32,"discounted_cash":1006.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357064 = Hospital System Supply Identifier | 1082651 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250675 5.0X67.5MM","code_information":[{"code":"Sx00-1525-067","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357226","type":"LOCAL"},{"code":"1082832","type":"LOCAL"}],"standard_charges":[{"gross_charge":1342.32,"discounted_cash":1006.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357226 = Hospital System Supply Identifier | 1082832 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250725 5.0X72.5MM","code_information":[{"code":"Sx00-1525-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356818","type":"LOCAL"},{"code":"1082699","type":"LOCAL"}],"standard_charges":[{"gross_charge":1342.32,"discounted_cash":1006.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356818 = Hospital System Supply Identifier | 1082699 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250775 5.0X77.5MM","code_information":[{"code":"Sx00-1525-077","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357044","type":"LOCAL"},{"code":"1082653","type":"LOCAL"}],"standard_charges":[{"gross_charge":1342.32,"discounted_cash":1006.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357044 = Hospital System Supply Identifier | 1082653 = Lawson ID"}]},{"description":"ENDCAP INTRAMEDULLARY NAIL FLUSH PNP TIBIA 0015300000","code_information":[{"code":"Sx00-1530-000","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356550","type":"LOCAL"},{"code":"1082637","type":"LOCAL"}],"standard_charges":[{"gross_charge":914.09,"discounted_cash":685.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356550 = Hospital System Supply Identifier | 1082637 = Lawson ID"}]},{"description":"ENDCAP INTRAMEDULLARY NAIL CANNULATED PNP TIBIA 0015300005 9.75X5MM","code_information":[{"code":"Sx00-1530-000","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356306","type":"LOCAL"},{"code":"1082721","type":"LOCAL"}],"standard_charges":[{"gross_charge":914.09,"discounted_cash":685.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356306 = Hospital System Supply Identifier | 1082721 = Lawson ID"}]},{"description":"ENDCAP INTRAMEDULLARY NAIL CANNULATED PNP TIBIA 0015300015 9.75X15MM","code_information":[{"code":"Sx00-1530-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356442","type":"LOCAL"},{"code":"1082627","type":"LOCAL"}],"standard_charges":[{"gross_charge":914.09,"discounted_cash":685.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356442 = Hospital System Supply Identifier | 1082627 = Lawson ID"}]},{"description":"ENDCAP INTRAMEDULLARY NAIL CANNULATED PNP TIBIA 0015300010 9.75X10MM","code_information":[{"code":"Sx00-1530-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357208","type":"LOCAL"},{"code":"1082808","type":"LOCAL"}],"standard_charges":[{"gross_charge":914.09,"discounted_cash":685.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357208 = Hospital System Supply Identifier | 1082808 = Lawson ID"}]},{"description":"ENDCAP INTRAMEDULLARY NAIL CANNULATED PNP TIBIA 0015301005 10.5X5MM","code_information":[{"code":"Sx00-1530-100","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356893","type":"LOCAL"},{"code":"1082816","type":"LOCAL"}],"standard_charges":[{"gross_charge":914.09,"discounted_cash":685.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356893 = Hospital System Supply Identifier | 1082816 = Lawson ID"}]},{"description":"ENDCAP INTRAMEDULLARY NAIL CANNULATED PNP TIBIA 0015301010 10.5X10MM","code_information":[{"code":"Sx00-1530-101","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356652","type":"LOCAL"},{"code":"1082701","type":"LOCAL"}],"standard_charges":[{"gross_charge":914.09,"discounted_cash":685.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356652 = Hospital System Supply Identifier | 1082701 = Lawson ID"}]},{"description":"ENDCAP INTRAMEDULLARY NAIL CANNULATED PNP TIBIA 0015301015 10.5X15MM","code_information":[{"code":"Sx00-1530-101","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356529","type":"LOCAL"},{"code":"1082710","type":"LOCAL"}],"standard_charges":[{"gross_charge":914.09,"discounted_cash":685.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356529 = Hospital System Supply Identifier | 1082710 = Lawson ID"}]},{"description":"ENDCAP INTRAMEDULLARY NAIL CANNULATED PNP TIBIA 0015301105 11X5MM","code_information":[{"code":"Sx00-1530-110","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356782","type":"LOCAL"},{"code":"1082822","type":"LOCAL"}],"standard_charges":[{"gross_charge":914.09,"discounted_cash":685.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356782 = Hospital System Supply Identifier | 1082822 = Lawson ID"}]},{"description":"ENDCAP INTRAMEDULLARY NAIL CANNULATED PNP TIBIA 0015301110 11X10MM","code_information":[{"code":"Sx00-1530-111","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356956","type":"LOCAL"},{"code":"1082843","type":"LOCAL"}],"standard_charges":[{"gross_charge":914.09,"discounted_cash":685.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356956 = Hospital System Supply Identifier | 1082843 = Lawson ID"}]},{"description":"ENDCAP INTRAMEDULLARY NAIL CANNULATED PNP TIBIA 0015301115 11X15MM","code_information":[{"code":"Sx00-1530-111","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356653","type":"LOCAL"},{"code":"1082706","type":"LOCAL"}],"standard_charges":[{"gross_charge":914.09,"discounted_cash":685.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356653 = Hospital System Supply Identifier | 1082706 = Lawson ID"}]},{"description":"ENDCAP INTRAMEDULLARY NAIL CANNULATED PNP TIBIA 0015301205 12X5MM","code_information":[{"code":"Sx00-1530-120","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357114","type":"LOCAL"},{"code":"1082631","type":"LOCAL"}],"standard_charges":[{"gross_charge":914.09,"discounted_cash":685.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357114 = Hospital System Supply Identifier | 1082631 = Lawson ID"}]},{"description":"ENDCAP INTRAMEDULLARY NAIL CANNULATED PNP TIBIA 0015301210 12X10MM","code_information":[{"code":"Sx00-1530-121","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356553","type":"LOCAL"},{"code":"1082693","type":"LOCAL"}],"standard_charges":[{"gross_charge":914.09,"discounted_cash":685.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1356553 = Hospital System Supply Identifier | 1082693 = Lawson ID"}]},{"description":"ENDCAP INTRAMEDULLARY NAIL CANNULATED PNP TIBIA 0015301215 12X15MM","code_information":[{"code":"Sx00-1530-121","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357004","type":"LOCAL"},{"code":"1082844","type":"LOCAL"}],"standard_charges":[{"gross_charge":914.09,"discounted_cash":685.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1357004 = Hospital System Supply Identifier | 1082844 = Lawson ID"}]},{"description":"DISC - COLLAR CERV PHILA 2P MED 4.25","code_information":[{"code":"Sx00-1741-011","type":"CDM"},{"code":"274","type":"RC"},{"code":"L0120","type":"HCPCS"},{"code":"836004","type":"LOCAL"},{"code":"106761","type":"LOCAL"}],"standard_charges":[{"gross_charge":73.36,"discounted_cash":55.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 836004 = Hospital System Supply Identifier | 106761 = Lawson ID"}]},{"description":"REAMER FLEX IM 12.5MM DIA","code_information":[{"code":"Sx00-2228-012","type":"CDM"},{"code":"272","type":"RC"},{"code":"411217","type":"LOCAL"},{"code":"459165","type":"LOCAL"}],"standard_charges":[{"gross_charge":1297.2,"discounted_cash":972.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 411217 = Hospital System Supply Identifier | 459165 = Lawson ID"}]},{"description":"REAMER FLEX IM 13MM DIA","code_information":[{"code":"Sx00-2228-013","type":"CDM"},{"code":"272","type":"RC"},{"code":"411218","type":"LOCAL"},{"code":"459166","type":"LOCAL"}],"standard_charges":[{"gross_charge":1297.2,"discounted_cash":972.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 411218 = Hospital System Supply Identifier | 459166 = Lawson ID"}]},{"description":"REAMER FLEX IM 13.5MM DIA","code_information":[{"code":"Sx00-2228-013","type":"CDM"},{"code":"272","type":"RC"},{"code":"411219","type":"LOCAL"},{"code":"459167","type":"LOCAL"}],"standard_charges":[{"gross_charge":1297.2,"discounted_cash":972.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 411219 = Hospital System Supply Identifier | 459167 = Lawson ID"}]},{"description":"REAMER FLEX IM 14MM DIA","code_information":[{"code":"Sx00-2228-014","type":"CDM"},{"code":"272","type":"RC"},{"code":"411220","type":"LOCAL"},{"code":"459168","type":"LOCAL"}],"standard_charges":[{"gross_charge":1297.2,"discounted_cash":972.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 411220 = Hospital System Supply Identifier | 459168 = Lawson ID"}]},{"description":"REAMER SURGICAL 24MM FLEXIBLE","code_information":[{"code":"Sx00-2228-024","type":"CDM"},{"code":"272","type":"RC"},{"code":"35478","type":"LOCAL"},{"code":"158616","type":"LOCAL"}],"standard_charges":[{"gross_charge":278.35,"discounted_cash":208.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 35478 = Hospital System Supply Identifier | 158616 = Lawson ID"}]},{"description":"INST CABLE-READY SET","code_information":[{"code":"Sx00-2232-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"202248","type":"LOCAL"},{"code":"452346","type":"LOCAL"}],"standard_charges":[{"gross_charge":17071.6,"discounted_cash":12803.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 202248 = Hospital System Supply Identifier | 452346 = Lawson ID"}]},{"description":"BUTTON HEX 2.5MM 2232-01-25","code_information":[{"code":"Sx00-2232-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408802","type":"LOCAL"},{"code":"339930","type":"LOCAL"}],"standard_charges":[{"gross_charge":207.79,"discounted_cash":155.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408802 = Hospital System Supply Identifier | 339930 = Lawson ID"}]},{"description":"BUTTON HEX SS 5.0MM","code_information":[{"code":"Sx00-2232-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410423","type":"LOCAL"},{"code":"416866","type":"LOCAL"}],"standard_charges":[{"gross_charge":175.8,"discounted_cash":131.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410423 = Hospital System Supply Identifier | 416866 = Lawson ID"}]},{"description":"BUTTON HEX SNGL 5.0MM","code_information":[{"code":"Sx00-2232-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"411310","type":"LOCAL"},{"code":"462060","type":"LOCAL"}],"standard_charges":[{"gross_charge":175.8,"discounted_cash":131.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 411310 = Hospital System Supply Identifier | 462060 = Lawson ID"}]},{"description":"BUTTON BONE GRIP CABLE READY 00223200225 TITANIUM 2.5MM","code_information":[{"code":"Sx00-2232-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1161459","type":"LOCAL"},{"code":"1002959","type":"LOCAL"}],"standard_charges":[{"gross_charge":207.79,"discounted_cash":155.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1161459 = Hospital System Supply Identifier | 1002959 = Lawson ID"}]},{"description":"CBL DEV GTR LNG W/O CBL","code_information":[{"code":"Sx00-2232-002","type":"CDM"},{"code":"272","type":"RC"},{"code":"17233","type":"LOCAL"},{"code":"144555","type":"LOCAL"}],"standard_charges":[{"gross_charge":4153.8,"discounted_cash":3115.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 17233 = Hospital System Supply Identifier | 144555 = Lawson ID"}]},{"description":"IMP CABLE SS 1.3 X 560MM","code_information":[{"code":"Sx00-2232-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408073","type":"LOCAL"},{"code":"245979","type":"LOCAL"}],"standard_charges":[{"gross_charge":820.7,"discounted_cash":615.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408073 = Hospital System Supply Identifier | 245979 = Lawson ID"}]},{"description":"PIN CABLE READY 2232-50-20","code_information":[{"code":"Sx00-2232-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"168183","type":"LOCAL"},{"code":"206449","type":"LOCAL"}],"standard_charges":[{"gross_charge":802.81,"discounted_cash":602.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 168183 = Hospital System Supply Identifier | 206449 = Lawson ID"}]},{"description":"PIN CABLE READY 2232-50-19","code_information":[{"code":"Sx00-2232-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407864","type":"LOCAL"},{"code":"206450","type":"LOCAL"}],"standard_charges":[{"gross_charge":802.81,"discounted_cash":602.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407864 = Hospital System Supply Identifier | 206450 = Lawson ID"}]},{"description":"PIN CABLE READY 2232-50-18","code_information":[{"code":"Sx00-2232-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407865","type":"LOCAL"},{"code":"206453","type":"LOCAL"}],"standard_charges":[{"gross_charge":802.81,"discounted_cash":602.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407865 = Hospital System Supply Identifier | 206453 = Lawson ID"}]},{"description":"PIN CABLE READY 2232-50-21","code_information":[{"code":"Sx00-2232-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407866","type":"LOCAL"},{"code":"206454","type":"LOCAL"}],"standard_charges":[{"gross_charge":802.81,"discounted_cash":602.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407866 = Hospital System Supply Identifier | 206454 = Lawson ID"}]},{"description":"NAIL FEM SS RG 9X380MM","code_information":[{"code":"Sx00-2240-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407750","type":"LOCAL"},{"code":"205434","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407750 = Hospital System Supply Identifier | 205434 = Lawson ID"}]},{"description":"NAIL FEM SS RG 9X360MM","code_information":[{"code":"Sx00-2240-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407749","type":"LOCAL"},{"code":"205433","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407749 = Hospital System Supply Identifier | 205433 = Lawson ID"}]},{"description":"NAIL FEM SS RG 9X400MM","code_information":[{"code":"Sx00-2240-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407751","type":"LOCAL"},{"code":"205435","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407751 = Hospital System Supply Identifier | 205435 = Lawson ID"}]},{"description":"NAIL FEM SS RG 9X480MM","code_information":[{"code":"Sx00-2240-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407755","type":"LOCAL"},{"code":"205439","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407755 = Hospital System Supply Identifier | 205439 = Lawson ID"}]},{"description":"NAIL FEM SS RG 9X440MM","code_information":[{"code":"Sx00-2240-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407753","type":"LOCAL"},{"code":"205437","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407753 = Hospital System Supply Identifier | 205437 = Lawson ID"}]},{"description":"NAIL FEM SS RG 9X460MM","code_information":[{"code":"Sx00-2240-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407754","type":"LOCAL"},{"code":"205438","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407754 = Hospital System Supply Identifier | 205438 = Lawson ID"}]},{"description":"NAIL FEM SS RG 9X340MM","code_information":[{"code":"Sx00-2240-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407748","type":"LOCAL"},{"code":"205431","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407748 = Hospital System Supply Identifier | 205431 = Lawson ID"}]},{"description":"NAIL FEM SS RG 9X420MM","code_information":[{"code":"Sx00-2240-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407752","type":"LOCAL"},{"code":"205436","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407752 = Hospital System Supply Identifier | 205436 = Lawson ID"}]},{"description":"NAIL FEM SS RG 9X320MM","code_information":[{"code":"Sx00-2240-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407747","type":"LOCAL"},{"code":"205430","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407747 = Hospital System Supply Identifier | 205430 = Lawson ID"}]},{"description":"NAIL FEM SS RG 9X180MM","code_information":[{"code":"Sx00-2240-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407703","type":"LOCAL"},{"code":"205386","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407703 = Hospital System Supply Identifier | 205386 = Lawson ID"}]},{"description":"NAIL FEM SS RG 9X280MM","code_information":[{"code":"Sx00-2240-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407745","type":"LOCAL"},{"code":"205428","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407745 = Hospital System Supply Identifier | 205428 = Lawson ID"}]},{"description":"NAIL FEM SS RG 9X260MM","code_information":[{"code":"Sx00-2240-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407744","type":"LOCAL"},{"code":"205427","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407744 = Hospital System Supply Identifier | 205427 = Lawson ID"}]},{"description":"NAIL FEM SS RG 9X240MM","code_information":[{"code":"Sx00-2240-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407743","type":"LOCAL"},{"code":"205426","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407743 = Hospital System Supply Identifier | 205426 = Lawson ID"}]},{"description":"NAIL FEM SS RG 9X220MM","code_information":[{"code":"Sx00-2240-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407708","type":"LOCAL"},{"code":"205391","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407708 = Hospital System Supply Identifier | 205391 = Lawson ID"}]},{"description":"NAIL FEM SS RG 9X200MM","code_information":[{"code":"Sx00-2240-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407706","type":"LOCAL"},{"code":"205389","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407706 = Hospital System Supply Identifier | 205389 = Lawson ID"}]},{"description":"NAIL FEM SS RG 9X160MM","code_information":[{"code":"Sx00-2240-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407699","type":"LOCAL"},{"code":"205382","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407699 = Hospital System Supply Identifier | 205382 = Lawson ID"}]},{"description":"NAIL FEM SS RG 9X300MM","code_information":[{"code":"Sx00-2240-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407746","type":"LOCAL"},{"code":"205429","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407746 = Hospital System Supply Identifier | 205429 = Lawson ID"}]},{"description":"NAIL FEM SS RG 9X140MM","code_information":[{"code":"Sx00-2240-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407696","type":"LOCAL"},{"code":"205379","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407696 = Hospital System Supply Identifier | 205379 = Lawson ID"}]},{"description":"NAIL FEM SS RG 10X240MM","code_information":[{"code":"Sx00-2240-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407761","type":"LOCAL"},{"code":"205445","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407761 = Hospital System Supply Identifier | 205445 = Lawson ID"}]},{"description":"NAIL FEM SS RG 10X260MM","code_information":[{"code":"Sx00-2240-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407762","type":"LOCAL"},{"code":"205446","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407762 = Hospital System Supply Identifier | 205446 = Lawson ID"}]},{"description":"NAIL FEM SS RG 10X280MM","code_information":[{"code":"Sx00-2240-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407763","type":"LOCAL"},{"code":"205447","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407763 = Hospital System Supply Identifier | 205447 = Lawson ID"}]},{"description":"NAIL FEM SS RG 10X340MM","code_information":[{"code":"Sx00-2240-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407766","type":"LOCAL"},{"code":"205450","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407766 = Hospital System Supply Identifier | 205450 = Lawson ID"}]},{"description":"NAIL FEM SS RG 10X320MM","code_information":[{"code":"Sx00-2240-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407765","type":"LOCAL"},{"code":"205449","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407765 = Hospital System Supply Identifier | 205449 = Lawson ID"}]},{"description":"NAIL FEM SS RG 10X360MM","code_information":[{"code":"Sx00-2240-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407767","type":"LOCAL"},{"code":"205451","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407767 = Hospital System Supply Identifier | 205451 = Lawson ID"}]},{"description":"NAIL FEM SS RG 10X220MM","code_information":[{"code":"Sx00-2240-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407760","type":"LOCAL"},{"code":"205444","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407760 = Hospital System Supply Identifier | 205444 = Lawson ID"}]},{"description":"NAIL FEM SS RG 10X300MM","code_information":[{"code":"Sx00-2240-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407764","type":"LOCAL"},{"code":"205448","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407764 = Hospital System Supply Identifier | 205448 = Lawson ID"}]},{"description":"NAIL FEM SS RG 10X200MM","code_information":[{"code":"Sx00-2240-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407759","type":"LOCAL"},{"code":"205443","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407759 = Hospital System Supply Identifier | 205443 = Lawson ID"}]},{"description":"NAIL FEM SS RG 10X420MM","code_information":[{"code":"Sx00-2240-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407570","type":"LOCAL"},{"code":"205251","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407570 = Hospital System Supply Identifier | 205251 = Lawson ID"}]},{"description":"NAIL FEM SS RG 10X160MM","code_information":[{"code":"Sx00-2240-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407757","type":"LOCAL"},{"code":"205441","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407757 = Hospital System Supply Identifier | 205441 = Lawson ID"}]},{"description":"NAIL FEM SS RG 10X140MM","code_information":[{"code":"Sx00-2240-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407756","type":"LOCAL"},{"code":"205440","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407756 = Hospital System Supply Identifier | 205440 = Lawson ID"}]},{"description":"NAIL FEM SS RG 10X480MM","code_information":[{"code":"Sx00-2240-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407574","type":"LOCAL"},{"code":"205255","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407574 = Hospital System Supply Identifier | 205255 = Lawson ID"}]},{"description":"NAIL FEM SS RG 10X460MM","code_information":[{"code":"Sx00-2240-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407572","type":"LOCAL"},{"code":"205253","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407572 = Hospital System Supply Identifier | 205253 = Lawson ID"}]},{"description":"NAIL FEM SS RG 10X440MM","code_information":[{"code":"Sx00-2240-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407571","type":"LOCAL"},{"code":"205252","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407571 = Hospital System Supply Identifier | 205252 = Lawson ID"}]},{"description":"NAIL FEM SS RG 10X400MM","code_information":[{"code":"Sx00-2240-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407568","type":"LOCAL"},{"code":"205249","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407568 = Hospital System Supply Identifier | 205249 = Lawson ID"}]},{"description":"NAIL FEM SS RG 10X380MM","code_information":[{"code":"Sx00-2240-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407566","type":"LOCAL"},{"code":"205247","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407566 = Hospital System Supply Identifier | 205247 = Lawson ID"}]},{"description":"NAIL FEM SS RG 10X180MM","code_information":[{"code":"Sx00-2240-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407758","type":"LOCAL"},{"code":"205442","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407758 = Hospital System Supply Identifier | 205442 = Lawson ID"}]},{"description":"NAIL FEM SS RG 11X420MM","code_information":[{"code":"Sx00-2240-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407607","type":"LOCAL"},{"code":"205289","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407607 = Hospital System Supply Identifier | 205289 = Lawson ID"}]},{"description":"NAIL FEM SS RG 11X360MM","code_information":[{"code":"Sx00-2240-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407608","type":"LOCAL"},{"code":"205290","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407608 = Hospital System Supply Identifier | 205290 = Lawson ID"}]},{"description":"NAIL FEM SS RG 11X380MM","code_information":[{"code":"Sx00-2240-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407610","type":"LOCAL"},{"code":"205292","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407610 = Hospital System Supply Identifier | 205292 = Lawson ID"}]},{"description":"NAIL FEM SS RG 11X460MM","code_information":[{"code":"Sx00-2240-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407616","type":"LOCAL"},{"code":"205298","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407616 = Hospital System Supply Identifier | 205298 = Lawson ID"}]},{"description":"NAIL FEM SS RG 11X440MM","code_information":[{"code":"Sx00-2240-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407615","type":"LOCAL"},{"code":"205297","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407615 = Hospital System Supply Identifier | 205297 = Lawson ID"}]},{"description":"NAIL FEM SS RG 11X340MM","code_information":[{"code":"Sx00-2240-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407606","type":"LOCAL"},{"code":"205288","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407606 = Hospital System Supply Identifier | 205288 = Lawson ID"}]},{"description":"NAIL FEM SS RG 11X480MM","code_information":[{"code":"Sx00-2240-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407617","type":"LOCAL"},{"code":"205299","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407617 = Hospital System Supply Identifier | 205299 = Lawson ID"}]},{"description":"NAIL FEM SS RG 11X400MM","code_information":[{"code":"Sx00-2240-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407613","type":"LOCAL"},{"code":"205295","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407613 = Hospital System Supply Identifier | 205295 = Lawson ID"}]},{"description":"NAIL FEM SS RG 11X320MM","code_information":[{"code":"Sx00-2240-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407605","type":"LOCAL"},{"code":"205286","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407605 = Hospital System Supply Identifier | 205286 = Lawson ID"}]},{"description":"NAIL FEM SS RG 11X260MM","code_information":[{"code":"Sx00-2240-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407599","type":"LOCAL"},{"code":"205280","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407599 = Hospital System Supply Identifier | 205280 = Lawson ID"}]},{"description":"NAIL FEM SS RG 11X280MM","code_information":[{"code":"Sx00-2240-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407600","type":"LOCAL"},{"code":"205281","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407600 = Hospital System Supply Identifier | 205281 = Lawson ID"}]},{"description":"NAIL FEM SS RG 11X240MM","code_information":[{"code":"Sx00-2240-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407598","type":"LOCAL"},{"code":"205279","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407598 = Hospital System Supply Identifier | 205279 = Lawson ID"}]},{"description":"NAIL FEM SS RG 11X220MM","code_information":[{"code":"Sx00-2240-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407596","type":"LOCAL"},{"code":"205277","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407596 = Hospital System Supply Identifier | 205277 = Lawson ID"}]},{"description":"NAIL FEM SS RG 11X200MM","code_information":[{"code":"Sx00-2240-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407589","type":"LOCAL"},{"code":"205270","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407589 = Hospital System Supply Identifier | 205270 = Lawson ID"}]},{"description":"NAIL FEM SS RG 11X180MM","code_information":[{"code":"Sx00-2240-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407588","type":"LOCAL"},{"code":"205269","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407588 = Hospital System Supply Identifier | 205269 = Lawson ID"}]},{"description":"NAIL FEM SS RG 11X160MM","code_information":[{"code":"Sx00-2240-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407579","type":"LOCAL"},{"code":"205260","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407579 = Hospital System Supply Identifier | 205260 = Lawson ID"}]},{"description":"NAIL FEM SS RG 11X140MM","code_information":[{"code":"Sx00-2240-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407577","type":"LOCAL"},{"code":"205258","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407577 = Hospital System Supply Identifier | 205258 = Lawson ID"}]},{"description":"NAIL FEM SS RG 11X300MM","code_information":[{"code":"Sx00-2240-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407601","type":"LOCAL"},{"code":"205282","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407601 = Hospital System Supply Identifier | 205282 = Lawson ID"}]},{"description":"NAIL FEM SS RG 12X400MM","code_information":[{"code":"Sx00-2240-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407657","type":"LOCAL"},{"code":"205340","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407657 = Hospital System Supply Identifier | 205340 = Lawson ID"}]},{"description":"NAIL FEM SS RG 12X380MM","code_information":[{"code":"Sx00-2240-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407653","type":"LOCAL"},{"code":"205336","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407653 = Hospital System Supply Identifier | 205336 = Lawson ID"}]},{"description":"NAIL FEM SS RG 12X420MM","code_information":[{"code":"Sx00-2240-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407661","type":"LOCAL"},{"code":"205344","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407661 = Hospital System Supply Identifier | 205344 = Lawson ID"}]},{"description":"NAIL FEM SS RG 12X340MM","code_information":[{"code":"Sx00-2240-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407642","type":"LOCAL"},{"code":"205325","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407642 = Hospital System Supply Identifier | 205325 = Lawson ID"}]},{"description":"NAIL FEM SS RG 12X460MM","code_information":[{"code":"Sx00-2240-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407664","type":"LOCAL"},{"code":"205347","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407664 = Hospital System Supply Identifier | 205347 = Lawson ID"}]},{"description":"NAIL FEM SS RG 12X480MM","code_information":[{"code":"Sx00-2240-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407665","type":"LOCAL"},{"code":"205348","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407665 = Hospital System Supply Identifier | 205348 = Lawson ID"}]},{"description":"NAIL FEM SS RG 12X440MM","code_information":[{"code":"Sx00-2240-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407663","type":"LOCAL"},{"code":"205346","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407663 = Hospital System Supply Identifier | 205346 = Lawson ID"}]},{"description":"NAIL FEM SS RG 12X320MM","code_information":[{"code":"Sx00-2240-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407638","type":"LOCAL"},{"code":"205321","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407638 = Hospital System Supply Identifier | 205321 = Lawson ID"}]},{"description":"NAIL FEM SS RG 12X360MM","code_information":[{"code":"Sx00-2240-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407649","type":"LOCAL"},{"code":"205332","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407649 = Hospital System Supply Identifier | 205332 = Lawson ID"}]},{"description":"NAIL FEM SS RG 12X280MM","code_information":[{"code":"Sx00-2240-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407631","type":"LOCAL"},{"code":"205314","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407631 = Hospital System Supply Identifier | 205314 = Lawson ID"}]},{"description":"NAIL FEM SS RG 12X160MM","code_information":[{"code":"Sx00-2240-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407622","type":"LOCAL"},{"code":"205304","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407622 = Hospital System Supply Identifier | 205304 = Lawson ID"}]},{"description":"NAIL FEM SS RG 12X180MM","code_information":[{"code":"Sx00-2240-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407623","type":"LOCAL"},{"code":"205305","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407623 = Hospital System Supply Identifier | 205305 = Lawson ID"}]},{"description":"NAIL FEM SS RG 12X200MM","code_information":[{"code":"Sx00-2240-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407625","type":"LOCAL"},{"code":"205307","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407625 = Hospital System Supply Identifier | 205307 = Lawson ID"}]},{"description":"NAIL FEM SS RG 12X140MM","code_information":[{"code":"Sx00-2240-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407620","type":"LOCAL"},{"code":"205302","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407620 = Hospital System Supply Identifier | 205302 = Lawson ID"}]},{"description":"NAIL FEM SS RG 12X240MM","code_information":[{"code":"Sx00-2240-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407629","type":"LOCAL"},{"code":"205312","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407629 = Hospital System Supply Identifier | 205312 = Lawson ID"}]},{"description":"NAIL FEM SS RG 12X300MM","code_information":[{"code":"Sx00-2240-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407636","type":"LOCAL"},{"code":"205319","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407636 = Hospital System Supply Identifier | 205319 = Lawson ID"}]},{"description":"NAIL FEM SS RG 12X260MM","code_information":[{"code":"Sx00-2240-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407630","type":"LOCAL"},{"code":"205313","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407630 = Hospital System Supply Identifier | 205313 = Lawson ID"}]},{"description":"NAIL FEM SS RG 12X220MM","code_information":[{"code":"Sx00-2240-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407628","type":"LOCAL"},{"code":"205311","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407628 = Hospital System Supply Identifier | 205311 = Lawson ID"}]},{"description":"NAIL FEM SS RG 13X340MM","code_information":[{"code":"Sx00-2240-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407692","type":"LOCAL"},{"code":"205375","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407692 = Hospital System Supply Identifier | 205375 = Lawson ID"}]},{"description":"NAIL FEM SS RG 13X480MM","code_information":[{"code":"Sx00-2240-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407772","type":"LOCAL"},{"code":"205456","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407772 = Hospital System Supply Identifier | 205456 = Lawson ID"}]},{"description":"NAIL FEM SS RG 13X460MM","code_information":[{"code":"Sx00-2240-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407771","type":"LOCAL"},{"code":"205455","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407771 = Hospital System Supply Identifier | 205455 = Lawson ID"}]},{"description":"NAIL FEM SS RG 13X440MM","code_information":[{"code":"Sx00-2240-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407770","type":"LOCAL"},{"code":"205454","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407770 = Hospital System Supply Identifier | 205454 = Lawson ID"}]},{"description":"NAIL FEM SS RG 13X420MM","code_information":[{"code":"Sx00-2240-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407769","type":"LOCAL"},{"code":"205453","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407769 = Hospital System Supply Identifier | 205453 = Lawson ID"}]},{"description":"NAIL FEM SS RG 13X400MM","code_information":[{"code":"Sx00-2240-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407768","type":"LOCAL"},{"code":"205452","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407768 = Hospital System Supply Identifier | 205452 = Lawson ID"}]},{"description":"NAIL FEM SS RG 13X380MM","code_information":[{"code":"Sx00-2240-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407695","type":"LOCAL"},{"code":"205378","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407695 = Hospital System Supply Identifier | 205378 = Lawson ID"}]},{"description":"NAIL FEM SS RG 13X360MM","code_information":[{"code":"Sx00-2240-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407693","type":"LOCAL"},{"code":"205376","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407693 = Hospital System Supply Identifier | 205376 = Lawson ID"}]},{"description":"NAIL FEM SS RG 13X320MM","code_information":[{"code":"Sx00-2240-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407688","type":"LOCAL"},{"code":"205371","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407688 = Hospital System Supply Identifier | 205371 = Lawson ID"}]},{"description":"NAIL FEM SS RG 13X300MM","code_information":[{"code":"Sx00-2240-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407687","type":"LOCAL"},{"code":"205370","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407687 = Hospital System Supply Identifier | 205370 = Lawson ID"}]},{"description":"NAIL FEM SS RG 13X280MM","code_information":[{"code":"Sx00-2240-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407686","type":"LOCAL"},{"code":"205369","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407686 = Hospital System Supply Identifier | 205369 = Lawson ID"}]},{"description":"NAIL FEM SS RG 13X260MM","code_information":[{"code":"Sx00-2240-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407685","type":"LOCAL"},{"code":"205368","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407685 = Hospital System Supply Identifier | 205368 = Lawson ID"}]},{"description":"NAIL FEM SS RG 13X240MM","code_information":[{"code":"Sx00-2240-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407678","type":"LOCAL"},{"code":"205361","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407678 = Hospital System Supply Identifier | 205361 = Lawson ID"}]},{"description":"NAIL FEM SS RG 13X220MM","code_information":[{"code":"Sx00-2240-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407677","type":"LOCAL"},{"code":"205360","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407677 = Hospital System Supply Identifier | 205360 = Lawson ID"}]},{"description":"NAIL FEM SS RG 13X200MM","code_information":[{"code":"Sx00-2240-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407672","type":"LOCAL"},{"code":"205355","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407672 = Hospital System Supply Identifier | 205355 = Lawson ID"}]},{"description":"NAIL FEM SS RG 13X180MM","code_information":[{"code":"Sx00-2240-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407668","type":"LOCAL"},{"code":"205351","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407668 = Hospital System Supply Identifier | 205351 = Lawson ID"}]},{"description":"NAIL FEM SS RG 13X160MM","code_information":[{"code":"Sx00-2240-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407667","type":"LOCAL"},{"code":"205350","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407667 = Hospital System Supply Identifier | 205350 = Lawson ID"}]},{"description":"NAIL FEM SS RG 13X140MM","code_information":[{"code":"Sx00-2240-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407666","type":"LOCAL"},{"code":"205349","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407666 = Hospital System Supply Identifier | 205349 = Lawson ID"}]},{"description":"NAIL FEM SS RG 14X460MM","code_information":[{"code":"Sx00-2240-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407789","type":"LOCAL"},{"code":"205473","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407789 = Hospital System Supply Identifier | 205473 = Lawson ID"}]},{"description":"NAIL FEM SS RG 14X440MM","code_information":[{"code":"Sx00-2240-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407788","type":"LOCAL"},{"code":"205472","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407788 = Hospital System Supply Identifier | 205472 = Lawson ID"}]},{"description":"NAIL FEM SS RG 14X480MM","code_information":[{"code":"Sx00-2240-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407790","type":"LOCAL"},{"code":"205474","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407790 = Hospital System Supply Identifier | 205474 = Lawson ID"}]},{"description":"NAIL FEM SS RG 14X400MM","code_information":[{"code":"Sx00-2240-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407786","type":"LOCAL"},{"code":"205470","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407786 = Hospital System Supply Identifier | 205470 = Lawson ID"}]},{"description":"NAIL FEM SS RG 14X380MM","code_information":[{"code":"Sx00-2240-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407785","type":"LOCAL"},{"code":"205469","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407785 = Hospital System Supply Identifier | 205469 = Lawson ID"}]},{"description":"NAIL FEM SS RG 14X360MM","code_information":[{"code":"Sx00-2240-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407784","type":"LOCAL"},{"code":"205468","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407784 = Hospital System Supply Identifier | 205468 = Lawson ID"}]},{"description":"NAIL FEM SS RG 14X340MM","code_information":[{"code":"Sx00-2240-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407783","type":"LOCAL"},{"code":"205467","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407783 = Hospital System Supply Identifier | 205467 = Lawson ID"}]},{"description":"NAIL FEM SS RG 14X320MM","code_information":[{"code":"Sx00-2240-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407782","type":"LOCAL"},{"code":"205466","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407782 = Hospital System Supply Identifier | 205466 = Lawson ID"}]},{"description":"NAIL FEM SS RG 14X420MM","code_information":[{"code":"Sx00-2240-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407787","type":"LOCAL"},{"code":"205471","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407787 = Hospital System Supply Identifier | 205471 = Lawson ID"}]},{"description":"NAIL FEM SS RG 14X280MM","code_information":[{"code":"Sx00-2240-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407780","type":"LOCAL"},{"code":"205464","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407780 = Hospital System Supply Identifier | 205464 = Lawson ID"}]},{"description":"NAIL FEM SS RG 14X260MM","code_information":[{"code":"Sx00-2240-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407779","type":"LOCAL"},{"code":"205463","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407779 = Hospital System Supply Identifier | 205463 = Lawson ID"}]},{"description":"NAIL FEM SS RG 14X240MM","code_information":[{"code":"Sx00-2240-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407778","type":"LOCAL"},{"code":"205462","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407778 = Hospital System Supply Identifier | 205462 = Lawson ID"}]},{"description":"NAIL FEM SS RG 14X220MM","code_information":[{"code":"Sx00-2240-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407777","type":"LOCAL"},{"code":"205461","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407777 = Hospital System Supply Identifier | 205461 = Lawson ID"}]},{"description":"NAIL FEM SS RG 14X200MM","code_information":[{"code":"Sx00-2240-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407776","type":"LOCAL"},{"code":"205460","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407776 = Hospital System Supply Identifier | 205460 = Lawson ID"}]},{"description":"NAIL FEM SS RG 14X180MM","code_information":[{"code":"Sx00-2240-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407775","type":"LOCAL"},{"code":"205459","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407775 = Hospital System Supply Identifier | 205459 = Lawson ID"}]},{"description":"NAIL FEM SS RG 14X160MM","code_information":[{"code":"Sx00-2240-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407774","type":"LOCAL"},{"code":"205458","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407774 = Hospital System Supply Identifier | 205458 = Lawson ID"}]},{"description":"NAIL FEM SS RG 14X140MM","code_information":[{"code":"Sx00-2240-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407773","type":"LOCAL"},{"code":"205457","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407773 = Hospital System Supply Identifier | 205457 = Lawson ID"}]},{"description":"NAIL FEM SS RG 14X300MM","code_information":[{"code":"Sx00-2240-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407781","type":"LOCAL"},{"code":"205465","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407781 = Hospital System Supply Identifier | 205465 = Lawson ID"}]},{"description":"NUT CORTICAL LOCK 2240-50","code_information":[{"code":"Sx00-2240-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407812","type":"LOCAL"},{"code":"205508","type":"LOCAL"}],"standard_charges":[{"gross_charge":432.99,"discounted_cash":324.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407812 = Hospital System Supply Identifier | 205508 = Lawson ID"}]},{"description":"DISC - BIT DRILL PROX TIP 5.0 MM","code_information":[{"code":"Sx00-2241-012","type":"CDM"},{"code":"272","type":"RC"},{"code":"408248","type":"LOCAL"},{"code":"303893","type":"LOCAL"}],"standard_charges":[{"gross_charge":432.7,"discounted_cash":324.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408248 = Hospital System Supply Identifier | 303893 = Lawson ID"}]},{"description":"CAP NAIL EXTENDED 15MM","code_information":[{"code":"Sx00-2252-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407368","type":"LOCAL"},{"code":"146490","type":"LOCAL"}],"standard_charges":[{"gross_charge":384.79,"discounted_cash":288.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407368 = Hospital System Supply Identifier | 146490 = Lawson ID"}]},{"description":"CAP NAIL EXTENDED 10MM","code_information":[{"code":"Sx00-2252-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407367","type":"LOCAL"},{"code":"146489","type":"LOCAL"}],"standard_charges":[{"gross_charge":384.79,"discounted_cash":288.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407367 = Hospital System Supply Identifier | 146489 = Lawson ID"}]},{"description":"CAP NAIL FLUSH","code_information":[{"code":"Sx00-2252-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407366","type":"LOCAL"},{"code":"146487","type":"LOCAL"}],"standard_charges":[{"gross_charge":384.79,"discounted_cash":288.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407366 = Hospital System Supply Identifier | 146487 = Lawson ID"}]},{"description":"CAP NAIL EXTENDED 5MM","code_information":[{"code":"Sx00-2252-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"17380","type":"LOCAL"},{"code":"146488","type":"LOCAL"}],"standard_charges":[{"gross_charge":384.79,"discounted_cash":288.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 17380 = Hospital System Supply Identifier | 146488 = Lawson ID"}]},{"description":"NO USAGE - WASHER ORTHO 13 MM M/DN","code_information":[{"code":"Sx00-2252-002","type":"CDM"},{"code":"270","type":"RC"},{"code":"407810","type":"LOCAL"},{"code":"205506","type":"LOCAL"}],"standard_charges":[{"gross_charge":192.79,"discounted_cash":144.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407810 = Hospital System Supply Identifier | 205506 = Lawson ID"}]},{"description":"CAP NAIL HUM LCK","code_information":[{"code":"Sx00-2252-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407811","type":"LOCAL"},{"code":"205507","type":"LOCAL"}],"standard_charges":[{"gross_charge":384.79,"discounted_cash":288.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407811 = Hospital System Supply Identifier | 205507 = Lawson ID"}]},{"description":"SCREW RECON M/DN 5.5X60MM","code_information":[{"code":"Sx00-2252-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407369","type":"LOCAL"},{"code":"146491","type":"LOCAL"}],"standard_charges":[{"gross_charge":740.18,"discounted_cash":555.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407369 = Hospital System Supply Identifier | 146491 = Lawson ID"}]},{"description":"SCREW RECON M/DN 5.5X65MM","code_information":[{"code":"Sx00-2252-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407370","type":"LOCAL"},{"code":"146492","type":"LOCAL"}],"standard_charges":[{"gross_charge":740.18,"discounted_cash":555.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407370 = Hospital System Supply Identifier | 146492 = Lawson ID"}]},{"description":"SCREW RECON M/DN 5.5X70MM","code_information":[{"code":"Sx00-2252-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407371","type":"LOCAL"},{"code":"146493","type":"LOCAL"}],"standard_charges":[{"gross_charge":740.18,"discounted_cash":555.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407371 = Hospital System Supply Identifier | 146493 = Lawson ID"}]},{"description":"SCREW RECON M/DN 5.5X75MM","code_information":[{"code":"Sx00-2252-075","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407372","type":"LOCAL"},{"code":"146494","type":"LOCAL"}],"standard_charges":[{"gross_charge":740.18,"discounted_cash":555.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407372 = Hospital System Supply Identifier | 146494 = Lawson ID"}]},{"description":"SCREW RECON M/DN 5.5X80MM","code_information":[{"code":"Sx00-2252-080","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407373","type":"LOCAL"},{"code":"146495","type":"LOCAL"}],"standard_charges":[{"gross_charge":740.18,"discounted_cash":555.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407373 = Hospital System Supply Identifier | 146495 = Lawson ID"}]},{"description":"SCREW RECON M/DN 5.5X85MM","code_information":[{"code":"Sx00-2252-085","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407374","type":"LOCAL"},{"code":"146496","type":"LOCAL"}],"standard_charges":[{"gross_charge":740.18,"discounted_cash":555.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407374 = Hospital System Supply Identifier | 146496 = Lawson ID"}]},{"description":"SCREW RECON M/DN 5.5X90MM","code_information":[{"code":"Sx00-2252-090","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"17381","type":"LOCAL"},{"code":"146497","type":"LOCAL"}],"standard_charges":[{"gross_charge":740.18,"discounted_cash":555.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 17381 = Hospital System Supply Identifier | 146497 = Lawson ID"}]},{"description":"SCREW RECON M/DN 5.5X95MM","code_information":[{"code":"Sx00-2252-095","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"17382","type":"LOCAL"},{"code":"146498","type":"LOCAL"}],"standard_charges":[{"gross_charge":740.18,"discounted_cash":555.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 17382 = Hospital System Supply Identifier | 146498 = Lawson ID"}]},{"description":"SCREW RECON M/DN 5.5X100MM","code_information":[{"code":"Sx00-2252-100","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407375","type":"LOCAL"},{"code":"146499","type":"LOCAL"}],"standard_charges":[{"gross_charge":740.18,"discounted_cash":555.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407375 = Hospital System Supply Identifier | 146499 = Lawson ID"}]},{"description":"SCREW RECON M/DN 5.5X105MM","code_information":[{"code":"Sx00-2252-105","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407376","type":"LOCAL"},{"code":"146500","type":"LOCAL"}],"standard_charges":[{"gross_charge":740.18,"discounted_cash":555.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407376 = Hospital System Supply Identifier | 146500 = Lawson ID"}]},{"description":"SCREW RECON M/DN 5.5X110MM","code_information":[{"code":"Sx00-2252-110","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407377","type":"LOCAL"},{"code":"146501","type":"LOCAL"}],"standard_charges":[{"gross_charge":740.18,"discounted_cash":555.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407377 = Hospital System Supply Identifier | 146501 = Lawson ID"}]},{"description":"SCREW RECON M/DN 5.5X115MM","code_information":[{"code":"Sx00-2252-115","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407378","type":"LOCAL"},{"code":"146502","type":"LOCAL"}],"standard_charges":[{"gross_charge":740.18,"discounted_cash":555.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407378 = Hospital System Supply Identifier | 146502 = Lawson ID"}]},{"description":"SCREW RECON M/DN 5.5X120MM","code_information":[{"code":"Sx00-2252-120","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407379","type":"LOCAL"},{"code":"146503","type":"LOCAL"}],"standard_charges":[{"gross_charge":740.18,"discounted_cash":555.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407379 = Hospital System Supply Identifier | 146503 = Lawson ID"}]},{"description":"SCREW RECON M/DN 5.5X125MM","code_information":[{"code":"Sx00-2252-125","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407380","type":"LOCAL"},{"code":"146504","type":"LOCAL"}],"standard_charges":[{"gross_charge":740.18,"discounted_cash":555.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407380 = Hospital System Supply Identifier | 146504 = Lawson ID"}]},{"description":"SCREW RECON M/DN 5.5X130MM","code_information":[{"code":"Sx00-2252-130","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407381","type":"LOCAL"},{"code":"146505","type":"LOCAL"}],"standard_charges":[{"gross_charge":740.18,"discounted_cash":555.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407381 = Hospital System Supply Identifier | 146505 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 13X240MM","code_information":[{"code":"Sx00-2252-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407604","type":"LOCAL"},{"code":"205285","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407604 = Hospital System Supply Identifier | 205285 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 12X240MM","code_information":[{"code":"Sx00-2252-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407592","type":"LOCAL"},{"code":"205273","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407592 = Hospital System Supply Identifier | 205273 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 11X240MM","code_information":[{"code":"Sx00-2252-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407583","type":"LOCAL"},{"code":"205264","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407583 = Hospital System Supply Identifier | 205264 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 9X240MM","code_information":[{"code":"Sx00-2252-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407562","type":"LOCAL"},{"code":"205243","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407562 = Hospital System Supply Identifier | 205243 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 8X240MM","code_information":[{"code":"Sx00-2252-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407551","type":"LOCAL"},{"code":"205232","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407551 = Hospital System Supply Identifier | 205232 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 10X240MM","code_information":[{"code":"Sx00-2252-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407573","type":"LOCAL"},{"code":"205254","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407573 = Hospital System Supply Identifier | 205254 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 8X260MM","code_information":[{"code":"Sx00-2252-260","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407552","type":"LOCAL"},{"code":"205233","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407552 = Hospital System Supply Identifier | 205233 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 9X260MM","code_information":[{"code":"Sx00-2252-260","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407563","type":"LOCAL"},{"code":"205244","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407563 = Hospital System Supply Identifier | 205244 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 10X260MM","code_information":[{"code":"Sx00-2252-260","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407575","type":"LOCAL"},{"code":"205256","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407575 = Hospital System Supply Identifier | 205256 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 11X260MM","code_information":[{"code":"Sx00-2252-260","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407584","type":"LOCAL"},{"code":"205265","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407584 = Hospital System Supply Identifier | 205265 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 12X260MM","code_information":[{"code":"Sx00-2252-260","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407593","type":"LOCAL"},{"code":"205274","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407593 = Hospital System Supply Identifier | 205274 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 13X260MM","code_information":[{"code":"Sx00-2252-260","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407609","type":"LOCAL"},{"code":"205291","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407609 = Hospital System Supply Identifier | 205291 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 14X280MM","code_information":[{"code":"Sx00-2252-280","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407621","type":"LOCAL"},{"code":"205303","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407621 = Hospital System Supply Identifier | 205303 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 13X280MM","code_information":[{"code":"Sx00-2252-280","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407611","type":"LOCAL"},{"code":"205293","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407611 = Hospital System Supply Identifier | 205293 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 11X280MM","code_information":[{"code":"Sx00-2252-280","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407585","type":"LOCAL"},{"code":"205266","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407585 = Hospital System Supply Identifier | 205266 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 12X280MM","code_information":[{"code":"Sx00-2252-280","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407594","type":"LOCAL"},{"code":"205275","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407594 = Hospital System Supply Identifier | 205275 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 9X280MM","code_information":[{"code":"Sx00-2252-280","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407564","type":"LOCAL"},{"code":"205245","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407564 = Hospital System Supply Identifier | 205245 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 10X280MM","code_information":[{"code":"Sx00-2252-280","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407576","type":"LOCAL"},{"code":"205257","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407576 = Hospital System Supply Identifier | 205257 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 8X280MM","code_information":[{"code":"Sx00-2252-280","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407553","type":"LOCAL"},{"code":"205234","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407553 = Hospital System Supply Identifier | 205234 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 15X300MM","code_information":[{"code":"Sx00-2252-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407634","type":"LOCAL"},{"code":"205317","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407634 = Hospital System Supply Identifier | 205317 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 14X300MM","code_information":[{"code":"Sx00-2252-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407624","type":"LOCAL"},{"code":"205306","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407624 = Hospital System Supply Identifier | 205306 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 13X300MM","code_information":[{"code":"Sx00-2252-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407612","type":"LOCAL"},{"code":"205294","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407612 = Hospital System Supply Identifier | 205294 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 12X300MM","code_information":[{"code":"Sx00-2252-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407595","type":"LOCAL"},{"code":"205276","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407595 = Hospital System Supply Identifier | 205276 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 16X300MM","code_information":[{"code":"Sx00-2252-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407648","type":"LOCAL"},{"code":"205331","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407648 = Hospital System Supply Identifier | 205331 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 10X300MM","code_information":[{"code":"Sx00-2252-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407578","type":"LOCAL"},{"code":"205259","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407578 = Hospital System Supply Identifier | 205259 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 9X300MM","code_information":[{"code":"Sx00-2252-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407565","type":"LOCAL"},{"code":"205246","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407565 = Hospital System Supply Identifier | 205246 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 8X300MM","code_information":[{"code":"Sx00-2252-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407555","type":"LOCAL"},{"code":"205236","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407555 = Hospital System Supply Identifier | 205236 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 11X300MM","code_information":[{"code":"Sx00-2252-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407586","type":"LOCAL"},{"code":"205267","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407586 = Hospital System Supply Identifier | 205267 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 16X320MM","code_information":[{"code":"Sx00-2252-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407650","type":"LOCAL"},{"code":"205333","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407650 = Hospital System Supply Identifier | 205333 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 9X320MM","code_information":[{"code":"Sx00-2252-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407382","type":"LOCAL"},{"code":"146506","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407382 = Hospital System Supply Identifier | 146506 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 8X320MM","code_information":[{"code":"Sx00-2252-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407554","type":"LOCAL"},{"code":"205235","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407554 = Hospital System Supply Identifier | 205235 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 11X320MM","code_information":[{"code":"Sx00-2252-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407587","type":"LOCAL"},{"code":"205268","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407587 = Hospital System Supply Identifier | 205268 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 12X320MM","code_information":[{"code":"Sx00-2252-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407597","type":"LOCAL"},{"code":"205278","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407597 = Hospital System Supply Identifier | 205278 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 13X320MM","code_information":[{"code":"Sx00-2252-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407614","type":"LOCAL"},{"code":"205296","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407614 = Hospital System Supply Identifier | 205296 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 14X320MM","code_information":[{"code":"Sx00-2252-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407626","type":"LOCAL"},{"code":"205308","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407626 = Hospital System Supply Identifier | 205308 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 15X320MM","code_information":[{"code":"Sx00-2252-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407635","type":"LOCAL"},{"code":"205318","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407635 = Hospital System Supply Identifier | 205318 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 10X320MM","code_information":[{"code":"Sx00-2252-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407388","type":"LOCAL"},{"code":"146512","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407388 = Hospital System Supply Identifier | 146512 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 15X340MM","code_information":[{"code":"Sx00-2252-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407637","type":"LOCAL"},{"code":"205320","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407637 = Hospital System Supply Identifier | 205320 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 10X340MM","code_information":[{"code":"Sx00-2252-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407389","type":"LOCAL"},{"code":"146513","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407389 = Hospital System Supply Identifier | 146513 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 14X340MM","code_information":[{"code":"Sx00-2252-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407627","type":"LOCAL"},{"code":"205309","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407627 = Hospital System Supply Identifier | 205309 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 16X340MM","code_information":[{"code":"Sx00-2252-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407651","type":"LOCAL"},{"code":"205334","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407651 = Hospital System Supply Identifier | 205334 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 8X340MM","code_information":[{"code":"Sx00-2252-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407556","type":"LOCAL"},{"code":"205237","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407556 = Hospital System Supply Identifier | 205237 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 9X340MM","code_information":[{"code":"Sx00-2252-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407383","type":"LOCAL"},{"code":"146507","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407383 = Hospital System Supply Identifier | 146507 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 12X340MM","code_information":[{"code":"Sx00-2252-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407400","type":"LOCAL"},{"code":"146524","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407400 = Hospital System Supply Identifier | 146524 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 11X340MM","code_information":[{"code":"Sx00-2252-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407394","type":"LOCAL"},{"code":"146518","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407394 = Hospital System Supply Identifier | 146518 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 13X340MM","code_information":[{"code":"Sx00-2252-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407405","type":"LOCAL"},{"code":"146530","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407405 = Hospital System Supply Identifier | 146530 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 9X360MM","code_information":[{"code":"Sx00-2252-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407384","type":"LOCAL"},{"code":"146508","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407384 = Hospital System Supply Identifier | 146508 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 10X360MM","code_information":[{"code":"Sx00-2252-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407390","type":"LOCAL"},{"code":"146514","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407390 = Hospital System Supply Identifier | 146514 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 11X360MM","code_information":[{"code":"Sx00-2252-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407395","type":"LOCAL"},{"code":"146519","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407395 = Hospital System Supply Identifier | 146519 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 12X360MM","code_information":[{"code":"Sx00-2252-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407401","type":"LOCAL"},{"code":"146525","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407401 = Hospital System Supply Identifier | 146525 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 13X360MM","code_information":[{"code":"Sx00-2252-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407406","type":"LOCAL"},{"code":"146531","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407406 = Hospital System Supply Identifier | 146531 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 14X360MM","code_information":[{"code":"Sx00-2252-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407412","type":"LOCAL"},{"code":"146537","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407412 = Hospital System Supply Identifier | 146537 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 8X360MM","code_information":[{"code":"Sx00-2252-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407557","type":"LOCAL"},{"code":"205238","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407557 = Hospital System Supply Identifier | 205238 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 15X360MM","code_information":[{"code":"Sx00-2252-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407639","type":"LOCAL"},{"code":"205322","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407639 = Hospital System Supply Identifier | 205322 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 16X360MM","code_information":[{"code":"Sx00-2252-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407652","type":"LOCAL"},{"code":"205335","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407652 = Hospital System Supply Identifier | 205335 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 14X380MM","code_information":[{"code":"Sx00-2252-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407413","type":"LOCAL"},{"code":"146538","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407413 = Hospital System Supply Identifier | 146538 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 15X380MM","code_information":[{"code":"Sx00-2252-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407640","type":"LOCAL"},{"code":"205323","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407640 = Hospital System Supply Identifier | 205323 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 8X380MM","code_information":[{"code":"Sx00-2252-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407558","type":"LOCAL"},{"code":"205239","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407558 = Hospital System Supply Identifier | 205239 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 16X380MM","code_information":[{"code":"Sx00-2252-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407654","type":"LOCAL"},{"code":"205337","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407654 = Hospital System Supply Identifier | 205337 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 12X380MM","code_information":[{"code":"Sx00-2252-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"17383","type":"LOCAL"},{"code":"146526","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 17383 = Hospital System Supply Identifier | 146526 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 11X380MM","code_information":[{"code":"Sx00-2252-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407396","type":"LOCAL"},{"code":"146520","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407396 = Hospital System Supply Identifier | 146520 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 10X380MM","code_information":[{"code":"Sx00-2252-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407391","type":"LOCAL"},{"code":"146515","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407391 = Hospital System Supply Identifier | 146515 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 9X380MM","code_information":[{"code":"Sx00-2252-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407385","type":"LOCAL"},{"code":"146509","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407385 = Hospital System Supply Identifier | 146509 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 13X380MM","code_information":[{"code":"Sx00-2252-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407407","type":"LOCAL"},{"code":"146532","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407407 = Hospital System Supply Identifier | 146532 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 16X400MM","code_information":[{"code":"Sx00-2252-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407655","type":"LOCAL"},{"code":"205338","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407655 = Hospital System Supply Identifier | 205338 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 15X400MM","code_information":[{"code":"Sx00-2252-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407641","type":"LOCAL"},{"code":"205324","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407641 = Hospital System Supply Identifier | 205324 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 8X400MM","code_information":[{"code":"Sx00-2252-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407559","type":"LOCAL"},{"code":"205240","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407559 = Hospital System Supply Identifier | 205240 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 14X400MM","code_information":[{"code":"Sx00-2252-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407414","type":"LOCAL"},{"code":"146539","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407414 = Hospital System Supply Identifier | 146539 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 13X400MM","code_information":[{"code":"Sx00-2252-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407408","type":"LOCAL"},{"code":"146533","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407408 = Hospital System Supply Identifier | 146533 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 12X400MM","code_information":[{"code":"Sx00-2252-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407402","type":"LOCAL"},{"code":"146527","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407402 = Hospital System Supply Identifier | 146527 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 11X400MM","code_information":[{"code":"Sx00-2252-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407397","type":"LOCAL"},{"code":"146521","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407397 = Hospital System Supply Identifier | 146521 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 10X400MM","code_information":[{"code":"Sx00-2252-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407392","type":"LOCAL"},{"code":"146516","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407392 = Hospital System Supply Identifier | 146516 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 9X400MM","code_information":[{"code":"Sx00-2252-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407386","type":"LOCAL"},{"code":"146510","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407386 = Hospital System Supply Identifier | 146510 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 16X420MM","code_information":[{"code":"Sx00-2252-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407656","type":"LOCAL"},{"code":"205339","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407656 = Hospital System Supply Identifier | 205339 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 8X420MM","code_information":[{"code":"Sx00-2252-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407560","type":"LOCAL"},{"code":"205241","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407560 = Hospital System Supply Identifier | 205241 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 14X420MM","code_information":[{"code":"Sx00-2252-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407415","type":"LOCAL"},{"code":"146540","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407415 = Hospital System Supply Identifier | 146540 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 13X420MM","code_information":[{"code":"Sx00-2252-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407409","type":"LOCAL"},{"code":"146534","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407409 = Hospital System Supply Identifier | 146534 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 15X420MM","code_information":[{"code":"Sx00-2252-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407643","type":"LOCAL"},{"code":"205326","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407643 = Hospital System Supply Identifier | 205326 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 11X420MM","code_information":[{"code":"Sx00-2252-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407398","type":"LOCAL"},{"code":"146522","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407398 = Hospital System Supply Identifier | 146522 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 10X420MM","code_information":[{"code":"Sx00-2252-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407393","type":"LOCAL"},{"code":"146517","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407393 = Hospital System Supply Identifier | 146517 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 9X420MM","code_information":[{"code":"Sx00-2252-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407387","type":"LOCAL"},{"code":"146511","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407387 = Hospital System Supply Identifier | 146511 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 12X420MM","code_information":[{"code":"Sx00-2252-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407403","type":"LOCAL"},{"code":"146528","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407403 = Hospital System Supply Identifier | 146528 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 16X440MM","code_information":[{"code":"Sx00-2252-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407658","type":"LOCAL"},{"code":"205341","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407658 = Hospital System Supply Identifier | 205341 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 10X440MM","code_information":[{"code":"Sx00-2252-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407580","type":"LOCAL"},{"code":"205261","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407580 = Hospital System Supply Identifier | 205261 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 9X440MM","code_information":[{"code":"Sx00-2252-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407567","type":"LOCAL"},{"code":"205248","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407567 = Hospital System Supply Identifier | 205248 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 8X440MM","code_information":[{"code":"Sx00-2252-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407561","type":"LOCAL"},{"code":"205242","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407561 = Hospital System Supply Identifier | 205242 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 15X440MM","code_information":[{"code":"Sx00-2252-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407644","type":"LOCAL"},{"code":"205327","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407644 = Hospital System Supply Identifier | 205327 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 13X440MM","code_information":[{"code":"Sx00-2252-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407410","type":"LOCAL"},{"code":"146535","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407410 = Hospital System Supply Identifier | 146535 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 12X440MM","code_information":[{"code":"Sx00-2252-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407404","type":"LOCAL"},{"code":"146529","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407404 = Hospital System Supply Identifier | 146529 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 11X440MM","code_information":[{"code":"Sx00-2252-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407399","type":"LOCAL"},{"code":"146523","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407399 = Hospital System Supply Identifier | 146523 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 14X440MM","code_information":[{"code":"Sx00-2252-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407416","type":"LOCAL"},{"code":"146541","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407416 = Hospital System Supply Identifier | 146541 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 13X460MM","code_information":[{"code":"Sx00-2252-460","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407411","type":"LOCAL"},{"code":"146536","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407411 = Hospital System Supply Identifier | 146536 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 14X460MM","code_information":[{"code":"Sx00-2252-460","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407417","type":"LOCAL"},{"code":"146542","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407417 = Hospital System Supply Identifier | 146542 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 9X460MM","code_information":[{"code":"Sx00-2252-460","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407569","type":"LOCAL"},{"code":"205250","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407569 = Hospital System Supply Identifier | 205250 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 10X460MM","code_information":[{"code":"Sx00-2252-460","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407581","type":"LOCAL"},{"code":"205262","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407581 = Hospital System Supply Identifier | 205262 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 11X460MM","code_information":[{"code":"Sx00-2252-460","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407590","type":"LOCAL"},{"code":"205271","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407590 = Hospital System Supply Identifier | 205271 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 12X460MM","code_information":[{"code":"Sx00-2252-460","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407602","type":"LOCAL"},{"code":"205283","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407602 = Hospital System Supply Identifier | 205283 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 15X460MM","code_information":[{"code":"Sx00-2252-460","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407645","type":"LOCAL"},{"code":"205328","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407645 = Hospital System Supply Identifier | 205328 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 16X460MM","code_information":[{"code":"Sx00-2252-460","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407659","type":"LOCAL"},{"code":"205342","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407659 = Hospital System Supply Identifier | 205342 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 16X480MM","code_information":[{"code":"Sx00-2252-480","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407660","type":"LOCAL"},{"code":"205343","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407660 = Hospital System Supply Identifier | 205343 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 15X480MM","code_information":[{"code":"Sx00-2252-480","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407646","type":"LOCAL"},{"code":"205329","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407646 = Hospital System Supply Identifier | 205329 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 14X480MM","code_information":[{"code":"Sx00-2252-480","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407632","type":"LOCAL"},{"code":"205315","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407632 = Hospital System Supply Identifier | 205315 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 11X480MM","code_information":[{"code":"Sx00-2252-480","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407591","type":"LOCAL"},{"code":"205272","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407591 = Hospital System Supply Identifier | 205272 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 12X480MM","code_information":[{"code":"Sx00-2252-480","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407603","type":"LOCAL"},{"code":"205284","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407603 = Hospital System Supply Identifier | 205284 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 13X480MM","code_information":[{"code":"Sx00-2252-480","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407618","type":"LOCAL"},{"code":"205300","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407618 = Hospital System Supply Identifier | 205300 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 10X480MM","code_information":[{"code":"Sx00-2252-480","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407582","type":"LOCAL"},{"code":"205263","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407582 = Hospital System Supply Identifier | 205263 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 13X500MM","code_information":[{"code":"Sx00-2252-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407619","type":"LOCAL"},{"code":"205301","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407619 = Hospital System Supply Identifier | 205301 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 14X500MM","code_information":[{"code":"Sx00-2252-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407633","type":"LOCAL"},{"code":"205316","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407633 = Hospital System Supply Identifier | 205316 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 15X500MM","code_information":[{"code":"Sx00-2252-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407647","type":"LOCAL"},{"code":"205330","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407647 = Hospital System Supply Identifier | 205330 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 16X500MM","code_information":[{"code":"Sx00-2252-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407662","type":"LOCAL"},{"code":"205345","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.28,"discounted_cash":1422.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407662 = Hospital System Supply Identifier | 205345 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X20","code_information":[{"code":"Sx00-2253-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407448","type":"LOCAL"},{"code":"146575","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407448 = Hospital System Supply Identifier | 146575 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X20","code_information":[{"code":"Sx00-2253-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407463","type":"LOCAL"},{"code":"146590","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407463 = Hospital System Supply Identifier | 146590 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 5.5X20","code_information":[{"code":"Sx00-2253-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407474","type":"LOCAL"},{"code":"146605","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407474 = Hospital System Supply Identifier | 146605 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X20","code_information":[{"code":"Sx00-2253-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408803","type":"LOCAL"},{"code":"339933","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408803 = Hospital System Supply Identifier | 339933 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X22.5M","code_information":[{"code":"Sx00-2253-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409830","type":"LOCAL"},{"code":"407369","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 409830 = Hospital System Supply Identifier | 407369 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X22.5","code_information":[{"code":"Sx00-2253-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407885","type":"LOCAL"},{"code":"206933","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407885 = Hospital System Supply Identifier | 206933 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X22.5","code_information":[{"code":"Sx00-2253-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407872","type":"LOCAL"},{"code":"206919","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407872 = Hospital System Supply Identifier | 206919 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X25","code_information":[{"code":"Sx00-2253-025","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407449","type":"LOCAL"},{"code":"146576","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407449 = Hospital System Supply Identifier | 146576 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X25","code_information":[{"code":"Sx00-2253-025","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407464","type":"LOCAL"},{"code":"146591","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407464 = Hospital System Supply Identifier | 146591 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 5.5X25","code_information":[{"code":"Sx00-2253-025","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407475","type":"LOCAL"},{"code":"146606","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407475 = Hospital System Supply Identifier | 146606 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X25","code_information":[{"code":"Sx00-2253-025","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408804","type":"LOCAL"},{"code":"339934","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408804 = Hospital System Supply Identifier | 339934 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X27.5","code_information":[{"code":"Sx00-2253-027","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407886","type":"LOCAL"},{"code":"206934","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407886 = Hospital System Supply Identifier | 206934 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X27.5","code_information":[{"code":"Sx00-2253-027","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407893","type":"LOCAL"},{"code":"206941","type":"LOCAL"}],"standard_charges":[{"gross_charge":320.92,"discounted_cash":240.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407893 = Hospital System Supply Identifier | 206941 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X27.5M","code_information":[{"code":"Sx00-2253-027","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409831","type":"LOCAL"},{"code":"407370","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 409831 = Hospital System Supply Identifier | 407370 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X30","code_information":[{"code":"Sx00-2253-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408805","type":"LOCAL"},{"code":"339935","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408805 = Hospital System Supply Identifier | 339935 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 5.5X30","code_information":[{"code":"Sx00-2253-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"102021","type":"LOCAL"},{"code":"146607","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 102021 = Hospital System Supply Identifier | 146607 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X30","code_information":[{"code":"Sx00-2253-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407465","type":"LOCAL"},{"code":"146592","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407465 = Hospital System Supply Identifier | 146592 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X30","code_information":[{"code":"Sx00-2253-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407450","type":"LOCAL"},{"code":"146577","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407450 = Hospital System Supply Identifier | 146577 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X32.5","code_information":[{"code":"Sx00-2253-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407873","type":"LOCAL"},{"code":"206920","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407873 = Hospital System Supply Identifier | 206920 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X32.5","code_information":[{"code":"Sx00-2253-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407891","type":"LOCAL"},{"code":"206939","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407891 = Hospital System Supply Identifier | 206939 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X32.5M","code_information":[{"code":"Sx00-2253-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409832","type":"LOCAL"},{"code":"407371","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 409832 = Hospital System Supply Identifier | 407371 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X35","code_information":[{"code":"Sx00-2253-035","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407451","type":"LOCAL"},{"code":"146578","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407451 = Hospital System Supply Identifier | 146578 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X35","code_information":[{"code":"Sx00-2253-035","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"100908","type":"LOCAL"},{"code":"146593","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 100908 = Hospital System Supply Identifier | 146593 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 5.5X35","code_information":[{"code":"Sx00-2253-035","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"102022","type":"LOCAL"},{"code":"146608","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 102022 = Hospital System Supply Identifier | 146608 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X35","code_information":[{"code":"Sx00-2253-035","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408806","type":"LOCAL"},{"code":"339936","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408806 = Hospital System Supply Identifier | 339936 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X37.5M","code_information":[{"code":"Sx00-2253-037","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409833","type":"LOCAL"},{"code":"407372","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 409833 = Hospital System Supply Identifier | 407372 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X37.5","code_information":[{"code":"Sx00-2253-037","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407892","type":"LOCAL"},{"code":"206940","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407892 = Hospital System Supply Identifier | 206940 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X37.5","code_information":[{"code":"Sx00-2253-037","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407883","type":"LOCAL"},{"code":"206931","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407883 = Hospital System Supply Identifier | 206931 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X40","code_information":[{"code":"Sx00-2253-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407452","type":"LOCAL"},{"code":"146579","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407452 = Hospital System Supply Identifier | 146579 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X40","code_information":[{"code":"Sx00-2253-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"102019","type":"LOCAL"},{"code":"146594","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 102019 = Hospital System Supply Identifier | 146594 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 5.5X40","code_information":[{"code":"Sx00-2253-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"102023","type":"LOCAL"},{"code":"146609","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 102023 = Hospital System Supply Identifier | 146609 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X40","code_information":[{"code":"Sx00-2253-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408807","type":"LOCAL"},{"code":"339937","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408807 = Hospital System Supply Identifier | 339937 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X42.5","code_information":[{"code":"Sx00-2253-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407867","type":"LOCAL"},{"code":"206914","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407867 = Hospital System Supply Identifier | 206914 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X42.5","code_information":[{"code":"Sx00-2253-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407884","type":"LOCAL"},{"code":"206932","type":"LOCAL"}],"standard_charges":[{"gross_charge":320.92,"discounted_cash":240.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407884 = Hospital System Supply Identifier | 206932 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X42.5M","code_information":[{"code":"Sx00-2253-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409834","type":"LOCAL"},{"code":"407373","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 409834 = Hospital System Supply Identifier | 407373 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X45","code_information":[{"code":"Sx00-2253-045","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408808","type":"LOCAL"},{"code":"339938","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408808 = Hospital System Supply Identifier | 339938 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 5.5X45","code_information":[{"code":"Sx00-2253-045","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"17384","type":"LOCAL"},{"code":"146610","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 17384 = Hospital System Supply Identifier | 146610 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X45","code_information":[{"code":"Sx00-2253-045","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"102020","type":"LOCAL"},{"code":"146595","type":"LOCAL"}],"standard_charges":[{"gross_charge":320.92,"discounted_cash":240.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 102020 = Hospital System Supply Identifier | 146595 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X45","code_information":[{"code":"Sx00-2253-045","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407453","type":"LOCAL"},{"code":"146580","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407453 = Hospital System Supply Identifier | 146580 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X47.5","code_information":[{"code":"Sx00-2253-047","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407868","type":"LOCAL"},{"code":"206915","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407868 = Hospital System Supply Identifier | 206915 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X47.5","code_information":[{"code":"Sx00-2253-047","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407874","type":"LOCAL"},{"code":"206921","type":"LOCAL"}],"standard_charges":[{"gross_charge":320.92,"discounted_cash":240.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407874 = Hospital System Supply Identifier | 206921 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X47.5M","code_information":[{"code":"Sx00-2253-047","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409835","type":"LOCAL"},{"code":"407374","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 409835 = Hospital System Supply Identifier | 407374 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X50","code_information":[{"code":"Sx00-2253-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407454","type":"LOCAL"},{"code":"146581","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407454 = Hospital System Supply Identifier | 146581 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X50","code_information":[{"code":"Sx00-2253-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"100909","type":"LOCAL"},{"code":"146596","type":"LOCAL"}],"standard_charges":[{"gross_charge":320.92,"discounted_cash":240.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 100909 = Hospital System Supply Identifier | 146596 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 5.5X50","code_information":[{"code":"Sx00-2253-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407476","type":"LOCAL"},{"code":"146611","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407476 = Hospital System Supply Identifier | 146611 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X52.5M","code_information":[{"code":"Sx00-2253-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409836","type":"LOCAL"},{"code":"407375","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 409836 = Hospital System Supply Identifier | 407375 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X52.5","code_information":[{"code":"Sx00-2253-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407875","type":"LOCAL"},{"code":"206922","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407875 = Hospital System Supply Identifier | 206922 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X52.5","code_information":[{"code":"Sx00-2253-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407869","type":"LOCAL"},{"code":"206916","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407869 = Hospital System Supply Identifier | 206916 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X55","code_information":[{"code":"Sx00-2253-055","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407455","type":"LOCAL"},{"code":"146582","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407455 = Hospital System Supply Identifier | 146582 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X55","code_information":[{"code":"Sx00-2253-055","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407466","type":"LOCAL"},{"code":"146597","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407466 = Hospital System Supply Identifier | 146597 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 5.5X55","code_information":[{"code":"Sx00-2253-055","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407477","type":"LOCAL"},{"code":"146612","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407477 = Hospital System Supply Identifier | 146612 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X55","code_information":[{"code":"Sx00-2253-055","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408809","type":"LOCAL"},{"code":"339939","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408809 = Hospital System Supply Identifier | 339939 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X57.5","code_information":[{"code":"Sx00-2253-057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407870","type":"LOCAL"},{"code":"206917","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407870 = Hospital System Supply Identifier | 206917 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X57.5","code_information":[{"code":"Sx00-2253-057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407876","type":"LOCAL"},{"code":"206923","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407876 = Hospital System Supply Identifier | 206923 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X57.5M","code_information":[{"code":"Sx00-2253-057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409837","type":"LOCAL"},{"code":"407376","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 409837 = Hospital System Supply Identifier | 407376 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X60","code_information":[{"code":"Sx00-2253-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408810","type":"LOCAL"},{"code":"339940","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408810 = Hospital System Supply Identifier | 339940 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 5.5X60","code_information":[{"code":"Sx00-2253-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"100910","type":"LOCAL"},{"code":"146613","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 100910 = Hospital System Supply Identifier | 146613 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X60","code_information":[{"code":"Sx00-2253-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407456","type":"LOCAL"},{"code":"146583","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407456 = Hospital System Supply Identifier | 146583 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X60","code_information":[{"code":"Sx00-2253-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407467","type":"LOCAL"},{"code":"146598","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407467 = Hospital System Supply Identifier | 146598 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X62.5","code_information":[{"code":"Sx00-2253-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407871","type":"LOCAL"},{"code":"206918","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407871 = Hospital System Supply Identifier | 206918 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X62.5","code_information":[{"code":"Sx00-2253-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407877","type":"LOCAL"},{"code":"206924","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407877 = Hospital System Supply Identifier | 206924 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X62.5M","code_information":[{"code":"Sx00-2253-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409838","type":"LOCAL"},{"code":"407377","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 409838 = Hospital System Supply Identifier | 407377 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X65","code_information":[{"code":"Sx00-2253-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407457","type":"LOCAL"},{"code":"146584","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407457 = Hospital System Supply Identifier | 146584 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X65","code_information":[{"code":"Sx00-2253-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407468","type":"LOCAL"},{"code":"146599","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407468 = Hospital System Supply Identifier | 146599 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 5.5X65","code_information":[{"code":"Sx00-2253-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"102024","type":"LOCAL"},{"code":"146614","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 102024 = Hospital System Supply Identifier | 146614 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X65","code_information":[{"code":"Sx00-2253-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408811","type":"LOCAL"},{"code":"339941","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408811 = Hospital System Supply Identifier | 339941 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X67.5","code_information":[{"code":"Sx00-2253-067","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407887","type":"LOCAL"},{"code":"206935","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407887 = Hospital System Supply Identifier | 206935 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X67.5M","code_information":[{"code":"Sx00-2253-067","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409839","type":"LOCAL"},{"code":"407378","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 409839 = Hospital System Supply Identifier | 407378 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X67.5","code_information":[{"code":"Sx00-2253-067","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407881","type":"LOCAL"},{"code":"206928","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407881 = Hospital System Supply Identifier | 206928 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X70","code_information":[{"code":"Sx00-2253-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407458","type":"LOCAL"},{"code":"146585","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407458 = Hospital System Supply Identifier | 146585 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X70","code_information":[{"code":"Sx00-2253-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407469","type":"LOCAL"},{"code":"146600","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407469 = Hospital System Supply Identifier | 146600 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 5.5X70","code_information":[{"code":"Sx00-2253-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407478","type":"LOCAL"},{"code":"146615","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407478 = Hospital System Supply Identifier | 146615 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X70","code_information":[{"code":"Sx00-2253-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408812","type":"LOCAL"},{"code":"339942","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408812 = Hospital System Supply Identifier | 339942 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X72.5","code_information":[{"code":"Sx00-2253-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407882","type":"LOCAL"},{"code":"206930","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407882 = Hospital System Supply Identifier | 206930 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X72.5","code_information":[{"code":"Sx00-2253-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407888","type":"LOCAL"},{"code":"206936","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407888 = Hospital System Supply Identifier | 206936 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X72.5M","code_information":[{"code":"Sx00-2253-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409840","type":"LOCAL"},{"code":"407379","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 409840 = Hospital System Supply Identifier | 407379 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X75","code_information":[{"code":"Sx00-2253-075","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408813","type":"LOCAL"},{"code":"339943","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408813 = Hospital System Supply Identifier | 339943 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 5.5X75","code_information":[{"code":"Sx00-2253-075","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"102025","type":"LOCAL"},{"code":"146616","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 102025 = Hospital System Supply Identifier | 146616 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X75","code_information":[{"code":"Sx00-2253-075","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407459","type":"LOCAL"},{"code":"146586","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407459 = Hospital System Supply Identifier | 146586 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X75","code_information":[{"code":"Sx00-2253-075","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407470","type":"LOCAL"},{"code":"146601","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407470 = Hospital System Supply Identifier | 146601 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X77.5","code_information":[{"code":"Sx00-2253-077","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407791","type":"LOCAL"},{"code":"205483","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407791 = Hospital System Supply Identifier | 205483 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X77.5","code_information":[{"code":"Sx00-2253-077","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407878","type":"LOCAL"},{"code":"206925","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407878 = Hospital System Supply Identifier | 206925 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X77.5M","code_information":[{"code":"Sx00-2253-077","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409841","type":"LOCAL"},{"code":"407380","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 409841 = Hospital System Supply Identifier | 407380 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X80","code_information":[{"code":"Sx00-2253-080","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407460","type":"LOCAL"},{"code":"146587","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407460 = Hospital System Supply Identifier | 146587 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X80","code_information":[{"code":"Sx00-2253-080","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407471","type":"LOCAL"},{"code":"146602","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407471 = Hospital System Supply Identifier | 146602 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 5.5X80","code_information":[{"code":"Sx00-2253-080","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407479","type":"LOCAL"},{"code":"146617","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407479 = Hospital System Supply Identifier | 146617 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X80","code_information":[{"code":"Sx00-2253-080","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408814","type":"LOCAL"},{"code":"339944","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408814 = Hospital System Supply Identifier | 339944 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X82.5M","code_information":[{"code":"Sx00-2253-082","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409842","type":"LOCAL"},{"code":"407381","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 409842 = Hospital System Supply Identifier | 407381 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X82.5","code_information":[{"code":"Sx00-2253-082","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407889","type":"LOCAL"},{"code":"206937","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407889 = Hospital System Supply Identifier | 206937 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X82.5","code_information":[{"code":"Sx00-2253-082","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407879","type":"LOCAL"},{"code":"206926","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407879 = Hospital System Supply Identifier | 206926 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X85","code_information":[{"code":"Sx00-2253-085","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407461","type":"LOCAL"},{"code":"146588","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407461 = Hospital System Supply Identifier | 146588 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X85","code_information":[{"code":"Sx00-2253-085","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407472","type":"LOCAL"},{"code":"146603","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407472 = Hospital System Supply Identifier | 146603 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 5.5X85","code_information":[{"code":"Sx00-2253-085","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"102026","type":"LOCAL"},{"code":"146618","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 102026 = Hospital System Supply Identifier | 146618 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X85","code_information":[{"code":"Sx00-2253-085","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408815","type":"LOCAL"},{"code":"339945","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408815 = Hospital System Supply Identifier | 339945 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X87.5","code_information":[{"code":"Sx00-2253-087","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407880","type":"LOCAL"},{"code":"206927","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407880 = Hospital System Supply Identifier | 206927 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X87.5","code_information":[{"code":"Sx00-2253-087","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407890","type":"LOCAL"},{"code":"206938","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407890 = Hospital System Supply Identifier | 206938 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X87.5M","code_information":[{"code":"Sx00-2253-087","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409843","type":"LOCAL"},{"code":"407382","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 409843 = Hospital System Supply Identifier | 407382 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X90","code_information":[{"code":"Sx00-2253-090","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408816","type":"LOCAL"},{"code":"339946","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408816 = Hospital System Supply Identifier | 339946 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 5.5X90","code_information":[{"code":"Sx00-2253-090","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"166618","type":"LOCAL"},{"code":"146619","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 166618 = Hospital System Supply Identifier | 146619 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X90","code_information":[{"code":"Sx00-2253-090","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407462","type":"LOCAL"},{"code":"146589","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407462 = Hospital System Supply Identifier | 146589 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X90","code_information":[{"code":"Sx00-2253-090","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407473","type":"LOCAL"},{"code":"146604","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407473 = Hospital System Supply Identifier | 146604 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 5.5X95","code_information":[{"code":"Sx00-2253-095","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407480","type":"LOCAL"},{"code":"146620","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407480 = Hospital System Supply Identifier | 146620 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 5.5X100","code_information":[{"code":"Sx00-2253-100","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407481","type":"LOCAL"},{"code":"146621","type":"LOCAL"}],"standard_charges":[{"gross_charge":417.37,"discounted_cash":313.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407481 = Hospital System Supply Identifier | 146621 = Lawson ID"}]},{"description":"NAIL TIB SS 9X180MM","code_information":[{"code":"Sx00-2253-180","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407843","type":"LOCAL"},{"code":"205569","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407843 = Hospital System Supply Identifier | 205569 = Lawson ID"}]},{"description":"NAIL TIB SS 7X180MM","code_information":[{"code":"Sx00-2253-180","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407541","type":"LOCAL"},{"code":"203126","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407541 = Hospital System Supply Identifier | 203126 = Lawson ID"}]},{"description":"NAIL TIB SS 10X180MM","code_information":[{"code":"Sx00-2253-180","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407671","type":"LOCAL"},{"code":"205354","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407671 = Hospital System Supply Identifier | 205354 = Lawson ID"}]},{"description":"NAIL TIB SS 11X180MM","code_information":[{"code":"Sx00-2253-180","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407682","type":"LOCAL"},{"code":"205365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407682 = Hospital System Supply Identifier | 205365 = Lawson ID"}]},{"description":"NAIL TIB SS 6X180MM","code_information":[{"code":"Sx00-2253-180","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407830","type":"LOCAL"},{"code":"205528","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407830 = Hospital System Supply Identifier | 205528 = Lawson ID"}]},{"description":"NAIL TIB SS 8X180MM","code_information":[{"code":"Sx00-2253-180","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407837","type":"LOCAL"},{"code":"205536","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407837 = Hospital System Supply Identifier | 205536 = Lawson ID"}]},{"description":"NAIL TIB SS 8X200MM","code_information":[{"code":"Sx00-2253-200","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407838","type":"LOCAL"},{"code":"205537","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407838 = Hospital System Supply Identifier | 205537 = Lawson ID"}]},{"description":"NAIL TIB SS 6X200MM","code_information":[{"code":"Sx00-2253-200","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407831","type":"LOCAL"},{"code":"205529","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407831 = Hospital System Supply Identifier | 205529 = Lawson ID"}]},{"description":"NAIL TIB SS 7X200MM","code_information":[{"code":"Sx00-2253-200","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407813","type":"LOCAL"},{"code":"205509","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407813 = Hospital System Supply Identifier | 205509 = Lawson ID"}]},{"description":"NAIL TIB SS 9X200MM","code_information":[{"code":"Sx00-2253-200","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407844","type":"LOCAL"},{"code":"205570","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407844 = Hospital System Supply Identifier | 205570 = Lawson ID"}]},{"description":"NAIL TIB SS 11X200MM","code_information":[{"code":"Sx00-2253-200","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407683","type":"LOCAL"},{"code":"205366","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407683 = Hospital System Supply Identifier | 205366 = Lawson ID"}]},{"description":"NAIL TIB SS 10X200MM","code_information":[{"code":"Sx00-2253-200","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407673","type":"LOCAL"},{"code":"205356","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407673 = Hospital System Supply Identifier | 205356 = Lawson ID"}]},{"description":"NAIL TIB SS 12X200MM","code_information":[{"code":"Sx00-2253-200","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407701","type":"LOCAL"},{"code":"205384","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407701 = Hospital System Supply Identifier | 205384 = Lawson ID"}]},{"description":"NAIL TIB SS 8X220MM","code_information":[{"code":"Sx00-2253-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407839","type":"LOCAL"},{"code":"205538","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407839 = Hospital System Supply Identifier | 205538 = Lawson ID"}]},{"description":"NAIL TIB SS 12X220MM","code_information":[{"code":"Sx00-2253-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407702","type":"LOCAL"},{"code":"205385","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407702 = Hospital System Supply Identifier | 205385 = Lawson ID"}]},{"description":"NAIL TIB SS 9X220MM","code_information":[{"code":"Sx00-2253-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407845","type":"LOCAL"},{"code":"205571","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407845 = Hospital System Supply Identifier | 205571 = Lawson ID"}]},{"description":"NAIL TIB SS 6X220MM","code_information":[{"code":"Sx00-2253-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407832","type":"LOCAL"},{"code":"205530","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407832 = Hospital System Supply Identifier | 205530 = Lawson ID"}]},{"description":"NAIL TIB SS 10X220MM","code_information":[{"code":"Sx00-2253-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407674","type":"LOCAL"},{"code":"205357","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407674 = Hospital System Supply Identifier | 205357 = Lawson ID"}]},{"description":"NAIL TIB SS 13X220MM","code_information":[{"code":"Sx00-2253-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407713","type":"LOCAL"},{"code":"205396","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407713 = Hospital System Supply Identifier | 205396 = Lawson ID"}]},{"description":"NAIL TIB SS 11X220MM","code_information":[{"code":"Sx00-2253-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407684","type":"LOCAL"},{"code":"205367","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407684 = Hospital System Supply Identifier | 205367 = Lawson ID"}]},{"description":"NAIL TIB SS 7X220MM","code_information":[{"code":"Sx00-2253-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407814","type":"LOCAL"},{"code":"205510","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407814 = Hospital System Supply Identifier | 205510 = Lawson ID"}]},{"description":"NAIL TIB SS 9X240MM","code_information":[{"code":"Sx00-2253-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407841","type":"LOCAL"},{"code":"205540","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407841 = Hospital System Supply Identifier | 205540 = Lawson ID"}]},{"description":"NAIL TIB SS 8X240MM","code_information":[{"code":"Sx00-2253-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407840","type":"LOCAL"},{"code":"205539","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407840 = Hospital System Supply Identifier | 205539 = Lawson ID"}]},{"description":"NAIL TIB SS 6X240MM","code_information":[{"code":"Sx00-2253-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407833","type":"LOCAL"},{"code":"205531","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407833 = Hospital System Supply Identifier | 205531 = Lawson ID"}]},{"description":"NAIL TIB SS 7X240MM","code_information":[{"code":"Sx00-2253-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407815","type":"LOCAL"},{"code":"205511","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407815 = Hospital System Supply Identifier | 205511 = Lawson ID"}]},{"description":"NAIL TIB SS 15X240MM","code_information":[{"code":"Sx00-2253-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407732","type":"LOCAL"},{"code":"205415","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407732 = Hospital System Supply Identifier | 205415 = Lawson ID"}]},{"description":"NAIL TIB SS 13X240MM","code_information":[{"code":"Sx00-2253-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407714","type":"LOCAL"},{"code":"205397","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407714 = Hospital System Supply Identifier | 205397 = Lawson ID"}]},{"description":"NAIL TIB SS 12X240MM","code_information":[{"code":"Sx00-2253-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407704","type":"LOCAL"},{"code":"205387","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407704 = Hospital System Supply Identifier | 205387 = Lawson ID"}]},{"description":"NAIL TIB SS 11X240MM","code_information":[{"code":"Sx00-2253-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407689","type":"LOCAL"},{"code":"205372","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407689 = Hospital System Supply Identifier | 205372 = Lawson ID"}]},{"description":"NAIL TIB SS 10X240MM","code_information":[{"code":"Sx00-2253-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407675","type":"LOCAL"},{"code":"205358","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407675 = Hospital System Supply Identifier | 205358 = Lawson ID"}]},{"description":"NAIL TIB SS 14X240MM","code_information":[{"code":"Sx00-2253-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407721","type":"LOCAL"},{"code":"205404","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407721 = Hospital System Supply Identifier | 205404 = Lawson ID"}]},{"description":"NAIL TIB SS 8X260MM","code_information":[{"code":"Sx00-2253-260","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407842","type":"LOCAL"},{"code":"205541","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407842 = Hospital System Supply Identifier | 205541 = Lawson ID"}]},{"description":"NAIL TIB SS 9X260MM","code_information":[{"code":"Sx00-2253-260","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407836","type":"LOCAL"},{"code":"205535","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407836 = Hospital System Supply Identifier | 205535 = Lawson ID"}]},{"description":"NAIL TIB SS 7X260MM","code_information":[{"code":"Sx00-2253-260","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407816","type":"LOCAL"},{"code":"205512","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407816 = Hospital System Supply Identifier | 205512 = Lawson ID"}]},{"description":"NAIL TIB SS 15X260MM","code_information":[{"code":"Sx00-2253-260","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407733","type":"LOCAL"},{"code":"205416","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407733 = Hospital System Supply Identifier | 205416 = Lawson ID"}]},{"description":"NAIL TIB SS 14X260MM","code_information":[{"code":"Sx00-2253-260","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407722","type":"LOCAL"},{"code":"205405","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407722 = Hospital System Supply Identifier | 205405 = Lawson ID"}]},{"description":"NAIL TIB SS 12X260MM","code_information":[{"code":"Sx00-2253-260","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407705","type":"LOCAL"},{"code":"205388","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407705 = Hospital System Supply Identifier | 205388 = Lawson ID"}]},{"description":"NAIL TIB SS 11X260MM","code_information":[{"code":"Sx00-2253-260","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407690","type":"LOCAL"},{"code":"205373","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407690 = Hospital System Supply Identifier | 205373 = Lawson ID"}]},{"description":"NAIL TIB SS 10X260MM","code_information":[{"code":"Sx00-2253-260","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407676","type":"LOCAL"},{"code":"205359","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407676 = Hospital System Supply Identifier | 205359 = Lawson ID"}]},{"description":"NAIL TIB SS 6X260MM","code_information":[{"code":"Sx00-2253-260","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"82280","type":"LOCAL"},{"code":"162223","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 82280 = Hospital System Supply Identifier | 162223 = Lawson ID"}]},{"description":"NAIL TIB SS 13X260MM","code_information":[{"code":"Sx00-2253-260","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407715","type":"LOCAL"},{"code":"205398","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407715 = Hospital System Supply Identifier | 205398 = Lawson ID"}]},{"description":"NAIL TIB SS 6X280MM","code_information":[{"code":"Sx00-2253-280","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407824","type":"LOCAL"},{"code":"205522","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407824 = Hospital System Supply Identifier | 205522 = Lawson ID"}]},{"description":"NAIL TIB SS 8X280MM","code_information":[{"code":"Sx00-2253-280","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407418","type":"LOCAL"},{"code":"146543","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407418 = Hospital System Supply Identifier | 146543 = Lawson ID"}]},{"description":"NAIL TIB SS 9X280MM","code_information":[{"code":"Sx00-2253-280","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407424","type":"LOCAL"},{"code":"146549","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407424 = Hospital System Supply Identifier | 146549 = Lawson ID"}]},{"description":"NAIL TIB SS 10X280MM","code_information":[{"code":"Sx00-2253-280","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407429","type":"LOCAL"},{"code":"146554","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407429 = Hospital System Supply Identifier | 146554 = Lawson ID"}]},{"description":"NAIL TIB SS 11X280MM","code_information":[{"code":"Sx00-2253-280","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407691","type":"LOCAL"},{"code":"205374","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407691 = Hospital System Supply Identifier | 205374 = Lawson ID"}]},{"description":"NAIL TIB SS 12X280MM","code_information":[{"code":"Sx00-2253-280","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407707","type":"LOCAL"},{"code":"205390","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407707 = Hospital System Supply Identifier | 205390 = Lawson ID"}]},{"description":"NAIL TIB SS 13X280MM","code_information":[{"code":"Sx00-2253-280","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407716","type":"LOCAL"},{"code":"205399","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407716 = Hospital System Supply Identifier | 205399 = Lawson ID"}]},{"description":"NAIL TIB SS 14X280MM","code_information":[{"code":"Sx00-2253-280","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407723","type":"LOCAL"},{"code":"205406","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407723 = Hospital System Supply Identifier | 205406 = Lawson ID"}]},{"description":"NAIL TIB SS 15X280MM","code_information":[{"code":"Sx00-2253-280","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407734","type":"LOCAL"},{"code":"205417","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407734 = Hospital System Supply Identifier | 205417 = Lawson ID"}]},{"description":"NAIL TIB SS 7X280MM","code_information":[{"code":"Sx00-2253-280","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407817","type":"LOCAL"},{"code":"205513","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407817 = Hospital System Supply Identifier | 205513 = Lawson ID"}]},{"description":"NAIL TIB SS 15X300MM","code_information":[{"code":"Sx00-2253-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407735","type":"LOCAL"},{"code":"205418","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407735 = Hospital System Supply Identifier | 205418 = Lawson ID"}]},{"description":"NAIL TIB SS 14X300MM","code_information":[{"code":"Sx00-2253-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407724","type":"LOCAL"},{"code":"205407","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407724 = Hospital System Supply Identifier | 205407 = Lawson ID"}]},{"description":"NAIL TIB SS 6X300MM","code_information":[{"code":"Sx00-2253-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407825","type":"LOCAL"},{"code":"205523","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407825 = Hospital System Supply Identifier | 205523 = Lawson ID"}]},{"description":"NAIL TIB SS 7X300MM","code_information":[{"code":"Sx00-2253-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407818","type":"LOCAL"},{"code":"205514","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407818 = Hospital System Supply Identifier | 205514 = Lawson ID"}]},{"description":"NAIL TIB SS 13X300MM","code_information":[{"code":"Sx00-2253-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407443","type":"LOCAL"},{"code":"146570","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407443 = Hospital System Supply Identifier | 146570 = Lawson ID"}]},{"description":"NAIL TIB SS 12X300MM","code_information":[{"code":"Sx00-2253-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407438","type":"LOCAL"},{"code":"146565","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407438 = Hospital System Supply Identifier | 146565 = Lawson ID"}]},{"description":"NAIL TIB SS 11X300MM","code_information":[{"code":"Sx00-2253-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407433","type":"LOCAL"},{"code":"146560","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407433 = Hospital System Supply Identifier | 146560 = Lawson ID"}]},{"description":"NAIL TIB SS 9X300MM","code_information":[{"code":"Sx00-2253-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407425","type":"LOCAL"},{"code":"146550","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407425 = Hospital System Supply Identifier | 146550 = Lawson ID"}]},{"description":"NAIL TIB SS 8X300MM","code_information":[{"code":"Sx00-2253-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407419","type":"LOCAL"},{"code":"146544","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407419 = Hospital System Supply Identifier | 146544 = Lawson ID"}]},{"description":"NAIL TIB SS 10X300MM","code_information":[{"code":"Sx00-2253-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407365","type":"LOCAL"},{"code":"145989","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407365 = Hospital System Supply Identifier | 145989 = Lawson ID"}]},{"description":"NAIL TIB SS 6X320MM","code_information":[{"code":"Sx00-2253-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407826","type":"LOCAL"},{"code":"205524","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407826 = Hospital System Supply Identifier | 205524 = Lawson ID"}]},{"description":"NAIL TIB SS 7X320MM","code_information":[{"code":"Sx00-2253-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407819","type":"LOCAL"},{"code":"205515","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407819 = Hospital System Supply Identifier | 205515 = Lawson ID"}]},{"description":"NAIL TIB SS 15X320MM","code_information":[{"code":"Sx00-2253-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407736","type":"LOCAL"},{"code":"205419","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407736 = Hospital System Supply Identifier | 205419 = Lawson ID"}]},{"description":"NAIL TIB SS 14X320MM","code_information":[{"code":"Sx00-2253-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407725","type":"LOCAL"},{"code":"205408","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407725 = Hospital System Supply Identifier | 205408 = Lawson ID"}]},{"description":"NAIL TIB SS 13X320MM","code_information":[{"code":"Sx00-2253-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407444","type":"LOCAL"},{"code":"146571","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407444 = Hospital System Supply Identifier | 146571 = Lawson ID"}]},{"description":"NAIL TIB SS 12X320MM","code_information":[{"code":"Sx00-2253-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407439","type":"LOCAL"},{"code":"146566","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407439 = Hospital System Supply Identifier | 146566 = Lawson ID"}]},{"description":"NAIL TIB SS 11X320MM","code_information":[{"code":"Sx00-2253-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407434","type":"LOCAL"},{"code":"146561","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407434 = Hospital System Supply Identifier | 146561 = Lawson ID"}]},{"description":"NAIL TIB SS 10X320MM","code_information":[{"code":"Sx00-2253-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407430","type":"LOCAL"},{"code":"146556","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407430 = Hospital System Supply Identifier | 146556 = Lawson ID"}]},{"description":"NAIL TIB SS 9X320MM","code_information":[{"code":"Sx00-2253-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407426","type":"LOCAL"},{"code":"146551","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407426 = Hospital System Supply Identifier | 146551 = Lawson ID"}]},{"description":"NAIL TIB SS 8X320MM","code_information":[{"code":"Sx00-2253-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407420","type":"LOCAL"},{"code":"146545","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407420 = Hospital System Supply Identifier | 146545 = Lawson ID"}]},{"description":"NAIL TIB SS 6X340MM","code_information":[{"code":"Sx00-2253-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407827","type":"LOCAL"},{"code":"205525","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407827 = Hospital System Supply Identifier | 205525 = Lawson ID"}]},{"description":"NAIL TIB SS 7X340MM","code_information":[{"code":"Sx00-2253-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407820","type":"LOCAL"},{"code":"205517","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407820 = Hospital System Supply Identifier | 205517 = Lawson ID"}]},{"description":"NAIL TIB SS 15X340MM","code_information":[{"code":"Sx00-2253-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407737","type":"LOCAL"},{"code":"205420","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407737 = Hospital System Supply Identifier | 205420 = Lawson ID"}]},{"description":"NAIL TIB SS 14X340MM","code_information":[{"code":"Sx00-2253-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407726","type":"LOCAL"},{"code":"205409","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407726 = Hospital System Supply Identifier | 205409 = Lawson ID"}]},{"description":"NAIL TIB SS 9X340MM","code_information":[{"code":"Sx00-2253-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407495","type":"LOCAL"},{"code":"148332","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407495 = Hospital System Supply Identifier | 148332 = Lawson ID"}]},{"description":"NAIL TIB SS 12X340MM","code_information":[{"code":"Sx00-2253-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407440","type":"LOCAL"},{"code":"146567","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407440 = Hospital System Supply Identifier | 146567 = Lawson ID"}]},{"description":"NAIL TIB SS 11X340MM","code_information":[{"code":"Sx00-2253-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407435","type":"LOCAL"},{"code":"146562","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407435 = Hospital System Supply Identifier | 146562 = Lawson ID"}]},{"description":"NAIL TIB SS 10X340MM","code_information":[{"code":"Sx00-2253-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407431","type":"LOCAL"},{"code":"146557","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407431 = Hospital System Supply Identifier | 146557 = Lawson ID"}]},{"description":"NAIL TIB SS 8X340MM","code_information":[{"code":"Sx00-2253-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407421","type":"LOCAL"},{"code":"146546","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407421 = Hospital System Supply Identifier | 146546 = Lawson ID"}]},{"description":"NAIL TIB SS 13X340MM","code_information":[{"code":"Sx00-2253-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407445","type":"LOCAL"},{"code":"146572","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407445 = Hospital System Supply Identifier | 146572 = Lawson ID"}]},{"description":"NAIL TIB SS 12X360MM","code_information":[{"code":"Sx00-2253-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407441","type":"LOCAL"},{"code":"146568","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407441 = Hospital System Supply Identifier | 146568 = Lawson ID"}]},{"description":"NAIL TIB SS 8X360MM","code_information":[{"code":"Sx00-2253-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407422","type":"LOCAL"},{"code":"146547","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407422 = Hospital System Supply Identifier | 146547 = Lawson ID"}]},{"description":"NAIL TIB SS 9X360MM","code_information":[{"code":"Sx00-2253-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407427","type":"LOCAL"},{"code":"146552","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407427 = Hospital System Supply Identifier | 146552 = Lawson ID"}]},{"description":"NAIL TIB SS 10X360MM","code_information":[{"code":"Sx00-2253-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407432","type":"LOCAL"},{"code":"146558","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407432 = Hospital System Supply Identifier | 146558 = Lawson ID"}]},{"description":"NAIL TIB SS 11X360MM","code_information":[{"code":"Sx00-2253-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407436","type":"LOCAL"},{"code":"146563","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407436 = Hospital System Supply Identifier | 146563 = Lawson ID"}]},{"description":"NAIL TIB SS 13X360MM","code_information":[{"code":"Sx00-2253-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407446","type":"LOCAL"},{"code":"146573","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407446 = Hospital System Supply Identifier | 146573 = Lawson ID"}]},{"description":"NAIL TIB SS 14X360MM","code_information":[{"code":"Sx00-2253-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407727","type":"LOCAL"},{"code":"205410","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407727 = Hospital System Supply Identifier | 205410 = Lawson ID"}]},{"description":"NAIL TIB SS 15X360MM","code_information":[{"code":"Sx00-2253-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407738","type":"LOCAL"},{"code":"205421","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407738 = Hospital System Supply Identifier | 205421 = Lawson ID"}]},{"description":"NAIL TIB SS 7X360MM","code_information":[{"code":"Sx00-2253-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407821","type":"LOCAL"},{"code":"205519","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407821 = Hospital System Supply Identifier | 205519 = Lawson ID"}]},{"description":"NAIL TIB SS 6X360MM","code_information":[{"code":"Sx00-2253-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407828","type":"LOCAL"},{"code":"205526","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407828 = Hospital System Supply Identifier | 205526 = Lawson ID"}]},{"description":"NAIL TIB SS 15X380MM","code_information":[{"code":"Sx00-2253-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407739","type":"LOCAL"},{"code":"205422","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407739 = Hospital System Supply Identifier | 205422 = Lawson ID"}]},{"description":"NAIL TIB SS 14X380MM","code_information":[{"code":"Sx00-2253-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407728","type":"LOCAL"},{"code":"205411","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407728 = Hospital System Supply Identifier | 205411 = Lawson ID"}]},{"description":"NAIL TIB SS 6X380MM","code_information":[{"code":"Sx00-2253-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407829","type":"LOCAL"},{"code":"205527","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407829 = Hospital System Supply Identifier | 205527 = Lawson ID"}]},{"description":"NAIL TIB SS 7X380MM","code_information":[{"code":"Sx00-2253-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407822","type":"LOCAL"},{"code":"205520","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407822 = Hospital System Supply Identifier | 205520 = Lawson ID"}]},{"description":"NAIL TIB SS 13X380MM","code_information":[{"code":"Sx00-2253-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407447","type":"LOCAL"},{"code":"146574","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407447 = Hospital System Supply Identifier | 146574 = Lawson ID"}]},{"description":"NAIL TIB SS 12X380MM","code_information":[{"code":"Sx00-2253-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407442","type":"LOCAL"},{"code":"146569","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407442 = Hospital System Supply Identifier | 146569 = Lawson ID"}]},{"description":"NAIL TIB SS 11X380MM","code_information":[{"code":"Sx00-2253-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407437","type":"LOCAL"},{"code":"146564","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407437 = Hospital System Supply Identifier | 146564 = Lawson ID"}]},{"description":"NAIL TIB SS 10X380MM","code_information":[{"code":"Sx00-2253-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"100907","type":"LOCAL"},{"code":"146559","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 100907 = Hospital System Supply Identifier | 146559 = Lawson ID"}]},{"description":"NAIL TIB SS 9X380MM","code_information":[{"code":"Sx00-2253-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407428","type":"LOCAL"},{"code":"146553","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407428 = Hospital System Supply Identifier | 146553 = Lawson ID"}]},{"description":"NAIL TIB SS 8X380MM","code_information":[{"code":"Sx00-2253-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407423","type":"LOCAL"},{"code":"146548","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407423 = Hospital System Supply Identifier | 146548 = Lawson ID"}]},{"description":"NAIL TIB SS 9X400MM","code_information":[{"code":"Sx00-2253-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407669","type":"LOCAL"},{"code":"205352","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407669 = Hospital System Supply Identifier | 205352 = Lawson ID"}]},{"description":"NAIL TIB SS 10X400MM","code_information":[{"code":"Sx00-2253-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407679","type":"LOCAL"},{"code":"205362","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407679 = Hospital System Supply Identifier | 205362 = Lawson ID"}]},{"description":"NAIL TIB SS 11X400MM","code_information":[{"code":"Sx00-2253-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407694","type":"LOCAL"},{"code":"205377","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407694 = Hospital System Supply Identifier | 205377 = Lawson ID"}]},{"description":"NAIL TIB SS 12X400MM","code_information":[{"code":"Sx00-2253-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407709","type":"LOCAL"},{"code":"205392","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407709 = Hospital System Supply Identifier | 205392 = Lawson ID"}]},{"description":"NAIL TIB SS 13X400MM","code_information":[{"code":"Sx00-2253-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407717","type":"LOCAL"},{"code":"205400","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407717 = Hospital System Supply Identifier | 205400 = Lawson ID"}]},{"description":"NAIL TIB SS 14X400MM","code_information":[{"code":"Sx00-2253-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407729","type":"LOCAL"},{"code":"205412","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407729 = Hospital System Supply Identifier | 205412 = Lawson ID"}]},{"description":"NAIL TIB SS 15X400MM","code_information":[{"code":"Sx00-2253-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407740","type":"LOCAL"},{"code":"205423","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407740 = Hospital System Supply Identifier | 205423 = Lawson ID"}]},{"description":"NAIL TIB SS 7X400MM","code_information":[{"code":"Sx00-2253-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407823","type":"LOCAL"},{"code":"205521","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407823 = Hospital System Supply Identifier | 205521 = Lawson ID"}]},{"description":"NAIL TIB SS 8X400MM","code_information":[{"code":"Sx00-2253-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407834","type":"LOCAL"},{"code":"205533","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407834 = Hospital System Supply Identifier | 205533 = Lawson ID"}]},{"description":"NAIL TIB SS 8X420MM","code_information":[{"code":"Sx00-2253-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407835","type":"LOCAL"},{"code":"205534","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407835 = Hospital System Supply Identifier | 205534 = Lawson ID"}]},{"description":"NAIL TIB SS 15X420MM","code_information":[{"code":"Sx00-2253-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407741","type":"LOCAL"},{"code":"205424","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407741 = Hospital System Supply Identifier | 205424 = Lawson ID"}]},{"description":"NAIL TIB SS 13X420MM","code_information":[{"code":"Sx00-2253-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407718","type":"LOCAL"},{"code":"205401","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407718 = Hospital System Supply Identifier | 205401 = Lawson ID"}]},{"description":"NAIL TIB SS 14X420MM","code_information":[{"code":"Sx00-2253-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407730","type":"LOCAL"},{"code":"205413","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407730 = Hospital System Supply Identifier | 205413 = Lawson ID"}]},{"description":"NAIL TIB SS 11X420MM","code_information":[{"code":"Sx00-2253-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407697","type":"LOCAL"},{"code":"205380","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407697 = Hospital System Supply Identifier | 205380 = Lawson ID"}]},{"description":"NAIL TIB SS 10X420MM","code_information":[{"code":"Sx00-2253-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407680","type":"LOCAL"},{"code":"205363","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407680 = Hospital System Supply Identifier | 205363 = Lawson ID"}]},{"description":"NAIL TIB SS 9X420MM","code_information":[{"code":"Sx00-2253-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407670","type":"LOCAL"},{"code":"205353","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407670 = Hospital System Supply Identifier | 205353 = Lawson ID"}]},{"description":"NAIL TIB SS 12X420MM","code_information":[{"code":"Sx00-2253-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407710","type":"LOCAL"},{"code":"205393","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407710 = Hospital System Supply Identifier | 205393 = Lawson ID"}]},{"description":"NAIL TIB SS 10X440MM","code_information":[{"code":"Sx00-2253-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407681","type":"LOCAL"},{"code":"205364","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407681 = Hospital System Supply Identifier | 205364 = Lawson ID"}]},{"description":"NAIL TIB SS 11X440MM","code_information":[{"code":"Sx00-2253-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407698","type":"LOCAL"},{"code":"205381","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407698 = Hospital System Supply Identifier | 205381 = Lawson ID"}]},{"description":"NAIL TIB SS 12X440MM","code_information":[{"code":"Sx00-2253-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407711","type":"LOCAL"},{"code":"205394","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407711 = Hospital System Supply Identifier | 205394 = Lawson ID"}]},{"description":"NAIL TIB SS 13X440MM","code_information":[{"code":"Sx00-2253-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407719","type":"LOCAL"},{"code":"205402","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407719 = Hospital System Supply Identifier | 205402 = Lawson ID"}]},{"description":"NAIL TIB SS 14X440MM","code_information":[{"code":"Sx00-2253-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407731","type":"LOCAL"},{"code":"205414","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407731 = Hospital System Supply Identifier | 205414 = Lawson ID"}]},{"description":"NAIL TIB SS 15X440MM","code_information":[{"code":"Sx00-2253-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407742","type":"LOCAL"},{"code":"205425","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407742 = Hospital System Supply Identifier | 205425 = Lawson ID"}]},{"description":"NAIL TIB SS 13X460MM","code_information":[{"code":"Sx00-2253-460","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407720","type":"LOCAL"},{"code":"205403","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407720 = Hospital System Supply Identifier | 205403 = Lawson ID"}]},{"description":"NAIL TIB SS 11X460MM","code_information":[{"code":"Sx00-2253-460","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407700","type":"LOCAL"},{"code":"205383","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407700 = Hospital System Supply Identifier | 205383 = Lawson ID"}]},{"description":"NAIL TIB SS 12X460MM","code_information":[{"code":"Sx00-2253-460","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407712","type":"LOCAL"},{"code":"205395","type":"LOCAL"}],"standard_charges":[{"gross_charge":1947.68,"discounted_cash":1460.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407712 = Hospital System Supply Identifier | 205395 = Lawson ID"}]},{"description":"NAIL HUM MD/N 6MMX180MM","code_information":[{"code":"Sx00-2254-180","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410363","type":"LOCAL"},{"code":"411619","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.44,"discounted_cash":1958.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410363 = Hospital System Supply Identifier | 411619 = Lawson ID"}]},{"description":"NAIL HUM MD/N 7MMX180MM","code_information":[{"code":"Sx00-2254-180","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410364","type":"LOCAL"},{"code":"411620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.44,"discounted_cash":1958.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410364 = Hospital System Supply Identifier | 411620 = Lawson ID"}]},{"description":"NAIL HUM MD/N 9MMX180MM","code_information":[{"code":"Sx00-2254-180","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410365","type":"LOCAL"},{"code":"411621","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.44,"discounted_cash":1958.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410365 = Hospital System Supply Identifier | 411621 = Lawson ID"}]},{"description":"NAIL HUM MD/N 10MMX180MM","code_information":[{"code":"Sx00-2254-180","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410366","type":"LOCAL"},{"code":"411622","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.44,"discounted_cash":1958.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410366 = Hospital System Supply Identifier | 411622 = Lawson ID"}]},{"description":"NAIL HUM MD/N 12MMX180MM","code_information":[{"code":"Sx00-2254-180","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410367","type":"LOCAL"},{"code":"411623","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.44,"discounted_cash":1958.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410367 = Hospital System Supply Identifier | 411623 = Lawson ID"}]},{"description":"NAIL HUM MD/N 11MMX195MM","code_information":[{"code":"Sx00-2254-195","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410372","type":"LOCAL"},{"code":"411628","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.44,"discounted_cash":1958.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410372 = Hospital System Supply Identifier | 411628 = Lawson ID"}]},{"description":"NAIL HUM MD/N 12MMX195MM","code_information":[{"code":"Sx00-2254-195","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410373","type":"LOCAL"},{"code":"411629","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.44,"discounted_cash":1958.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410373 = Hospital System Supply Identifier | 411629 = Lawson ID"}]},{"description":"NAIL HUM MD/N 10MMX195MM","code_information":[{"code":"Sx00-2254-195","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410371","type":"LOCAL"},{"code":"411627","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.44,"discounted_cash":1958.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410371 = Hospital System Supply Identifier | 411627 = Lawson ID"}]},{"description":"NAIL HUM MD/N 13MMX195MM","code_information":[{"code":"Sx00-2254-195","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410374","type":"LOCAL"},{"code":"411630","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.44,"discounted_cash":1958.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410374 = Hospital System Supply Identifier | 411630 = Lawson ID"}]},{"description":"NAIL HUM MD/N 7MMX195MM","code_information":[{"code":"Sx00-2254-195","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410369","type":"LOCAL"},{"code":"411625","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.44,"discounted_cash":1958.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410369 = Hospital System Supply Identifier | 411625 = Lawson ID"}]},{"description":"NAIL HUM MD/N 6MMX195MM","code_information":[{"code":"Sx00-2254-195","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410368","type":"LOCAL"},{"code":"411624","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.44,"discounted_cash":1958.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410368 = Hospital System Supply Identifier | 411624 = Lawson ID"}]},{"description":"NAIL HUM MD/N 8MMX195MM","code_information":[{"code":"Sx00-2254-195","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410362","type":"LOCAL"},{"code":"411293","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.44,"discounted_cash":1958.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410362 = Hospital System Supply Identifier | 411293 = Lawson ID"}]},{"description":"NAIL HUM MD/N 9MMX195MM","code_information":[{"code":"Sx00-2254-195","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410370","type":"LOCAL"},{"code":"411626","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.44,"discounted_cash":1958.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410370 = Hospital System Supply Identifier | 411626 = Lawson ID"}]},{"description":"NAIL HUM SS 7X210MM","code_information":[{"code":"Sx00-2254-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407792","type":"LOCAL"},{"code":"205488","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.44,"discounted_cash":1958.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407792 = Hospital System Supply Identifier | 205488 = Lawson ID"}]},{"description":"NAIL HUM SS 8X210MM","code_information":[{"code":"Sx00-2254-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407796","type":"LOCAL"},{"code":"205492","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.44,"discounted_cash":1958.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407796 = Hospital System Supply Identifier | 205492 = Lawson ID"}]},{"description":"NAIL HUM SS 9X210MM","code_information":[{"code":"Sx00-2254-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407801","type":"LOCAL"},{"code":"205497","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.44,"discounted_cash":1958.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407801 = Hospital System Supply Identifier | 205497 = Lawson ID"}]},{"description":"NAIL HUM SS 10X210MM","code_information":[{"code":"Sx00-2254-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407806","type":"LOCAL"},{"code":"205502","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.44,"discounted_cash":1958.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407806 = Hospital System Supply Identifier | 205502 = Lawson ID"}]},{"description":"NAIL HUM MD/N 6MMX210MM","code_information":[{"code":"Sx00-2254-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410375","type":"LOCAL"},{"code":"411631","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.44,"discounted_cash":1958.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410375 = Hospital System Supply Identifier | 411631 = Lawson ID"}]},{"description":"NAIL HUM MD/N 11MMX210MM","code_information":[{"code":"Sx00-2254-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410376","type":"LOCAL"},{"code":"411632","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.44,"discounted_cash":1958.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410376 = Hospital System Supply Identifier | 411632 = Lawson ID"}]},{"description":"NAIL HUM MD/N 12MMX210MM","code_information":[{"code":"Sx00-2254-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410377","type":"LOCAL"},{"code":"411633","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.44,"discounted_cash":1958.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410377 = Hospital System Supply Identifier | 411633 = Lawson ID"}]},{"description":"NAIL HUM MD/N 13MMX210MM","code_information":[{"code":"Sx00-2254-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410378","type":"LOCAL"},{"code":"411634","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.44,"discounted_cash":1958.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410378 = Hospital System Supply Identifier | 411634 = Lawson ID"}]},{"description":"NAIL HUM MD/N 13MMX225MM","code_information":[{"code":"Sx00-2254-225","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410382","type":"LOCAL"},{"code":"411638","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.44,"discounted_cash":1958.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410382 = Hospital System Supply Identifier | 411638 = Lawson ID"}]},{"description":"NAIL HUM MD/N 11MMX225MM","code_information":[{"code":"Sx00-2254-225","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410380","type":"LOCAL"},{"code":"411636","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.44,"discounted_cash":1958.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410380 = Hospital System Supply Identifier | 411636 = Lawson ID"}]},{"description":"NAIL HUM MD/N 6MMX255MM","code_information":[{"code":"Sx00-2254-225","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410379","type":"LOCAL"},{"code":"411635","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.44,"discounted_cash":1958.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410379 = Hospital System Supply Identifier | 411635 = Lawson ID"}]},{"description":"NAIL HUM MD/N 12MMX225MM","code_information":[{"code":"Sx00-2254-225","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410381","type":"LOCAL"},{"code":"411637","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.44,"discounted_cash":1958.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410381 = Hospital System Supply Identifier | 411637 = Lawson ID"}]},{"description":"NAIL HUM SS 9X225MM","code_information":[{"code":"Sx00-2254-225","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407802","type":"LOCAL"},{"code":"205498","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.44,"discounted_cash":1958.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407802 = Hospital System Supply Identifier | 205498 = Lawson ID"}]},{"description":"NAIL HUM SS 8X225MM","code_information":[{"code":"Sx00-2254-225","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407797","type":"LOCAL"},{"code":"205493","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.44,"discounted_cash":1958.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407797 = Hospital System Supply Identifier | 205493 = Lawson ID"}]},{"description":"NAIL HUM SS 7X225MM","code_information":[{"code":"Sx00-2254-225","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407793","type":"LOCAL"},{"code":"205489","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.44,"discounted_cash":1958.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407793 = Hospital System Supply Identifier | 205489 = Lawson ID"}]},{"description":"NAIL HUM SS 10X225MM","code_information":[{"code":"Sx00-2254-225","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407807","type":"LOCAL"},{"code":"205503","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.44,"discounted_cash":1958.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407807 = Hospital System Supply Identifier | 205503 = Lawson ID"}]},{"description":"NAIL HUM MD/N 13MMX240MM","code_information":[{"code":"Sx00-2254-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410386","type":"LOCAL"},{"code":"411642","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.44,"discounted_cash":1958.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410386 = Hospital System Supply Identifier | 411642 = Lawson ID"}]},{"description":"NAIL HUM MD/N 11MMX240MM","code_information":[{"code":"Sx00-2254-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410384","type":"LOCAL"},{"code":"411640","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.44,"discounted_cash":1958.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410384 = Hospital System Supply Identifier | 411640 = Lawson ID"}]},{"description":"NAIL HUM MD/N 6MMX240MM","code_information":[{"code":"Sx00-2254-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410383","type":"LOCAL"},{"code":"411639","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.44,"discounted_cash":1958.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410383 = Hospital System Supply Identifier | 411639 = Lawson ID"}]},{"description":"NAIL HUM MD/N 12MMX240MM","code_information":[{"code":"Sx00-2254-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410385","type":"LOCAL"},{"code":"411641","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.44,"discounted_cash":1958.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410385 = Hospital System Supply Identifier | 411641 = Lawson ID"}]},{"description":"NAIL HUM SS 9X240MM","code_information":[{"code":"Sx00-2254-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407803","type":"LOCAL"},{"code":"205499","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.44,"discounted_cash":1958.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407803 = Hospital System Supply Identifier | 205499 = Lawson ID"}]},{"description":"NAIL HUM SS 8X240MM","code_information":[{"code":"Sx00-2254-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407798","type":"LOCAL"},{"code":"205494","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.44,"discounted_cash":1958.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407798 = Hospital System Supply Identifier | 205494 = Lawson ID"}]},{"description":"NAIL HUM SS 7X240MM","code_information":[{"code":"Sx00-2254-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407794","type":"LOCAL"},{"code":"205490","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.44,"discounted_cash":1958.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407794 = Hospital System Supply Identifier | 205490 = Lawson ID"}]},{"description":"NAIL HUM SS 10X240MM","code_information":[{"code":"Sx00-2254-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407808","type":"LOCAL"},{"code":"205504","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.44,"discounted_cash":1958.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407808 = Hospital System Supply Identifier | 205504 = Lawson ID"}]},{"description":"NAIL HUM SS 10X255MM","code_information":[{"code":"Sx00-2254-255","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407499","type":"LOCAL"},{"code":"152149","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.44,"discounted_cash":1958.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407499 = Hospital System Supply Identifier | 152149 = Lawson ID"}]},{"description":"NAIL HUM SS 7X255MM","code_information":[{"code":"Sx00-2254-255","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407795","type":"LOCAL"},{"code":"205491","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.44,"discounted_cash":1958.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407795 = Hospital System Supply Identifier | 205491 = Lawson ID"}]},{"description":"NAIL HUM SS 8X255MM","code_information":[{"code":"Sx00-2254-255","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407799","type":"LOCAL"},{"code":"205495","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.44,"discounted_cash":1958.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407799 = Hospital System Supply Identifier | 205495 = Lawson ID"}]},{"description":"NAIL HUM SS 9X255MM","code_information":[{"code":"Sx00-2254-255","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407804","type":"LOCAL"},{"code":"205500","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.44,"discounted_cash":1958.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407804 = Hospital System Supply Identifier | 205500 = Lawson ID"}]},{"description":"NAIL HUM SS 11X255MM","code_information":[{"code":"Sx00-2254-255","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409546","type":"LOCAL"},{"code":"401978","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.44,"discounted_cash":1958.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 409546 = Hospital System Supply Identifier | 401978 = Lawson ID"}]},{"description":"NAIL HUM MD/N 12MMX255MM","code_information":[{"code":"Sx00-2254-255","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410387","type":"LOCAL"},{"code":"411644","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.44,"discounted_cash":1958.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410387 = Hospital System Supply Identifier | 411644 = Lawson ID"}]},{"description":"NAIL HUM MD/N 13MMX255MM","code_information":[{"code":"Sx00-2254-255","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410388","type":"LOCAL"},{"code":"411645","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.44,"discounted_cash":1958.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410388 = Hospital System Supply Identifier | 411645 = Lawson ID"}]},{"description":"NAIL HUM MD/N 11MMX270MM","code_information":[{"code":"Sx00-2254-270","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410390","type":"LOCAL"},{"code":"411647","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.44,"discounted_cash":1958.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410390 = Hospital System Supply Identifier | 411647 = Lawson ID"}]},{"description":"NAIL HUM MD/N 12MMX270MM","code_information":[{"code":"Sx00-2254-270","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410391","type":"LOCAL"},{"code":"411648","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.44,"discounted_cash":1958.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410391 = Hospital System Supply Identifier | 411648 = Lawson ID"}]},{"description":"NAIL HUM MD/N 6MMX270MM","code_information":[{"code":"Sx00-2254-270","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410389","type":"LOCAL"},{"code":"411646","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.44,"discounted_cash":1958.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410389 = Hospital System Supply Identifier | 411646 = Lawson ID"}]},{"description":"NAIL HUM MD/N 13MMX270MM","code_information":[{"code":"Sx00-2254-270","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410392","type":"LOCAL"},{"code":"411649","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.44,"discounted_cash":1958.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410392 = Hospital System Supply Identifier | 411649 = Lawson ID"}]},{"description":"NAIL HUM SS 10X270MM","code_information":[{"code":"Sx00-2254-270","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407809","type":"LOCAL"},{"code":"205505","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.44,"discounted_cash":1958.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407809 = Hospital System Supply Identifier | 205505 = Lawson ID"}]},{"description":"NAIL HUM SS 9X270MM","code_information":[{"code":"Sx00-2254-270","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407805","type":"LOCAL"},{"code":"205501","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.44,"discounted_cash":1958.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407805 = Hospital System Supply Identifier | 205501 = Lawson ID"}]},{"description":"NAIL HUM SS 8X270MM","code_information":[{"code":"Sx00-2254-270","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407800","type":"LOCAL"},{"code":"205496","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.44,"discounted_cash":1958.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407800 = Hospital System Supply Identifier | 205496 = Lawson ID"}]},{"description":"NAIL HUM SS 7X270MM","code_information":[{"code":"Sx00-2254-270","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408817","type":"LOCAL"},{"code":"339947","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.44,"discounted_cash":1958.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408817 = Hospital System Supply Identifier | 339947 = Lawson ID"}]},{"description":"NAIL HUM MD/N 6MMX285MM","code_information":[{"code":"Sx00-2254-285","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410393","type":"LOCAL"},{"code":"411650","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.44,"discounted_cash":1958.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410393 = Hospital System Supply Identifier | 411650 = Lawson ID"}]},{"description":"NAIL HUM MD/N 7MMX285MM","code_information":[{"code":"Sx00-2254-285","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410394","type":"LOCAL"},{"code":"411651","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.44,"discounted_cash":1958.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410394 = Hospital System Supply Identifier | 411651 = Lawson ID"}]},{"description":"NAIL HUM MD/N 8MMX285MM","code_information":[{"code":"Sx00-2254-285","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410395","type":"LOCAL"},{"code":"411652","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.44,"discounted_cash":1958.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410395 = Hospital System Supply Identifier | 411652 = Lawson ID"}]},{"description":"NAIL HUM MD/N 9MMX285MM","code_information":[{"code":"Sx00-2254-285","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410396","type":"LOCAL"},{"code":"411653","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.44,"discounted_cash":1958.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410396 = Hospital System Supply Identifier | 411653 = Lawson ID"}]},{"description":"NAIL HUM MD/N 10MMX285MM","code_information":[{"code":"Sx00-2254-285","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410397","type":"LOCAL"},{"code":"411654","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.44,"discounted_cash":1958.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410397 = Hospital System Supply Identifier | 411654 = Lawson ID"}]},{"description":"NAIL HUM MD/N 11MMX285MM","code_information":[{"code":"Sx00-2254-285","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410398","type":"LOCAL"},{"code":"411655","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.44,"discounted_cash":1958.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410398 = Hospital System Supply Identifier | 411655 = Lawson ID"}]},{"description":"NAIL HUM MD/N 12MMX285MM","code_information":[{"code":"Sx00-2254-285","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410399","type":"LOCAL"},{"code":"411656","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.44,"discounted_cash":1958.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410399 = Hospital System Supply Identifier | 411656 = Lawson ID"}]},{"description":"NAIL HUM MD/N 13MMX285MM","code_information":[{"code":"Sx00-2254-285","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410400","type":"LOCAL"},{"code":"411657","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.44,"discounted_cash":1958.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410400 = Hospital System Supply Identifier | 411657 = Lawson ID"}]},{"description":"NAIL HUM MD/N 13MMX300MM","code_information":[{"code":"Sx00-2254-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410407","type":"LOCAL"},{"code":"411664","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.44,"discounted_cash":1958.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410407 = Hospital System Supply Identifier | 411664 = Lawson ID"}]},{"description":"NAIL HUM MD/N 12MMX300MM","code_information":[{"code":"Sx00-2254-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410406","type":"LOCAL"},{"code":"411663","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.44,"discounted_cash":1958.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410406 = Hospital System Supply Identifier | 411663 = Lawson ID"}]},{"description":"NAIL HUM MD/N 10MMX300MM","code_information":[{"code":"Sx00-2254-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410405","type":"LOCAL"},{"code":"411662","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.44,"discounted_cash":1958.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410405 = Hospital System Supply Identifier | 411662 = Lawson ID"}]},{"description":"NAIL HUM MD/N 9MMX300MM","code_information":[{"code":"Sx00-2254-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410404","type":"LOCAL"},{"code":"411661","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.44,"discounted_cash":1958.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410404 = Hospital System Supply Identifier | 411661 = Lawson ID"}]},{"description":"NAIL HUM SS 11X300MM","code_information":[{"code":"Sx00-2254-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407500","type":"LOCAL"},{"code":"155950","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.44,"discounted_cash":1958.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407500 = Hospital System Supply Identifier | 155950 = Lawson ID"}]},{"description":"NAIL HUM MD/N 7MMX300MM","code_information":[{"code":"Sx00-2254-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410402","type":"LOCAL"},{"code":"411659","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.44,"discounted_cash":1958.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410402 = Hospital System Supply Identifier | 411659 = Lawson ID"}]},{"description":"NAIL HUM MD/N 6MMX300MM","code_information":[{"code":"Sx00-2254-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410401","type":"LOCAL"},{"code":"411658","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.44,"discounted_cash":1958.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410401 = Hospital System Supply Identifier | 411658 = Lawson ID"}]},{"description":"NAIL HUM MD/N 8MMX300MM","code_information":[{"code":"Sx00-2254-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410403","type":"LOCAL"},{"code":"411660","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.44,"discounted_cash":1958.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410403 = Hospital System Supply Identifier | 411660 = Lawson ID"}]},{"description":"DISC - TROCAR DISTAL 3.7","code_information":[{"code":"Sx00-2255-012","type":"CDM"},{"code":"272","type":"RC"},{"code":"407490","type":"LOCAL"},{"code":"147987","type":"LOCAL"}],"standard_charges":[{"gross_charge":251.39,"discounted_cash":188.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407490 = Hospital System Supply Identifier | 147987 = Lawson ID"}]},{"description":"GUIDE PIN 2.4 SMOOTH","code_information":[{"code":"Sx00-2255-025","type":"CDM"},{"code":"272","type":"RC"},{"code":"81919","type":"LOCAL"},{"code":"155954","type":"LOCAL"}],"standard_charges":[{"gross_charge":146.5,"discounted_cash":109.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 81919 = Hospital System Supply Identifier | 155954 = Lawson ID"}]},{"description":"DISC - BIT DRILL TIB-HUM M/DN 3.7MM","code_information":[{"code":"Sx00-2255-032","type":"CDM"},{"code":"272","type":"RC"},{"code":"407488","type":"LOCAL"},{"code":"147985","type":"LOCAL"}],"standard_charges":[{"gross_charge":393.08,"discounted_cash":294.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407488 = Hospital System Supply Identifier | 147985 = Lawson ID"}]},{"description":"BOLT TIBIAL PROX LOCKING","code_information":[{"code":"Sx00-2255-033","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408250","type":"LOCAL"},{"code":"303896","type":"LOCAL"}],"standard_charges":[{"gross_charge":1044.81,"discounted_cash":783.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408250 = Hospital System Supply Identifier | 303896 = Lawson ID"}]},{"description":"DISC - BIT DRILL PILOT TIP DST 5.0MM","code_information":[{"code":"Sx00-2255-033","type":"CDM"},{"code":"272","type":"RC"},{"code":"407494","type":"LOCAL"},{"code":"147991","type":"LOCAL"}],"standard_charges":[{"gross_charge":287.96,"discounted_cash":215.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407494 = Hospital System Supply Identifier | 147991 = Lawson ID"}]},{"description":"DISC - BIT DRILL PILOT TIP DST 3.2MM","code_information":[{"code":"Sx00-2255-033","type":"CDM"},{"code":"272","type":"RC"},{"code":"407492","type":"LOCAL"},{"code":"147989","type":"LOCAL"}],"standard_charges":[{"gross_charge":287.96,"discounted_cash":215.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407492 = Hospital System Supply Identifier | 147989 = Lawson ID"}]},{"description":"BIT DRILL PILOT TIP DST 3.7MM","code_information":[{"code":"Sx00-2255-033","type":"CDM"},{"code":"272","type":"RC"},{"code":"407493","type":"LOCAL"},{"code":"147990","type":"LOCAL"}],"standard_charges":[{"gross_charge":287.96,"discounted_cash":215.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407493 = Hospital System Supply Identifier | 147990 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 15X180MM UNIV","code_information":[{"code":"Sx00-2257-180","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"149446","type":"LOCAL"},{"code":"236820","type":"LOCAL"}],"standard_charges":[{"gross_charge":1805.14,"discounted_cash":1353.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 149446 = Hospital System Supply Identifier | 236820 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 12X180MM UNIV","code_information":[{"code":"Sx00-2257-180","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408708","type":"LOCAL"},{"code":"339248","type":"LOCAL"}],"standard_charges":[{"gross_charge":1805.14,"discounted_cash":1353.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408708 = Hospital System Supply Identifier | 339248 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 10X180MM UNIV","code_information":[{"code":"Sx00-2257-180","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408819","type":"LOCAL"},{"code":"339950","type":"LOCAL"}],"standard_charges":[{"gross_charge":1805.14,"discounted_cash":1353.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408819 = Hospital System Supply Identifier | 339950 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 11X180MM UNIV","code_information":[{"code":"Sx00-2257-180","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408820","type":"LOCAL"},{"code":"339951","type":"LOCAL"}],"standard_charges":[{"gross_charge":1805.14,"discounted_cash":1353.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408820 = Hospital System Supply Identifier | 339951 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X180MM UNIV","code_information":[{"code":"Sx00-2257-180","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408821","type":"LOCAL"},{"code":"339952","type":"LOCAL"}],"standard_charges":[{"gross_charge":1805.14,"discounted_cash":1353.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408821 = Hospital System Supply Identifier | 339952 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 14X180MM UNIV","code_information":[{"code":"Sx00-2257-180","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408822","type":"LOCAL"},{"code":"339953","type":"LOCAL"}],"standard_charges":[{"gross_charge":1805.14,"discounted_cash":1353.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408822 = Hospital System Supply Identifier | 339953 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X300MM LT","code_information":[{"code":"Sx00-2257-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408826","type":"LOCAL"},{"code":"339957","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408826 = Hospital System Supply Identifier | 339957 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X300MM RT","code_information":[{"code":"Sx00-2257-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408831","type":"LOCAL"},{"code":"339962","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408831 = Hospital System Supply Identifier | 339962 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 12X300MM RT","code_information":[{"code":"Sx00-2257-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408830","type":"LOCAL"},{"code":"339961","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408830 = Hospital System Supply Identifier | 339961 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X400MM RT","code_information":[{"code":"Sx00-2257-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408829","type":"LOCAL"},{"code":"339960","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408829 = Hospital System Supply Identifier | 339960 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 10X300MM RT","code_information":[{"code":"Sx00-2257-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408828","type":"LOCAL"},{"code":"339959","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408828 = Hospital System Supply Identifier | 339959 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 11X300MM LT","code_information":[{"code":"Sx00-2257-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408824","type":"LOCAL"},{"code":"339955","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408824 = Hospital System Supply Identifier | 339955 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 12X300MM LT","code_information":[{"code":"Sx00-2257-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408825","type":"LOCAL"},{"code":"339956","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408825 = Hospital System Supply Identifier | 339956 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 14X300MM RT","code_information":[{"code":"Sx00-2257-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408832","type":"LOCAL"},{"code":"339963","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408832 = Hospital System Supply Identifier | 339963 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 10X300MM LT","code_information":[{"code":"Sx00-2257-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408823","type":"LOCAL"},{"code":"339954","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408823 = Hospital System Supply Identifier | 339954 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 14X300MM LT","code_information":[{"code":"Sx00-2257-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408827","type":"LOCAL"},{"code":"339958","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408827 = Hospital System Supply Identifier | 339958 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 12X320MM RT","code_information":[{"code":"Sx00-2257-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408448","type":"LOCAL"},{"code":"332579","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408448 = Hospital System Supply Identifier | 332579 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 11X320MM RT","code_information":[{"code":"Sx00-2257-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408447","type":"LOCAL"},{"code":"332578","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408447 = Hospital System Supply Identifier | 332578 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X320MM RT","code_information":[{"code":"Sx00-2257-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408449","type":"LOCAL"},{"code":"332580","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408449 = Hospital System Supply Identifier | 332580 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 14X320MM RT","code_information":[{"code":"Sx00-2257-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408450","type":"LOCAL"},{"code":"332581","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408450 = Hospital System Supply Identifier | 332581 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 10X320MM RT","code_information":[{"code":"Sx00-2257-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408446","type":"LOCAL"},{"code":"332577","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408446 = Hospital System Supply Identifier | 332577 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X320MM LT","code_information":[{"code":"Sx00-2257-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408444","type":"LOCAL"},{"code":"332575","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408444 = Hospital System Supply Identifier | 332575 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 12X320MM LT","code_information":[{"code":"Sx00-2257-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408443","type":"LOCAL"},{"code":"332574","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408443 = Hospital System Supply Identifier | 332574 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X420MM LT","code_information":[{"code":"Sx00-2257-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408442","type":"LOCAL"},{"code":"332573","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408442 = Hospital System Supply Identifier | 332573 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 10X320MM LT","code_information":[{"code":"Sx00-2257-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408441","type":"LOCAL"},{"code":"332572","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408441 = Hospital System Supply Identifier | 332572 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 14X320MM LT","code_information":[{"code":"Sx00-2257-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408445","type":"LOCAL"},{"code":"332576","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408445 = Hospital System Supply Identifier | 332576 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 14X340MM RT","code_information":[{"code":"Sx00-2257-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408460","type":"LOCAL"},{"code":"332591","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408460 = Hospital System Supply Identifier | 332591 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X340MM RT","code_information":[{"code":"Sx00-2257-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408459","type":"LOCAL"},{"code":"332590","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408459 = Hospital System Supply Identifier | 332590 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 12X340MM RT","code_information":[{"code":"Sx00-2257-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408458","type":"LOCAL"},{"code":"332589","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408458 = Hospital System Supply Identifier | 332589 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 11X340MM RT","code_information":[{"code":"Sx00-2257-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408457","type":"LOCAL"},{"code":"332588","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408457 = Hospital System Supply Identifier | 332588 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 10X340MM RT","code_information":[{"code":"Sx00-2257-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408456","type":"LOCAL"},{"code":"332587","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408456 = Hospital System Supply Identifier | 332587 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 14X340MM LT","code_information":[{"code":"Sx00-2257-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408455","type":"LOCAL"},{"code":"332586","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408455 = Hospital System Supply Identifier | 332586 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X340MM LT","code_information":[{"code":"Sx00-2257-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408454","type":"LOCAL"},{"code":"332585","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408454 = Hospital System Supply Identifier | 332585 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 12X340MM LT","code_information":[{"code":"Sx00-2257-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408453","type":"LOCAL"},{"code":"332584","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408453 = Hospital System Supply Identifier | 332584 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 11X340MM LT","code_information":[{"code":"Sx00-2257-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408452","type":"LOCAL"},{"code":"332583","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408452 = Hospital System Supply Identifier | 332583 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 10X340MM LT","code_information":[{"code":"Sx00-2257-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408451","type":"LOCAL"},{"code":"332582","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408451 = Hospital System Supply Identifier | 332582 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X360MM RT","code_information":[{"code":"Sx00-2257-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408836","type":"LOCAL"},{"code":"339967","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408836 = Hospital System Supply Identifier | 339967 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 12X360MM RT","code_information":[{"code":"Sx00-2257-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408835","type":"LOCAL"},{"code":"339966","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408835 = Hospital System Supply Identifier | 339966 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 11X360MM RT","code_information":[{"code":"Sx00-2257-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408834","type":"LOCAL"},{"code":"339965","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408834 = Hospital System Supply Identifier | 339965 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X360MM LT","code_information":[{"code":"Sx00-2257-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408833","type":"LOCAL"},{"code":"339964","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408833 = Hospital System Supply Identifier | 339964 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 14X360MM RT","code_information":[{"code":"Sx00-2257-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408466","type":"LOCAL"},{"code":"332597","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408466 = Hospital System Supply Identifier | 332597 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 10X360MM RT","code_information":[{"code":"Sx00-2257-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408465","type":"LOCAL"},{"code":"332596","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408465 = Hospital System Supply Identifier | 332596 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 14X360MM LT","code_information":[{"code":"Sx00-2257-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408464","type":"LOCAL"},{"code":"332595","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408464 = Hospital System Supply Identifier | 332595 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 12X360MM LT","code_information":[{"code":"Sx00-2257-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408463","type":"LOCAL"},{"code":"332594","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408463 = Hospital System Supply Identifier | 332594 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 11X360MM LT","code_information":[{"code":"Sx00-2257-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408462","type":"LOCAL"},{"code":"332593","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408462 = Hospital System Supply Identifier | 332593 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 10X360MM LT","code_information":[{"code":"Sx00-2257-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408461","type":"LOCAL"},{"code":"332592","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408461 = Hospital System Supply Identifier | 332592 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 11X380MM LT","code_information":[{"code":"Sx00-2257-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408837","type":"LOCAL"},{"code":"339968","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408837 = Hospital System Supply Identifier | 339968 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 14X380MM RT","code_information":[{"code":"Sx00-2257-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408475","type":"LOCAL"},{"code":"332606","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408475 = Hospital System Supply Identifier | 332606 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X380MM RT","code_information":[{"code":"Sx00-2257-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408474","type":"LOCAL"},{"code":"332605","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408474 = Hospital System Supply Identifier | 332605 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 12X380MM RT","code_information":[{"code":"Sx00-2257-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408473","type":"LOCAL"},{"code":"332604","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408473 = Hospital System Supply Identifier | 332604 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 11X380MM RT","code_information":[{"code":"Sx00-2257-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408472","type":"LOCAL"},{"code":"332603","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408472 = Hospital System Supply Identifier | 332603 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 14X380MM LT","code_information":[{"code":"Sx00-2257-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408470","type":"LOCAL"},{"code":"332601","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408470 = Hospital System Supply Identifier | 332601 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X380MM LT","code_information":[{"code":"Sx00-2257-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408469","type":"LOCAL"},{"code":"332600","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408469 = Hospital System Supply Identifier | 332600 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 12X380MM LT","code_information":[{"code":"Sx00-2257-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408468","type":"LOCAL"},{"code":"332599","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408468 = Hospital System Supply Identifier | 332599 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 10X380MM LT","code_information":[{"code":"Sx00-2257-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408467","type":"LOCAL"},{"code":"332598","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408467 = Hospital System Supply Identifier | 332598 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 10X380MM RT","code_information":[{"code":"Sx00-2257-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408471","type":"LOCAL"},{"code":"332602","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408471 = Hospital System Supply Identifier | 332602 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 11X400MM RT","code_information":[{"code":"Sx00-2257-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408482","type":"LOCAL"},{"code":"332613","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408482 = Hospital System Supply Identifier | 332613 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X400MM RT","code_information":[{"code":"Sx00-2257-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408838","type":"LOCAL"},{"code":"339969","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408838 = Hospital System Supply Identifier | 339969 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 14X400MM RT","code_information":[{"code":"Sx00-2257-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408484","type":"LOCAL"},{"code":"332615","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408484 = Hospital System Supply Identifier | 332615 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 12X400MM RT","code_information":[{"code":"Sx00-2257-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408483","type":"LOCAL"},{"code":"332614","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408483 = Hospital System Supply Identifier | 332614 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 10X400MM RT","code_information":[{"code":"Sx00-2257-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408481","type":"LOCAL"},{"code":"332612","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408481 = Hospital System Supply Identifier | 332612 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 14X400MM LT","code_information":[{"code":"Sx00-2257-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408480","type":"LOCAL"},{"code":"332611","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408480 = Hospital System Supply Identifier | 332611 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X400MM LT","code_information":[{"code":"Sx00-2257-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408479","type":"LOCAL"},{"code":"332610","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408479 = Hospital System Supply Identifier | 332610 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 12X400MM LT","code_information":[{"code":"Sx00-2257-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408478","type":"LOCAL"},{"code":"332609","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408478 = Hospital System Supply Identifier | 332609 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 11X400MM LT","code_information":[{"code":"Sx00-2257-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408477","type":"LOCAL"},{"code":"332608","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408477 = Hospital System Supply Identifier | 332608 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 10X400MM LT","code_information":[{"code":"Sx00-2257-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408476","type":"LOCAL"},{"code":"332607","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408476 = Hospital System Supply Identifier | 332607 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 14X420MM LT","code_information":[{"code":"Sx00-2257-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408839","type":"LOCAL"},{"code":"339970","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408839 = Hospital System Supply Identifier | 339970 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 14X420MM RT","code_information":[{"code":"Sx00-2257-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408493","type":"LOCAL"},{"code":"332624","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408493 = Hospital System Supply Identifier | 332624 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X420MM RT","code_information":[{"code":"Sx00-2257-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408492","type":"LOCAL"},{"code":"332623","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408492 = Hospital System Supply Identifier | 332623 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 12X420MM RT","code_information":[{"code":"Sx00-2257-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408491","type":"LOCAL"},{"code":"332622","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408491 = Hospital System Supply Identifier | 332622 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 11X420MM RT","code_information":[{"code":"Sx00-2257-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408490","type":"LOCAL"},{"code":"332621","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408490 = Hospital System Supply Identifier | 332621 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X420MM LT","code_information":[{"code":"Sx00-2257-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408488","type":"LOCAL"},{"code":"332619","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408488 = Hospital System Supply Identifier | 332619 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 12X420MM LT","code_information":[{"code":"Sx00-2257-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408487","type":"LOCAL"},{"code":"332618","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408487 = Hospital System Supply Identifier | 332618 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 11X420MM LT","code_information":[{"code":"Sx00-2257-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408486","type":"LOCAL"},{"code":"332617","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408486 = Hospital System Supply Identifier | 332617 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 10X420MM LT","code_information":[{"code":"Sx00-2257-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408485","type":"LOCAL"},{"code":"332616","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408485 = Hospital System Supply Identifier | 332616 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 10X420MM RT","code_information":[{"code":"Sx00-2257-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408489","type":"LOCAL"},{"code":"332620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408489 = Hospital System Supply Identifier | 332620 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 11X440MM RT","code_information":[{"code":"Sx00-2257-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408500","type":"LOCAL"},{"code":"332631","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408500 = Hospital System Supply Identifier | 332631 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 12X440MM RT","code_information":[{"code":"Sx00-2257-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408840","type":"LOCAL"},{"code":"339971","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408840 = Hospital System Supply Identifier | 339971 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 14X440MM RT","code_information":[{"code":"Sx00-2257-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408502","type":"LOCAL"},{"code":"332633","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408502 = Hospital System Supply Identifier | 332633 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X440MM RT","code_information":[{"code":"Sx00-2257-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408501","type":"LOCAL"},{"code":"332632","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408501 = Hospital System Supply Identifier | 332632 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 10X440MM RT","code_information":[{"code":"Sx00-2257-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408499","type":"LOCAL"},{"code":"332630","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408499 = Hospital System Supply Identifier | 332630 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 14X440MM LT","code_information":[{"code":"Sx00-2257-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408498","type":"LOCAL"},{"code":"332629","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408498 = Hospital System Supply Identifier | 332629 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X440MM LT","code_information":[{"code":"Sx00-2257-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408497","type":"LOCAL"},{"code":"332628","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408497 = Hospital System Supply Identifier | 332628 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 12X440MM LT","code_information":[{"code":"Sx00-2257-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408496","type":"LOCAL"},{"code":"332627","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408496 = Hospital System Supply Identifier | 332627 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 11X440MM LT","code_information":[{"code":"Sx00-2257-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408495","type":"LOCAL"},{"code":"332626","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408495 = Hospital System Supply Identifier | 332626 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 10X440MM LT","code_information":[{"code":"Sx00-2257-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408494","type":"LOCAL"},{"code":"332625","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408494 = Hospital System Supply Identifier | 332625 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 14X460MM RT","code_information":[{"code":"Sx00-2257-460","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408512","type":"LOCAL"},{"code":"332643","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408512 = Hospital System Supply Identifier | 332643 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X460MM RT","code_information":[{"code":"Sx00-2257-460","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408511","type":"LOCAL"},{"code":"332642","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408511 = Hospital System Supply Identifier | 332642 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 12X460MM RT","code_information":[{"code":"Sx00-2257-460","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408510","type":"LOCAL"},{"code":"332641","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408510 = Hospital System Supply Identifier | 332641 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 11X460MM RT","code_information":[{"code":"Sx00-2257-460","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408509","type":"LOCAL"},{"code":"332640","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408509 = Hospital System Supply Identifier | 332640 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 10X460MM RT","code_information":[{"code":"Sx00-2257-460","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408508","type":"LOCAL"},{"code":"332639","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408508 = Hospital System Supply Identifier | 332639 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 14X460MM LT","code_information":[{"code":"Sx00-2257-460","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408507","type":"LOCAL"},{"code":"332638","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408507 = Hospital System Supply Identifier | 332638 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X460MM LT","code_information":[{"code":"Sx00-2257-460","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408506","type":"LOCAL"},{"code":"332637","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408506 = Hospital System Supply Identifier | 332637 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 12X460MM LT","code_information":[{"code":"Sx00-2257-460","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408505","type":"LOCAL"},{"code":"332636","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408505 = Hospital System Supply Identifier | 332636 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 11X460MM LT","code_information":[{"code":"Sx00-2257-460","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408504","type":"LOCAL"},{"code":"332635","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408504 = Hospital System Supply Identifier | 332635 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 10X460MM LT","code_information":[{"code":"Sx00-2257-460","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408503","type":"LOCAL"},{"code":"332634","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408503 = Hospital System Supply Identifier | 332634 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 14X480MM RT","code_information":[{"code":"Sx00-2257-480","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408522","type":"LOCAL"},{"code":"332653","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408522 = Hospital System Supply Identifier | 332653 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X480MM RT","code_information":[{"code":"Sx00-2257-480","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408521","type":"LOCAL"},{"code":"332652","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408521 = Hospital System Supply Identifier | 332652 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 12X480MM RT","code_information":[{"code":"Sx00-2257-480","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408520","type":"LOCAL"},{"code":"332651","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408520 = Hospital System Supply Identifier | 332651 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 10X480MM RT","code_information":[{"code":"Sx00-2257-480","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408518","type":"LOCAL"},{"code":"332649","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408518 = Hospital System Supply Identifier | 332649 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 11X480MM RT","code_information":[{"code":"Sx00-2257-480","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408519","type":"LOCAL"},{"code":"332650","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408519 = Hospital System Supply Identifier | 332650 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X480MM LT","code_information":[{"code":"Sx00-2257-480","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408516","type":"LOCAL"},{"code":"332647","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408516 = Hospital System Supply Identifier | 332647 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 14X480MM LT","code_information":[{"code":"Sx00-2257-480","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408517","type":"LOCAL"},{"code":"332648","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408517 = Hospital System Supply Identifier | 332648 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 12X480MM LT","code_information":[{"code":"Sx00-2257-480","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408515","type":"LOCAL"},{"code":"332646","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408515 = Hospital System Supply Identifier | 332646 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 11X480MM LT","code_information":[{"code":"Sx00-2257-480","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408514","type":"LOCAL"},{"code":"332645","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408514 = Hospital System Supply Identifier | 332645 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 10X480MM LT","code_information":[{"code":"Sx00-2257-480","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408513","type":"LOCAL"},{"code":"332644","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408513 = Hospital System Supply Identifier | 332644 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 14X500MM RT","code_information":[{"code":"Sx00-2257-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408532","type":"LOCAL"},{"code":"332663","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408532 = Hospital System Supply Identifier | 332663 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X500MM RT","code_information":[{"code":"Sx00-2257-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408531","type":"LOCAL"},{"code":"332662","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408531 = Hospital System Supply Identifier | 332662 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 12X500MM RT","code_information":[{"code":"Sx00-2257-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408530","type":"LOCAL"},{"code":"332661","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408530 = Hospital System Supply Identifier | 332661 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 11X500MM RT","code_information":[{"code":"Sx00-2257-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408529","type":"LOCAL"},{"code":"332660","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408529 = Hospital System Supply Identifier | 332660 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 10X500MM RT","code_information":[{"code":"Sx00-2257-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408528","type":"LOCAL"},{"code":"332659","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408528 = Hospital System Supply Identifier | 332659 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X500MM LT","code_information":[{"code":"Sx00-2257-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408526","type":"LOCAL"},{"code":"332657","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408526 = Hospital System Supply Identifier | 332657 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 12X500MM LT","code_information":[{"code":"Sx00-2257-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408525","type":"LOCAL"},{"code":"332656","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408525 = Hospital System Supply Identifier | 332656 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 11X500MM LT","code_information":[{"code":"Sx00-2257-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408524","type":"LOCAL"},{"code":"332655","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408524 = Hospital System Supply Identifier | 332655 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 10X500MM LT","code_information":[{"code":"Sx00-2257-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408523","type":"LOCAL"},{"code":"332654","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408523 = Hospital System Supply Identifier | 332654 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 14X500MM LT","code_information":[{"code":"Sx00-2257-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408527","type":"LOCAL"},{"code":"332658","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408527 = Hospital System Supply Identifier | 332658 = Lawson ID"}]},{"description":"DISC - BIT DRILL FEM ITST 5.0MM","code_information":[{"code":"Sx00-2258-069","type":"CDM"},{"code":"272","type":"RC"},{"code":"149449","type":"LOCAL"},{"code":"236823","type":"LOCAL"}],"standard_charges":[{"gross_charge":542.05,"discounted_cash":406.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 149449 = Hospital System Supply Identifier | 236823 = Lawson ID"}]},{"description":"DISC - BIT DRILL FEM ITST 3.7MM","code_information":[{"code":"Sx00-2258-069","type":"CDM"},{"code":"272","type":"RC"},{"code":"149450","type":"LOCAL"},{"code":"236824","type":"LOCAL"}],"standard_charges":[{"gross_charge":307.65,"discounted_cash":230.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 149450 = Hospital System Supply Identifier | 236824 = Lawson ID"}]},{"description":"SCREW LAG ITST 11X105MM","code_information":[{"code":"Sx00-2259-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408551","type":"LOCAL"},{"code":"332682","type":"LOCAL"}],"standard_charges":[{"gross_charge":916.32,"discounted_cash":687.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408551 = Hospital System Supply Identifier | 332682 = Lawson ID"}]},{"description":"SCREW LAG ITST 11X115MM","code_information":[{"code":"Sx00-2259-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408842","type":"LOCAL"},{"code":"339973","type":"LOCAL"}],"standard_charges":[{"gross_charge":916.32,"discounted_cash":687.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408842 = Hospital System Supply Identifier | 339973 = Lawson ID"}]},{"description":"SCREW LAG ITST 11X110MM","code_information":[{"code":"Sx00-2259-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408841","type":"LOCAL"},{"code":"339972","type":"LOCAL"}],"standard_charges":[{"gross_charge":916.32,"discounted_cash":687.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408841 = Hospital System Supply Identifier | 339972 = Lawson ID"}]},{"description":"SCREW LAG ITST 11X120MM","code_information":[{"code":"Sx00-2259-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408843","type":"LOCAL"},{"code":"339974","type":"LOCAL"}],"standard_charges":[{"gross_charge":916.32,"discounted_cash":687.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408843 = Hospital System Supply Identifier | 339974 = Lawson ID"}]},{"description":"SCREW LAG ITST 11X95MM","code_information":[{"code":"Sx00-2259-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408550","type":"LOCAL"},{"code":"332681","type":"LOCAL"}],"standard_charges":[{"gross_charge":916.32,"discounted_cash":687.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408550 = Hospital System Supply Identifier | 332681 = Lawson ID"}]},{"description":"SCREW LAG ITST 11X70MM","code_information":[{"code":"Sx00-2259-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408546","type":"LOCAL"},{"code":"332677","type":"LOCAL"}],"standard_charges":[{"gross_charge":916.32,"discounted_cash":687.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408546 = Hospital System Supply Identifier | 332677 = Lawson ID"}]},{"description":"SCREW LAG ITST 11X80MM","code_information":[{"code":"Sx00-2259-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408548","type":"LOCAL"},{"code":"332679","type":"LOCAL"}],"standard_charges":[{"gross_charge":916.32,"discounted_cash":687.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408548 = Hospital System Supply Identifier | 332679 = Lawson ID"}]},{"description":"SCREW LAG ITST 11X75MM","code_information":[{"code":"Sx00-2259-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408547","type":"LOCAL"},{"code":"332678","type":"LOCAL"}],"standard_charges":[{"gross_charge":916.32,"discounted_cash":687.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408547 = Hospital System Supply Identifier | 332678 = Lawson ID"}]},{"description":"SCREW LAG ITST 11X90MM","code_information":[{"code":"Sx00-2259-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408436","type":"LOCAL"},{"code":"332557","type":"LOCAL"}],"standard_charges":[{"gross_charge":916.32,"discounted_cash":687.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408436 = Hospital System Supply Identifier | 332557 = Lawson ID"}]},{"description":"SCREW LAG ITST 11X100MM","code_information":[{"code":"Sx00-2259-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"149447","type":"LOCAL"},{"code":"236821","type":"LOCAL"}],"standard_charges":[{"gross_charge":916.32,"discounted_cash":687.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 149447 = Hospital System Supply Identifier | 236821 = Lawson ID"}]},{"description":"SCREW LAG ITST 11X85MM","code_information":[{"code":"Sx00-2259-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408549","type":"LOCAL"},{"code":"332680","type":"LOCAL"}],"standard_charges":[{"gross_charge":916.32,"discounted_cash":687.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408549 = Hospital System Supply Identifier | 332680 = Lawson ID"}]},{"description":"CAP NAIL SLIDING 2259-007-20","code_information":[{"code":"Sx00-2259-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408537","type":"LOCAL"},{"code":"332668","type":"LOCAL"}],"standard_charges":[{"gross_charge":384.79,"discounted_cash":288.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408537 = Hospital System Supply Identifier | 332668 = Lawson ID"}]},{"description":"CAP NAIL SLIDING 2259-007-10","code_information":[{"code":"Sx00-2259-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408535","type":"LOCAL"},{"code":"332666","type":"LOCAL"}],"standard_charges":[{"gross_charge":384.79,"discounted_cash":288.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408535 = Hospital System Supply Identifier | 332666 = Lawson ID"}]},{"description":"CAP NAIL SLIDING 2259-007-15","code_information":[{"code":"Sx00-2259-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408536","type":"LOCAL"},{"code":"332667","type":"LOCAL"}],"standard_charges":[{"gross_charge":384.79,"discounted_cash":288.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408536 = Hospital System Supply Identifier | 332667 = Lawson ID"}]},{"description":"CAP NAIL SLIDING 2259-007-00","code_information":[{"code":"Sx00-2259-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408533","type":"LOCAL"},{"code":"332664","type":"LOCAL"}],"standard_charges":[{"gross_charge":384.79,"discounted_cash":288.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408533 = Hospital System Supply Identifier | 332664 = Lawson ID"}]},{"description":"CAP NAIL SLIDING 2259-007-05","code_information":[{"code":"Sx00-2259-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408534","type":"LOCAL"},{"code":"332665","type":"LOCAL"}],"standard_charges":[{"gross_charge":384.79,"discounted_cash":288.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408534 = Hospital System Supply Identifier | 332665 = Lawson ID"}]},{"description":"CAP NAIL LOCKING 2259-008-00","code_information":[{"code":"Sx00-2259-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408538","type":"LOCAL"},{"code":"332669","type":"LOCAL"}],"standard_charges":[{"gross_charge":384.79,"discounted_cash":288.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408538 = Hospital System Supply Identifier | 332669 = Lawson ID"}]},{"description":"CAP NAIL LOCKING 2259-008-10","code_information":[{"code":"Sx00-2259-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408539","type":"LOCAL"},{"code":"332670","type":"LOCAL"}],"standard_charges":[{"gross_charge":384.79,"discounted_cash":288.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408539 = Hospital System Supply Identifier | 332670 = Lawson ID"}]},{"description":"CAP NAIL LOCKING 2259-008-15","code_information":[{"code":"Sx00-2259-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408540","type":"LOCAL"},{"code":"332671","type":"LOCAL"}],"standard_charges":[{"gross_charge":384.79,"discounted_cash":288.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408540 = Hospital System Supply Identifier | 332671 = Lawson ID"}]},{"description":"CAP NAIL LOCKING 2259-008-05","code_information":[{"code":"Sx00-2259-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408844","type":"LOCAL"},{"code":"339975","type":"LOCAL"}],"standard_charges":[{"gross_charge":384.79,"discounted_cash":288.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408844 = Hospital System Supply Identifier | 339975 = Lawson ID"}]},{"description":"CAP NAIL LOCKING 2259-008-20","code_information":[{"code":"Sx00-2259-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408845","type":"LOCAL"},{"code":"339976","type":"LOCAL"}],"standard_charges":[{"gross_charge":384.79,"discounted_cash":288.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408845 = Hospital System Supply Identifier | 339976 = Lawson ID"}]},{"description":"CAP NAIL NEUTRAL 2259-009-20","code_information":[{"code":"Sx00-2259-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408545","type":"LOCAL"},{"code":"332676","type":"LOCAL"}],"standard_charges":[{"gross_charge":384.79,"discounted_cash":288.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408545 = Hospital System Supply Identifier | 332676 = Lawson ID"}]},{"description":"CAP NAIL NEUTRAL 2259-009-10","code_information":[{"code":"Sx00-2259-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408543","type":"LOCAL"},{"code":"332674","type":"LOCAL"}],"standard_charges":[{"gross_charge":384.79,"discounted_cash":288.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408543 = Hospital System Supply Identifier | 332674 = Lawson ID"}]},{"description":"CAP NAIL NEUTRAL 2259-009-15","code_information":[{"code":"Sx00-2259-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408544","type":"LOCAL"},{"code":"332675","type":"LOCAL"}],"standard_charges":[{"gross_charge":384.79,"discounted_cash":288.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408544 = Hospital System Supply Identifier | 332675 = Lawson ID"}]},{"description":"CAP NAIL NEUTRAL 2259-009-00","code_information":[{"code":"Sx00-2259-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408541","type":"LOCAL"},{"code":"332672","type":"LOCAL"}],"standard_charges":[{"gross_charge":384.79,"discounted_cash":288.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408541 = Hospital System Supply Identifier | 332672 = Lawson ID"}]},{"description":"CAP NAIL NEUTRAL 2259-009-05","code_information":[{"code":"Sx00-2259-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408542","type":"LOCAL"},{"code":"332673","type":"LOCAL"}],"standard_charges":[{"gross_charge":384.79,"discounted_cash":288.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408542 = Hospital System Supply Identifier | 332673 = Lawson ID"}]},{"description":"BIT SCREWDRIVER HEX HD 3.5MM","code_information":[{"code":"Sx00-2305-017","type":"CDM"},{"code":"272","type":"RC"},{"code":"167243","type":"LOCAL"},{"code":"160088","type":"LOCAL"}],"standard_charges":[{"gross_charge":179.02,"discounted_cash":134.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 167243 = Hospital System Supply Identifier | 160088 = Lawson ID"}]},{"description":"NUT ECT 11 X 8 MM 2317-01","code_information":[{"code":"Sx00-2317-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39355","type":"LOCAL"},{"code":"157809","type":"LOCAL"}],"standard_charges":[{"gross_charge":40.95,"discounted_cash":30.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 39355 = Hospital System Supply Identifier | 157809 = Lawson ID"}]},{"description":"TAP SURG PERIARTC Q/C 4 130X35","code_information":[{"code":"Sx00-2346-046","type":"CDM"},{"code":"272","type":"RC"},{"code":"408076","type":"LOCAL"},{"code":"245986","type":"LOCAL"}],"standard_charges":[{"gross_charge":199.97,"discounted_cash":149.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408076 = Hospital System Supply Identifier | 245986 = Lawson ID"}]},{"description":"PLATE PERI-ART 2347-12-04","code_information":[{"code":"Sx00-2347-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"80197","type":"LOCAL"},{"code":"203545","type":"LOCAL"}],"standard_charges":[{"gross_charge":1665.76,"discounted_cash":1249.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 80197 = Hospital System Supply Identifier | 203545 = Lawson ID"}]},{"description":"SCREW PERIRTC 16MM THRD 6.5X25","code_information":[{"code":"Sx00-2347-024","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408074","type":"LOCAL"},{"code":"245983","type":"LOCAL"}],"standard_charges":[{"gross_charge":49.14,"discounted_cash":36.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408074 = Hospital System Supply Identifier | 245983 = Lawson ID"}]},{"description":"PLATE HUM LAT DST 92MM 4H RT","code_information":[{"code":"Sx00-2348-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410174","type":"LOCAL"},{"code":"410416","type":"LOCAL"}],"standard_charges":[{"gross_charge":1665.76,"discounted_cash":1249.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410174 = Hospital System Supply Identifier | 410416 = Lawson ID"}]},{"description":"PLATE DST POS/LAT HUM 2H RT","code_information":[{"code":"Sx00-2348-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407971","type":"LOCAL"},{"code":"228841","type":"LOCAL"}],"standard_charges":[{"gross_charge":2151.24,"discounted_cash":1613.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407971 = Hospital System Supply Identifier | 228841 = Lawson ID"}]},{"description":"PLATE DST POS/LAT HUM 10H RT","code_information":[{"code":"Sx00-2348-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407967","type":"LOCAL"},{"code":"228837","type":"LOCAL"}],"standard_charges":[{"gross_charge":2151.24,"discounted_cash":1613.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407967 = Hospital System Supply Identifier | 228837 = Lawson ID"}]},{"description":"PLATE DST POS/LAT HUM 12H RT","code_information":[{"code":"Sx00-2348-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407965","type":"LOCAL"},{"code":"228835","type":"LOCAL"}],"standard_charges":[{"gross_charge":2151.24,"discounted_cash":1613.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407965 = Hospital System Supply Identifier | 228835 = Lawson ID"}]},{"description":"PLATE DORSAL HUMERAL 2348-05-4","code_information":[{"code":"Sx00-2348-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"56229","type":"LOCAL"},{"code":"208696","type":"LOCAL"}],"standard_charges":[{"gross_charge":2151.24,"discounted_cash":1613.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 56229 = Hospital System Supply Identifier | 208696 = Lawson ID"}]},{"description":"PLATE DORSAL HUMERAL 2348-05-8","code_information":[{"code":"Sx00-2348-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407953","type":"LOCAL"},{"code":"208698","type":"LOCAL"}],"standard_charges":[{"gross_charge":2151.24,"discounted_cash":1613.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407953 = Hospital System Supply Identifier | 208698 = Lawson ID"}]},{"description":"PLATE DORSAL HUMERAL 2348-05-6","code_information":[{"code":"Sx00-2348-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407952","type":"LOCAL"},{"code":"208697","type":"LOCAL"}],"standard_charges":[{"gross_charge":2151.24,"discounted_cash":1613.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407952 = Hospital System Supply Identifier | 208697 = Lawson ID"}]},{"description":"PLATE DST POS/LAT HUM 14H RT","code_information":[{"code":"Sx00-2348-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407963","type":"LOCAL"},{"code":"228833","type":"LOCAL"}],"standard_charges":[{"gross_charge":2151.24,"discounted_cash":1613.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407963 = Hospital System Supply Identifier | 228833 = Lawson ID"}]},{"description":"PLATE DST POS/LAT HUM 12H LT","code_information":[{"code":"Sx00-2348-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407964","type":"LOCAL"},{"code":"228834","type":"LOCAL"}],"standard_charges":[{"gross_charge":2151.24,"discounted_cash":1613.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407964 = Hospital System Supply Identifier | 228834 = Lawson ID"}]},{"description":"PLATE DST POS/LAT HUM 2H LT","code_information":[{"code":"Sx00-2348-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407970","type":"LOCAL"},{"code":"228840","type":"LOCAL"}],"standard_charges":[{"gross_charge":2151.24,"discounted_cash":1613.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407970 = Hospital System Supply Identifier | 228840 = Lawson ID"}]},{"description":"PLATE DST POS/LAT HUM 14H LT","code_information":[{"code":"Sx00-2348-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407962","type":"LOCAL"},{"code":"228832","type":"LOCAL"}],"standard_charges":[{"gross_charge":2151.24,"discounted_cash":1613.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407962 = Hospital System Supply Identifier | 228832 = Lawson ID"}]},{"description":"PLATE DST POS/LAT HUM 10H LT","code_information":[{"code":"Sx00-2348-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407966","type":"LOCAL"},{"code":"228836","type":"LOCAL"}],"standard_charges":[{"gross_charge":2151.24,"discounted_cash":1613.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407966 = Hospital System Supply Identifier | 228836 = Lawson ID"}]},{"description":"PLATE DORSAL HUMERAL 2348-06-6","code_information":[{"code":"Sx00-2348-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407955","type":"LOCAL"},{"code":"208700","type":"LOCAL"}],"standard_charges":[{"gross_charge":2151.24,"discounted_cash":1613.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407955 = Hospital System Supply Identifier | 208700 = Lawson ID"}]},{"description":"PLATE DORSAL HUMERAL 2348-06-4","code_information":[{"code":"Sx00-2348-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407954","type":"LOCAL"},{"code":"208699","type":"LOCAL"}],"standard_charges":[{"gross_charge":2151.24,"discounted_cash":1613.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407954 = Hospital System Supply Identifier | 208699 = Lawson ID"}]},{"description":"PLATE DORSAL HUMERAL 2348-06-8","code_information":[{"code":"Sx00-2348-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407956","type":"LOCAL"},{"code":"208701","type":"LOCAL"}],"standard_charges":[{"gross_charge":2151.24,"discounted_cash":1613.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407956 = Hospital System Supply Identifier | 208701 = Lawson ID"}]},{"description":"PLATE HUMERAL 2348-07-12","code_information":[{"code":"Sx00-2348-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"56225","type":"LOCAL"},{"code":"208163","type":"LOCAL"}],"standard_charges":[{"gross_charge":2151.24,"discounted_cash":1613.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 56225 = Hospital System Supply Identifier | 208163 = Lawson ID"}]},{"description":"PLATE HUMERAL 2348-07-14","code_information":[{"code":"Sx00-2348-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407897","type":"LOCAL"},{"code":"208164","type":"LOCAL"}],"standard_charges":[{"gross_charge":2151.24,"discounted_cash":1613.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407897 = Hospital System Supply Identifier | 208164 = Lawson ID"}]},{"description":"PLATE HUMERAL DIST 2348-07-16","code_information":[{"code":"Sx00-2348-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407898","type":"LOCAL"},{"code":"208165","type":"LOCAL"}],"standard_charges":[{"gross_charge":2151.24,"discounted_cash":1613.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407898 = Hospital System Supply Identifier | 208165 = Lawson ID"}]},{"description":"PLATE PROX DRSL ULNAR 14H RT","code_information":[{"code":"Sx00-2348-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407973","type":"LOCAL"},{"code":"228843","type":"LOCAL"}],"standard_charges":[{"gross_charge":1971.98,"discounted_cash":1478.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407973 = Hospital System Supply Identifier | 228843 = Lawson ID"}]},{"description":"PLATE PROX DRSL ULNAR 10H RT","code_information":[{"code":"Sx00-2348-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407961","type":"LOCAL"},{"code":"228831","type":"LOCAL"}],"standard_charges":[{"gross_charge":1971.98,"discounted_cash":1478.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407961 = Hospital System Supply Identifier | 228831 = Lawson ID"}]},{"description":"PLATE PROX DRSL ULNAR 12H RT","code_information":[{"code":"Sx00-2348-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407959","type":"LOCAL"},{"code":"228829","type":"LOCAL"}],"standard_charges":[{"gross_charge":1971.98,"discounted_cash":1478.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407959 = Hospital System Supply Identifier | 228829 = Lawson ID"}]},{"description":"PLATE PROX DRSL ULNAR 2H RT","code_information":[{"code":"Sx00-2348-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407969","type":"LOCAL"},{"code":"228839","type":"LOCAL"}],"standard_charges":[{"gross_charge":1971.98,"discounted_cash":1478.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407969 = Hospital System Supply Identifier | 228839 = Lawson ID"}]},{"description":"PLATE DORSAL ULNA 2348-09-06","code_information":[{"code":"Sx00-2348-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407948","type":"LOCAL"},{"code":"208691","type":"LOCAL"}],"standard_charges":[{"gross_charge":1971.98,"discounted_cash":1478.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407948 = Hospital System Supply Identifier | 208691 = Lawson ID"}]},{"description":"PLATE DORSAL ULNA 2348-09-04","code_information":[{"code":"Sx00-2348-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"56228","type":"LOCAL"},{"code":"208690","type":"LOCAL"}],"standard_charges":[{"gross_charge":1971.98,"discounted_cash":1478.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 56228 = Hospital System Supply Identifier | 208690 = Lawson ID"}]},{"description":"PLATE DORSAL ULNA 2348-09-08","code_information":[{"code":"Sx00-2348-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407949","type":"LOCAL"},{"code":"208692","type":"LOCAL"}],"standard_charges":[{"gross_charge":1971.98,"discounted_cash":1478.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407949 = Hospital System Supply Identifier | 208692 = Lawson ID"}]},{"description":"PLATE DORSAL ULNA 2348-10-04","code_information":[{"code":"Sx00-2348-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"82363","type":"LOCAL"},{"code":"208693","type":"LOCAL"}],"standard_charges":[{"gross_charge":1971.98,"discounted_cash":1478.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 82363 = Hospital System Supply Identifier | 208693 = Lawson ID"}]},{"description":"PLATE PROX DRSL ULNAR 6H LT","code_information":[{"code":"Sx00-2348-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407950","type":"LOCAL"},{"code":"208694","type":"LOCAL"}],"standard_charges":[{"gross_charge":1971.98,"discounted_cash":1478.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407950 = Hospital System Supply Identifier | 208694 = Lawson ID"}]},{"description":"PLATE DORSAL ULNA 2348-10-08","code_information":[{"code":"Sx00-2348-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407951","type":"LOCAL"},{"code":"208695","type":"LOCAL"}],"standard_charges":[{"gross_charge":1971.98,"discounted_cash":1478.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407951 = Hospital System Supply Identifier | 208695 = Lawson ID"}]},{"description":"PLATE PROX DRSL ULNAR 10H LT","code_information":[{"code":"Sx00-2348-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407960","type":"LOCAL"},{"code":"228830","type":"LOCAL"}],"standard_charges":[{"gross_charge":1971.98,"discounted_cash":1478.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407960 = Hospital System Supply Identifier | 228830 = Lawson ID"}]},{"description":"PLATE PROX DRSL ULNAR 2H LT","code_information":[{"code":"Sx00-2348-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407968","type":"LOCAL"},{"code":"228838","type":"LOCAL"}],"standard_charges":[{"gross_charge":1971.98,"discounted_cash":1478.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407968 = Hospital System Supply Identifier | 228838 = Lawson ID"}]},{"description":"PLATE PROX DRSL ULNAR 14H LT","code_information":[{"code":"Sx00-2348-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407972","type":"LOCAL"},{"code":"228842","type":"LOCAL"}],"standard_charges":[{"gross_charge":1971.98,"discounted_cash":1478.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407972 = Hospital System Supply Identifier | 228842 = Lawson ID"}]},{"description":"PLATE PROX DRSL ULNAR 12H LT","code_information":[{"code":"Sx00-2348-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407974","type":"LOCAL"},{"code":"228844","type":"LOCAL"}],"standard_charges":[{"gross_charge":1971.98,"discounted_cash":1478.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407974 = Hospital System Supply Identifier | 228844 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-13-08","code_information":[{"code":"Sx00-2348-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407903","type":"LOCAL"},{"code":"208170","type":"LOCAL"}],"standard_charges":[{"gross_charge":1489.58,"discounted_cash":1117.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407903 = Hospital System Supply Identifier | 208170 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-13-10","code_information":[{"code":"Sx00-2348-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407904","type":"LOCAL"},{"code":"208171","type":"LOCAL"}],"standard_charges":[{"gross_charge":1569.66,"discounted_cash":1177.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407904 = Hospital System Supply Identifier | 208171 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-13-06","code_information":[{"code":"Sx00-2348-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407902","type":"LOCAL"},{"code":"208169","type":"LOCAL"}],"standard_charges":[{"gross_charge":1433.52,"discounted_cash":1075.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407902 = Hospital System Supply Identifier | 208169 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-13-12","code_information":[{"code":"Sx00-2348-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407905","type":"LOCAL"},{"code":"208172","type":"LOCAL"}],"standard_charges":[{"gross_charge":1665.76,"discounted_cash":1249.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407905 = Hospital System Supply Identifier | 208172 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-13-03","code_information":[{"code":"Sx00-2348-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407900","type":"LOCAL"},{"code":"208167","type":"LOCAL"}],"standard_charges":[{"gross_charge":1334.14,"discounted_cash":1000.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407900 = Hospital System Supply Identifier | 208167 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-13-02","code_information":[{"code":"Sx00-2348-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407899","type":"LOCAL"},{"code":"208166","type":"LOCAL"}],"standard_charges":[{"gross_charge":1334.14,"discounted_cash":1000.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407899 = Hospital System Supply Identifier | 208166 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-13-04","code_information":[{"code":"Sx00-2348-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407901","type":"LOCAL"},{"code":"208168","type":"LOCAL"}],"standard_charges":[{"gross_charge":1382.36,"discounted_cash":1036.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407901 = Hospital System Supply Identifier | 208168 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-14-02","code_information":[{"code":"Sx00-2348-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407906","type":"LOCAL"},{"code":"208173","type":"LOCAL"}],"standard_charges":[{"gross_charge":1334.14,"discounted_cash":1000.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407906 = Hospital System Supply Identifier | 208173 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-14-03","code_information":[{"code":"Sx00-2348-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407907","type":"LOCAL"},{"code":"208174","type":"LOCAL"}],"standard_charges":[{"gross_charge":1334.14,"discounted_cash":1000.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407907 = Hospital System Supply Identifier | 208174 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-14-04","code_information":[{"code":"Sx00-2348-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407908","type":"LOCAL"},{"code":"208175","type":"LOCAL"}],"standard_charges":[{"gross_charge":1382.36,"discounted_cash":1036.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407908 = Hospital System Supply Identifier | 208175 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-14-06","code_information":[{"code":"Sx00-2348-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407909","type":"LOCAL"},{"code":"208176","type":"LOCAL"}],"standard_charges":[{"gross_charge":1433.52,"discounted_cash":1075.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407909 = Hospital System Supply Identifier | 208176 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-14-08","code_information":[{"code":"Sx00-2348-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407910","type":"LOCAL"},{"code":"208177","type":"LOCAL"}],"standard_charges":[{"gross_charge":1489.58,"discounted_cash":1117.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407910 = Hospital System Supply Identifier | 208177 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-14-10","code_information":[{"code":"Sx00-2348-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407911","type":"LOCAL"},{"code":"208178","type":"LOCAL"}],"standard_charges":[{"gross_charge":1569.66,"discounted_cash":1177.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407911 = Hospital System Supply Identifier | 208178 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-14-12","code_information":[{"code":"Sx00-2348-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407912","type":"LOCAL"},{"code":"208179","type":"LOCAL"}],"standard_charges":[{"gross_charge":1665.76,"discounted_cash":1249.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407912 = Hospital System Supply Identifier | 208179 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-17-07","code_information":[{"code":"Sx00-2348-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407916","type":"LOCAL"},{"code":"208183","type":"LOCAL"}],"standard_charges":[{"gross_charge":1433.52,"discounted_cash":1075.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407916 = Hospital System Supply Identifier | 208183 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-17-05","code_information":[{"code":"Sx00-2348-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407915","type":"LOCAL"},{"code":"208182","type":"LOCAL"}],"standard_charges":[{"gross_charge":1382.36,"discounted_cash":1036.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407915 = Hospital System Supply Identifier | 208182 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-17-02","code_information":[{"code":"Sx00-2348-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407913","type":"LOCAL"},{"code":"208180","type":"LOCAL"}],"standard_charges":[{"gross_charge":1334.14,"discounted_cash":1000.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407913 = Hospital System Supply Identifier | 208180 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-17-03","code_information":[{"code":"Sx00-2348-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407914","type":"LOCAL"},{"code":"208181","type":"LOCAL"}],"standard_charges":[{"gross_charge":1334.14,"discounted_cash":1000.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407914 = Hospital System Supply Identifier | 208181 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-18-02","code_information":[{"code":"Sx00-2348-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407917","type":"LOCAL"},{"code":"208184","type":"LOCAL"}],"standard_charges":[{"gross_charge":1334.14,"discounted_cash":1000.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407917 = Hospital System Supply Identifier | 208184 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-18-03","code_information":[{"code":"Sx00-2348-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407918","type":"LOCAL"},{"code":"208185","type":"LOCAL"}],"standard_charges":[{"gross_charge":1334.14,"discounted_cash":1000.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407918 = Hospital System Supply Identifier | 208185 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-18-05","code_information":[{"code":"Sx00-2348-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407919","type":"LOCAL"},{"code":"208186","type":"LOCAL"}],"standard_charges":[{"gross_charge":1382.36,"discounted_cash":1036.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407919 = Hospital System Supply Identifier | 208186 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-18-07","code_information":[{"code":"Sx00-2348-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407920","type":"LOCAL"},{"code":"208187","type":"LOCAL"}],"standard_charges":[{"gross_charge":1433.52,"discounted_cash":1075.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407920 = Hospital System Supply Identifier | 208187 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-21-10","code_information":[{"code":"Sx00-2348-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407945","type":"LOCAL"},{"code":"208212","type":"LOCAL"}],"standard_charges":[{"gross_charge":1569.66,"discounted_cash":1177.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407945 = Hospital System Supply Identifier | 208212 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-21-12","code_information":[{"code":"Sx00-2348-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407946","type":"LOCAL"},{"code":"208213","type":"LOCAL"}],"standard_charges":[{"gross_charge":1665.76,"discounted_cash":1249.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407946 = Hospital System Supply Identifier | 208213 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-21-08","code_information":[{"code":"Sx00-2348-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407944","type":"LOCAL"},{"code":"208211","type":"LOCAL"}],"standard_charges":[{"gross_charge":1489.58,"discounted_cash":1117.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407944 = Hospital System Supply Identifier | 208211 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-21-03","code_information":[{"code":"Sx00-2348-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407941","type":"LOCAL"},{"code":"208208","type":"LOCAL"}],"standard_charges":[{"gross_charge":1334.14,"discounted_cash":1000.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407941 = Hospital System Supply Identifier | 208208 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-21-04","code_information":[{"code":"Sx00-2348-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407942","type":"LOCAL"},{"code":"208209","type":"LOCAL"}],"standard_charges":[{"gross_charge":1382.36,"discounted_cash":1036.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407942 = Hospital System Supply Identifier | 208209 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-21-02","code_information":[{"code":"Sx00-2348-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407940","type":"LOCAL"},{"code":"208207","type":"LOCAL"}],"standard_charges":[{"gross_charge":1334.14,"discounted_cash":1000.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407940 = Hospital System Supply Identifier | 208207 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-21-06","code_information":[{"code":"Sx00-2348-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407943","type":"LOCAL"},{"code":"208210","type":"LOCAL"}],"standard_charges":[{"gross_charge":1433.52,"discounted_cash":1075.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407943 = Hospital System Supply Identifier | 208210 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-22-12","code_information":[{"code":"Sx00-2348-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407939","type":"LOCAL"},{"code":"208206","type":"LOCAL"}],"standard_charges":[{"gross_charge":1665.76,"discounted_cash":1249.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407939 = Hospital System Supply Identifier | 208206 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-22-08","code_information":[{"code":"Sx00-2348-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407937","type":"LOCAL"},{"code":"208204","type":"LOCAL"}],"standard_charges":[{"gross_charge":1489.58,"discounted_cash":1117.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407937 = Hospital System Supply Identifier | 208204 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-22-06","code_information":[{"code":"Sx00-2348-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407936","type":"LOCAL"},{"code":"208203","type":"LOCAL"}],"standard_charges":[{"gross_charge":1433.52,"discounted_cash":1075.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407936 = Hospital System Supply Identifier | 208203 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-22-10","code_information":[{"code":"Sx00-2348-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407938","type":"LOCAL"},{"code":"208205","type":"LOCAL"}],"standard_charges":[{"gross_charge":1569.66,"discounted_cash":1177.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407938 = Hospital System Supply Identifier | 208205 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-22-03","code_information":[{"code":"Sx00-2348-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407934","type":"LOCAL"},{"code":"208201","type":"LOCAL"}],"standard_charges":[{"gross_charge":1334.14,"discounted_cash":1000.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407934 = Hospital System Supply Identifier | 208201 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-22-02","code_information":[{"code":"Sx00-2348-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407933","type":"LOCAL"},{"code":"208200","type":"LOCAL"}],"standard_charges":[{"gross_charge":1334.14,"discounted_cash":1000.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407933 = Hospital System Supply Identifier | 208200 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-22-04","code_information":[{"code":"Sx00-2348-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407935","type":"LOCAL"},{"code":"208202","type":"LOCAL"}],"standard_charges":[{"gross_charge":1382.36,"discounted_cash":1036.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407935 = Hospital System Supply Identifier | 208202 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-25-01","code_information":[{"code":"Sx00-2348-025","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407927","type":"LOCAL"},{"code":"208194","type":"LOCAL"}],"standard_charges":[{"gross_charge":1855.11,"discounted_cash":1391.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407927 = Hospital System Supply Identifier | 208194 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-25-02","code_information":[{"code":"Sx00-2348-025","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407928","type":"LOCAL"},{"code":"208195","type":"LOCAL"}],"standard_charges":[{"gross_charge":1855.11,"discounted_cash":1391.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407928 = Hospital System Supply Identifier | 208195 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-25-04","code_information":[{"code":"Sx00-2348-025","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407929","type":"LOCAL"},{"code":"208196","type":"LOCAL"}],"standard_charges":[{"gross_charge":1937.23,"discounted_cash":1452.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407929 = Hospital System Supply Identifier | 208196 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-25-06","code_information":[{"code":"Sx00-2348-025","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407930","type":"LOCAL"},{"code":"208197","type":"LOCAL"}],"standard_charges":[{"gross_charge":2027.73,"discounted_cash":1520.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407930 = Hospital System Supply Identifier | 208197 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-25-08","code_information":[{"code":"Sx00-2348-025","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407931","type":"LOCAL"},{"code":"208198","type":"LOCAL"}],"standard_charges":[{"gross_charge":2134.97,"discounted_cash":1601.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407931 = Hospital System Supply Identifier | 208198 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-25-10","code_information":[{"code":"Sx00-2348-025","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407932","type":"LOCAL"},{"code":"208199","type":"LOCAL"}],"standard_charges":[{"gross_charge":2287.66,"discounted_cash":1715.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407932 = Hospital System Supply Identifier | 208199 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-26-08","code_information":[{"code":"Sx00-2348-026","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407925","type":"LOCAL"},{"code":"208192","type":"LOCAL"}],"standard_charges":[{"gross_charge":2134.97,"discounted_cash":1601.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407925 = Hospital System Supply Identifier | 208192 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-26-06","code_information":[{"code":"Sx00-2348-026","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407924","type":"LOCAL"},{"code":"208191","type":"LOCAL"}],"standard_charges":[{"gross_charge":2027.73,"discounted_cash":1520.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407924 = Hospital System Supply Identifier | 208191 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-26-10","code_information":[{"code":"Sx00-2348-026","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407926","type":"LOCAL"},{"code":"208193","type":"LOCAL"}],"standard_charges":[{"gross_charge":2287.66,"discounted_cash":1715.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407926 = Hospital System Supply Identifier | 208193 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-26-02","code_information":[{"code":"Sx00-2348-026","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407922","type":"LOCAL"},{"code":"208189","type":"LOCAL"}],"standard_charges":[{"gross_charge":1855.11,"discounted_cash":1391.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407922 = Hospital System Supply Identifier | 208189 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-26-01","code_information":[{"code":"Sx00-2348-026","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407921","type":"LOCAL"},{"code":"208188","type":"LOCAL"}],"standard_charges":[{"gross_charge":1855.11,"discounted_cash":1391.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407921 = Hospital System Supply Identifier | 208188 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-26-04","code_information":[{"code":"Sx00-2348-026","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407923","type":"LOCAL"},{"code":"208190","type":"LOCAL"}],"standard_charges":[{"gross_charge":1937.23,"discounted_cash":1452.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 407923 = Hospital System Supply Identifier | 208190 = Lawson ID"}]},{"description":"PLATE LOK HUM DST 98MM 5H RT","code_information":[{"code":"Sx00-2358-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"196420","type":"LOCAL"},{"code":"410434","type":"LOCAL"}],"standard_charges":[{"gross_charge":2151.24,"discounted_cash":1613.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 196420 = Hospital System Supply Identifier | 410434 = Lawson ID"}]},{"description":"PLATE LOK HUM DST 150MM 9H RT","code_information":[{"code":"Sx00-2358-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410188","type":"LOCAL"},{"code":"410435","type":"LOCAL"}],"standard_charges":[{"gross_charge":2151.24,"discounted_cash":1613.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410188 = Hospital System Supply Identifier | 410435 = Lawson ID"}]},{"description":"PLATE LAT LOK DST HUM 5H LT","code_information":[{"code":"Sx00-2358-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409352","type":"LOCAL"},{"code":"395448","type":"LOCAL"}],"standard_charges":[{"gross_charge":2151.24,"discounted_cash":1613.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 409352 = Hospital System Supply Identifier | 395448 = Lawson ID"}]},{"description":"PLATE HUM DIST LOK LT 9H 150","code_information":[{"code":"Sx00-2358-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"411386","type":"LOCAL"},{"code":"479626","type":"LOCAL"}],"standard_charges":[{"gross_charge":2151.24,"discounted_cash":1613.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 411386 = Hospital System Supply Identifier | 479626 = Lawson ID"}]},{"description":"PLATE LOK HUM DST 3H RT NS","code_information":[{"code":"Sx00-2358-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410189","type":"LOCAL"},{"code":"410436","type":"LOCAL"}],"standard_charges":[{"gross_charge":2151.24,"discounted_cash":1613.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410189 = Hospital System Supply Identifier | 410436 = Lawson ID"}]},{"description":"PLATE LOK HUM DST 78MM 3H LT","code_information":[{"code":"Sx00-2358-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410190","type":"LOCAL"},{"code":"410437","type":"LOCAL"}],"standard_charges":[{"gross_charge":2151.24,"discounted_cash":1613.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410190 = Hospital System Supply Identifier | 410437 = Lawson ID"}]},{"description":"PLATE LOK HUM DST 104MM 5H LT","code_information":[{"code":"Sx00-2358-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410191","type":"LOCAL"},{"code":"410438","type":"LOCAL"}],"standard_charges":[{"gross_charge":2151.24,"discounted_cash":1613.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410191 = Hospital System Supply Identifier | 410438 = Lawson ID"}]},{"description":"PLATE LOK HUM DST 130MM 7H LT","code_information":[{"code":"Sx00-2358-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410192","type":"LOCAL"},{"code":"410439","type":"LOCAL"}],"standard_charges":[{"gross_charge":2151.24,"discounted_cash":1613.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410192 = Hospital System Supply Identifier | 410439 = Lawson ID"}]},{"description":"PLATE LOK PROX ULNA 5H RT","code_information":[{"code":"Sx00-2358-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"411070","type":"LOCAL"},{"code":"433869","type":"LOCAL"}],"standard_charges":[{"gross_charge":1958.18,"discounted_cash":1468.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 411070 = Hospital System Supply Identifier | 433869 = Lawson ID"}]},{"description":"PLATE LOK PROX ULNA 3H RT","code_information":[{"code":"Sx00-2358-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"81267","type":"LOCAL"},{"code":"392693","type":"LOCAL"}],"standard_charges":[{"gross_charge":1958.18,"discounted_cash":1468.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 81267 = Hospital System Supply Identifier | 392693 = Lawson ID"}]},{"description":"PLATE LOK PROX ULNA 5H LT","code_information":[{"code":"Sx00-2358-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"87198","type":"LOCAL"},{"code":"379064","type":"LOCAL"}],"standard_charges":[{"gross_charge":1958.18,"discounted_cash":1468.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 87198 = Hospital System Supply Identifier | 379064 = Lawson ID"}]},{"description":"PLATE LOK PROX ULNA 3H LT","code_information":[{"code":"Sx00-2358-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"195903","type":"LOCAL"},{"code":"395449","type":"LOCAL"}],"standard_charges":[{"gross_charge":1958.18,"discounted_cash":1468.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 195903 = Hospital System Supply Identifier | 395449 = Lawson ID"}]},{"description":"DISC - PLATE LOK DST VLR RAD 2H RT","code_information":[{"code":"Sx00-2358-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408140","type":"LOCAL"},{"code":"257689","type":"LOCAL"}],"standard_charges":[{"gross_charge":2678.4,"discounted_cash":2008.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408140 = Hospital System Supply Identifier | 257689 = Lawson ID"}]},{"description":"DISC - PLATE LOK DST VLR RAD 3H RT","code_information":[{"code":"Sx00-2358-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408141","type":"LOCAL"},{"code":"257690","type":"LOCAL"}],"standard_charges":[{"gross_charge":2678.4,"discounted_cash":2008.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408141 = Hospital System Supply Identifier | 257690 = Lawson ID"}]},{"description":"DISC - PLATE LOK DST VLR RAD 4H RT","code_information":[{"code":"Sx00-2358-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408142","type":"LOCAL"},{"code":"257691","type":"LOCAL"}],"standard_charges":[{"gross_charge":2678.4,"discounted_cash":2008.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408142 = Hospital System Supply Identifier | 257691 = Lawson ID"}]},{"description":"DISC - PLATE LOK DST VLR RAD 6H RT","code_information":[{"code":"Sx00-2358-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408143","type":"LOCAL"},{"code":"257692","type":"LOCAL"}],"standard_charges":[{"gross_charge":2678.4,"discounted_cash":2008.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408143 = Hospital System Supply Identifier | 257692 = Lawson ID"}]},{"description":"DISC - PLATE LOK DST VLR RAD 8H RT","code_information":[{"code":"Sx00-2358-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408164","type":"LOCAL"},{"code":"257713","type":"LOCAL"}],"standard_charges":[{"gross_charge":2678.4,"discounted_cash":2008.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408164 = Hospital System Supply Identifier | 257713 = Lawson ID"}]},{"description":"DISC - PLATE LOK DST VLR RAD 10H RT","code_information":[{"code":"Sx00-2358-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408165","type":"LOCAL"},{"code":"257714","type":"LOCAL"}],"standard_charges":[{"gross_charge":2678.4,"discounted_cash":2008.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408165 = Hospital System Supply Identifier | 257714 = Lawson ID"}]},{"description":"DISC - PLATE LOK DST VLR RAD 12H RT","code_information":[{"code":"Sx00-2358-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408166","type":"LOCAL"},{"code":"257715","type":"LOCAL"}],"standard_charges":[{"gross_charge":2678.4,"discounted_cash":2008.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408166 = Hospital System Supply Identifier | 257715 = Lawson ID"}]},{"description":"DISC - PLATE LOK DST VLR RAD 10H LT","code_information":[{"code":"Sx00-2358-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408168","type":"LOCAL"},{"code":"257717","type":"LOCAL"}],"standard_charges":[{"gross_charge":2678.4,"discounted_cash":2008.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408168 = Hospital System Supply Identifier | 257717 = Lawson ID"}]},{"description":"DISC - PLATE LOK DST VLR RAD 12H LT","code_information":[{"code":"Sx00-2358-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408169","type":"LOCAL"},{"code":"257718","type":"LOCAL"}],"standard_charges":[{"gross_charge":2678.4,"discounted_cash":2008.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408169 = Hospital System Supply Identifier | 257718 = Lawson ID"}]},{"description":"DISC - PLATE LOK DST VLR RAD 8H LT","code_information":[{"code":"Sx00-2358-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408167","type":"LOCAL"},{"code":"257716","type":"LOCAL"}],"standard_charges":[{"gross_charge":2678.4,"discounted_cash":2008.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408167 = Hospital System Supply Identifier | 257716 = Lawson ID"}]},{"description":"DISC - PLATE LOK DST VLR RAD 2H LT","code_information":[{"code":"Sx00-2358-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408144","type":"LOCAL"},{"code":"257693","type":"LOCAL"}],"standard_charges":[{"gross_charge":2678.4,"discounted_cash":2008.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408144 = Hospital System Supply Identifier | 257693 = Lawson ID"}]},{"description":"DISC - PLATE LOK DST VLR RAD 4H LT","code_information":[{"code":"Sx00-2358-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408146","type":"LOCAL"},{"code":"257695","type":"LOCAL"}],"standard_charges":[{"gross_charge":2678.4,"discounted_cash":2008.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408146 = Hospital System Supply Identifier | 257695 = Lawson ID"}]},{"description":"DISC - PLATE LOK DST VLR RAD 3H LT","code_information":[{"code":"Sx00-2358-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408145","type":"LOCAL"},{"code":"257694","type":"LOCAL"}],"standard_charges":[{"gross_charge":2678.4,"discounted_cash":2008.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408145 = Hospital System Supply Identifier | 257694 = Lawson ID"}]},{"description":"DISC - PLATE LOK DST VLR RAD 6H LT","code_information":[{"code":"Sx00-2358-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408147","type":"LOCAL"},{"code":"257696","type":"LOCAL"}],"standard_charges":[{"gross_charge":2678.4,"discounted_cash":2008.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408147 = Hospital System Supply Identifier | 257696 = Lawson ID"}]},{"description":"DISC - PLATE LOK DST VLR MED 2H RT","code_information":[{"code":"Sx00-2358-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408148","type":"LOCAL"},{"code":"257697","type":"LOCAL"}],"standard_charges":[{"gross_charge":2678.4,"discounted_cash":2008.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408148 = Hospital System Supply Identifier | 257697 = Lawson ID"}]},{"description":"DISC - PLATE LOK DST VLR MED 3H RT","code_information":[{"code":"Sx00-2358-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408149","type":"LOCAL"},{"code":"257698","type":"LOCAL"}],"standard_charges":[{"gross_charge":2678.4,"discounted_cash":2008.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408149 = Hospital System Supply Identifier | 257698 = Lawson ID"}]},{"description":"DISC - PLATE LOK DST VLR MED 4H RT","code_information":[{"code":"Sx00-2358-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408150","type":"LOCAL"},{"code":"257699","type":"LOCAL"}],"standard_charges":[{"gross_charge":2678.4,"discounted_cash":2008.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408150 = Hospital System Supply Identifier | 257699 = Lawson ID"}]},{"description":"DISC - PLATE LOK DST VLR MED 6H RT","code_information":[{"code":"Sx00-2358-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408151","type":"LOCAL"},{"code":"257700","type":"LOCAL"}],"standard_charges":[{"gross_charge":2678.4,"discounted_cash":2008.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408151 = Hospital System Supply Identifier | 257700 = Lawson ID"}]},{"description":"DISC - PLATE LOK DST VLR MED 6H LT","code_information":[{"code":"Sx00-2358-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408155","type":"LOCAL"},{"code":"257704","type":"LOCAL"}],"standard_charges":[{"gross_charge":2678.4,"discounted_cash":2008.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408155 = Hospital System Supply Identifier | 257704 = Lawson ID"}]},{"description":"DISC - PLATE LOK DST VLR MED 4H LT","code_information":[{"code":"Sx00-2358-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408154","type":"LOCAL"},{"code":"257703","type":"LOCAL"}],"standard_charges":[{"gross_charge":2678.4,"discounted_cash":2008.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408154 = Hospital System Supply Identifier | 257703 = Lawson ID"}]},{"description":"DISC - PLATE LOK DST VLR MED 2H LT","code_information":[{"code":"Sx00-2358-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408152","type":"LOCAL"},{"code":"257701","type":"LOCAL"}],"standard_charges":[{"gross_charge":2678.4,"discounted_cash":2008.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408152 = Hospital System Supply Identifier | 257701 = Lawson ID"}]},{"description":"DISC - PLATE LOK DST VLR MED 3H LT","code_information":[{"code":"Sx00-2358-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408153","type":"LOCAL"},{"code":"257702","type":"LOCAL"}],"standard_charges":[{"gross_charge":2678.4,"discounted_cash":2008.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408153 = Hospital System Supply Identifier | 257702 = Lawson ID"}]},{"description":"DISC - PLATE DST DRSL T LOK 2H RT","code_information":[{"code":"Sx00-2358-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408156","type":"LOCAL"},{"code":"257705","type":"LOCAL"}],"standard_charges":[{"gross_charge":2678.4,"discounted_cash":2008.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408156 = Hospital System Supply Identifier | 257705 = Lawson ID"}]},{"description":"DISC - PLATE DST DRSL T LOK 3H RT","code_information":[{"code":"Sx00-2358-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408157","type":"LOCAL"},{"code":"257706","type":"LOCAL"}],"standard_charges":[{"gross_charge":2678.4,"discounted_cash":2008.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408157 = Hospital System Supply Identifier | 257706 = Lawson ID"}]},{"description":"DISC - PLATE DST DRSL T LOK 4H RT","code_information":[{"code":"Sx00-2358-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408158","type":"LOCAL"},{"code":"257707","type":"LOCAL"}],"standard_charges":[{"gross_charge":2678.4,"discounted_cash":2008.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408158 = Hospital System Supply Identifier | 257707 = Lawson ID"}]},{"description":"DISC - PLATE DST DRSL T LOK 6H RT","code_information":[{"code":"Sx00-2358-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408159","type":"LOCAL"},{"code":"257708","type":"LOCAL"}],"standard_charges":[{"gross_charge":2678.4,"discounted_cash":2008.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408159 = Hospital System Supply Identifier | 257708 = Lawson ID"}]},{"description":"DISC - PLATE DST DRSL T LOK 8H RT","code_information":[{"code":"Sx00-2358-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408170","type":"LOCAL"},{"code":"257719","type":"LOCAL"}],"standard_charges":[{"gross_charge":2678.4,"discounted_cash":2008.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408170 = Hospital System Supply Identifier | 257719 = Lawson ID"}]},{"description":"DISC - PLATE DST DRSL T LOK 10H RT","code_information":[{"code":"Sx00-2358-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408171","type":"LOCAL"},{"code":"257720","type":"LOCAL"}],"standard_charges":[{"gross_charge":2678.4,"discounted_cash":2008.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408171 = Hospital System Supply Identifier | 257720 = Lawson ID"}]},{"description":"DISC - PLATE DST DRSL T LOK 8H LT","code_information":[{"code":"Sx00-2358-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"193228","type":"LOCAL"},{"code":"257721","type":"LOCAL"}],"standard_charges":[{"gross_charge":2678.4,"discounted_cash":2008.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 193228 = Hospital System Supply Identifier | 257721 = Lawson ID"}]},{"description":"DISC - PLATE DST DRSL T LOK 10H LT","code_information":[{"code":"Sx00-2358-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408172","type":"LOCAL"},{"code":"257722","type":"LOCAL"}],"standard_charges":[{"gross_charge":2678.4,"discounted_cash":2008.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408172 = Hospital System Supply Identifier | 257722 = Lawson ID"}]},{"description":"DISC - PLATE DST DRSL T LOK 6H LT","code_information":[{"code":"Sx00-2358-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408163","type":"LOCAL"},{"code":"257712","type":"LOCAL"}],"standard_charges":[{"gross_charge":2678.4,"discounted_cash":2008.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408163 = Hospital System Supply Identifier | 257712 = Lawson ID"}]},{"description":"DISC - PLATE DST DRSL T LOK 2H LT","code_information":[{"code":"Sx00-2358-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408160","type":"LOCAL"},{"code":"257709","type":"LOCAL"}],"standard_charges":[{"gross_charge":2678.4,"discounted_cash":2008.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408160 = Hospital System Supply Identifier | 257709 = Lawson ID"}]},{"description":"DISC - PLATE DST DRSL T LOK 3H LT","code_information":[{"code":"Sx00-2358-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408161","type":"LOCAL"},{"code":"257710","type":"LOCAL"}],"standard_charges":[{"gross_charge":2678.4,"discounted_cash":2008.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408161 = Hospital System Supply Identifier | 257710 = Lawson ID"}]},{"description":"DISC - PLATE DST DRSL T LOK 4H LT","code_information":[{"code":"Sx00-2358-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408162","type":"LOCAL"},{"code":"257711","type":"LOCAL"}],"standard_charges":[{"gross_charge":2678.4,"discounted_cash":2008.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408162 = Hospital System Supply Identifier | 257711 = Lawson ID"}]},{"description":"PLATE LAT LOK DST HUM 5H RT","code_information":[{"code":"Sx00-2358-023","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409353","type":"LOCAL"},{"code":"395450","type":"LOCAL"}],"standard_charges":[{"gross_charge":2151.24,"discounted_cash":1613.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 409353 = Hospital System Supply Identifier | 395450 = Lawson ID"}]},{"description":"PLATE LAT LOK DST HUM 7H RT","code_information":[{"code":"Sx00-2358-023","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409354","type":"LOCAL"},{"code":"395451","type":"LOCAL"}],"standard_charges":[{"gross_charge":2151.24,"discounted_cash":1613.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 409354 = Hospital System Supply Identifier | 395451 = Lawson ID"}]},{"description":"PLATE LOK HUM DST 5H LT","code_information":[{"code":"Sx00-2358-024","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410193","type":"LOCAL"},{"code":"410440","type":"LOCAL"}],"standard_charges":[{"gross_charge":2151.24,"discounted_cash":1613.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410193 = Hospital System Supply Identifier | 410440 = Lawson ID"}]},{"description":"PLATE LOK HUM DST 9H LT","code_information":[{"code":"Sx00-2358-024","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410194","type":"LOCAL"},{"code":"410441","type":"LOCAL"}],"standard_charges":[{"gross_charge":2151.24,"discounted_cash":1613.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410194 = Hospital System Supply Identifier | 410441 = Lawson ID"}]},{"description":"DISC - PLATE LOK RAD DST 52MM 2H RT","code_information":[{"code":"Sx00-2358-025","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410195","type":"LOCAL"},{"code":"410442","type":"LOCAL"}],"standard_charges":[{"gross_charge":2678.4,"discounted_cash":2008.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410195 = Hospital System Supply Identifier | 410442 = Lawson ID"}]},{"description":"DISC - PLATE LOK RAD DST 74MM 4H RT","code_information":[{"code":"Sx00-2358-025","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410196","type":"LOCAL"},{"code":"410443","type":"LOCAL"}],"standard_charges":[{"gross_charge":2678.4,"discounted_cash":2008.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410196 = Hospital System Supply Identifier | 410443 = Lawson ID"}]},{"description":"PLATE LOK DST HUM 7H RT","code_information":[{"code":"Sx00-2358-107","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409355","type":"LOCAL"},{"code":"395452","type":"LOCAL"}],"standard_charges":[{"gross_charge":2151.24,"discounted_cash":1613.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 409355 = Hospital System Supply Identifier | 395452 = Lawson ID"}]},{"description":"PLATE LOK HUM DST 74MM 3H RT","code_information":[{"code":"Sx00-2358-107","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410197","type":"LOCAL"},{"code":"410444","type":"LOCAL"}],"standard_charges":[{"gross_charge":2151.24,"discounted_cash":1613.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410197 = Hospital System Supply Identifier | 410444 = Lawson ID"}]},{"description":"PLATE LOK PERI HD/LM 7HL 126MM","code_information":[{"code":"Sx00-2358-108","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410541","type":"LOCAL"},{"code":"432322","type":"LOCAL"}],"standard_charges":[{"gross_charge":2151.24,"discounted_cash":1613.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410541 = Hospital System Supply Identifier | 432322 = Lawson ID"}]},{"description":"PLATE LOK DST HUM 3H LT","code_information":[{"code":"Sx00-2358-108","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409356","type":"LOCAL"},{"code":"395453","type":"LOCAL"}],"standard_charges":[{"gross_charge":2151.24,"discounted_cash":1613.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 409356 = Hospital System Supply Identifier | 395453 = Lawson ID"}]},{"description":"PLATE LOK HUM DST 100MM 5H LT","code_information":[{"code":"Sx00-2358-108","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410198","type":"LOCAL"},{"code":"410445","type":"LOCAL"}],"standard_charges":[{"gross_charge":2151.24,"discounted_cash":1613.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410198 = Hospital System Supply Identifier | 410445 = Lawson ID"}]},{"description":"SCREW PERIARTC LOK 2.4X12MM","code_information":[{"code":"Sx00-2359-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408106","type":"LOCAL"},{"code":"257649","type":"LOCAL"}],"standard_charges":[{"gross_charge":249.05,"discounted_cash":186.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408106 = Hospital System Supply Identifier | 257649 = Lawson ID"}]},{"description":"DISC - SCREW PERIARTC CNCL LOK 2.4X12","code_information":[{"code":"Sx00-2359-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408119","type":"LOCAL"},{"code":"257666","type":"LOCAL"}],"standard_charges":[{"gross_charge":249.05,"discounted_cash":186.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408119 = Hospital System Supply Identifier | 257666 = Lawson ID"}]},{"description":"SCREW PERIARTC LOK 2.4X14MM","code_information":[{"code":"Sx00-2359-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408107","type":"LOCAL"},{"code":"257650","type":"LOCAL"}],"standard_charges":[{"gross_charge":249.05,"discounted_cash":186.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408107 = Hospital System Supply Identifier | 257650 = Lawson ID"}]},{"description":"DISC - SCREW PERIARTC CNCL LOK 2.4X14","code_information":[{"code":"Sx00-2359-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408120","type":"LOCAL"},{"code":"257667","type":"LOCAL"}],"standard_charges":[{"gross_charge":249.05,"discounted_cash":186.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408120 = Hospital System Supply Identifier | 257667 = Lawson ID"}]},{"description":"SCREW PERIARTC LOK 2.4X16MM","code_information":[{"code":"Sx00-2359-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408108","type":"LOCAL"},{"code":"257651","type":"LOCAL"}],"standard_charges":[{"gross_charge":249.05,"discounted_cash":186.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408108 = Hospital System Supply Identifier | 257651 = Lawson ID"}]},{"description":"DISC - SCREW PERIARTC CNCL LOK 2.4X16","code_information":[{"code":"Sx00-2359-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408121","type":"LOCAL"},{"code":"257668","type":"LOCAL"}],"standard_charges":[{"gross_charge":249.05,"discounted_cash":186.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408121 = Hospital System Supply Identifier | 257668 = Lawson ID"}]},{"description":"DISC - SCREW PERIARTC CNCL LOK 2.4X18","code_information":[{"code":"Sx00-2359-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408122","type":"LOCAL"},{"code":"257669","type":"LOCAL"}],"standard_charges":[{"gross_charge":249.05,"discounted_cash":186.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408122 = Hospital System Supply Identifier | 257669 = Lawson ID"}]},{"description":"SCREW PERIARTC LOK 2.4X18MM","code_information":[{"code":"Sx00-2359-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"193222","type":"LOCAL"},{"code":"257652","type":"LOCAL"}],"standard_charges":[{"gross_charge":249.05,"discounted_cash":186.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 193222 = Hospital System Supply Identifier | 257652 = Lawson ID"}]},{"description":"DISC - SCREW PERIARTC CNCL LOK 2.4X22","code_information":[{"code":"Sx00-2359-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408123","type":"LOCAL"},{"code":"257671","type":"LOCAL"}],"standard_charges":[{"gross_charge":249.05,"discounted_cash":186.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408123 = Hospital System Supply Identifier | 257671 = Lawson ID"}]},{"description":"DISC - SCREW PERIARTC CNCL LOK 2.4X24","code_information":[{"code":"Sx00-2359-024","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408124","type":"LOCAL"},{"code":"257672","type":"LOCAL"}],"standard_charges":[{"gross_charge":249.05,"discounted_cash":186.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408124 = Hospital System Supply Identifier | 257672 = Lawson ID"}]},{"description":"SCREW PERIARTC CNCL LOK 2.4X26","code_information":[{"code":"Sx00-2359-026","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408125","type":"LOCAL"},{"code":"257673","type":"LOCAL"}],"standard_charges":[{"gross_charge":249.05,"discounted_cash":186.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408125 = Hospital System Supply Identifier | 257673 = Lawson ID"}]},{"description":"SCREW PERIARTC LOK 2.4X32MM","code_information":[{"code":"Sx00-2359-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408112","type":"LOCAL"},{"code":"257659","type":"LOCAL"}],"standard_charges":[{"gross_charge":249.05,"discounted_cash":186.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408112 = Hospital System Supply Identifier | 257659 = Lawson ID"}]},{"description":"DISC - SCREW PERIARTC CNCL LOK 2.4X36","code_information":[{"code":"Sx00-2359-036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408129","type":"LOCAL"},{"code":"257678","type":"LOCAL"}],"standard_charges":[{"gross_charge":249.05,"discounted_cash":186.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408129 = Hospital System Supply Identifier | 257678 = Lawson ID"}]},{"description":"SCREW CNCL 2.7X40MM","code_information":[{"code":"Sx00-2359-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410457","type":"LOCAL"},{"code":"419227","type":"LOCAL"}],"standard_charges":[{"gross_charge":152.41,"discounted_cash":114.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410457 = Hospital System Supply Identifier | 419227 = Lawson ID"}]},{"description":"GWIRE 1.6MM DRL TIP","code_information":[{"code":"Sx00-2360-033","type":"CDM"},{"code":"272","type":"RC"},{"code":"57445","type":"LOCAL"},{"code":"312606","type":"LOCAL"}],"standard_charges":[{"gross_charge":163.75,"discounted_cash":122.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 57445 = Hospital System Supply Identifier | 312606 = Lawson ID"}]},{"description":"GWIRE ORTH SMTH DRL 1.6X229MM","code_information":[{"code":"Sx00-2360-036","type":"CDM"},{"code":"272","type":"RC"},{"code":"409627","type":"LOCAL"},{"code":"402351","type":"LOCAL"}],"standard_charges":[{"gross_charge":175.8,"discounted_cash":131.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 409627 = Hospital System Supply Identifier | 402351 = Lawson ID"}]},{"description":"BIT DRILL CANN STD 4.7MM","code_information":[{"code":"Sx00-2360-071","type":"CDM"},{"code":"272","type":"RC"},{"code":"202228","type":"LOCAL"},{"code":"452326","type":"LOCAL"}],"standard_charges":[{"gross_charge":398.27,"discounted_cash":298.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 202228 = Hospital System Supply Identifier | 452326 = Lawson ID"}]},{"description":"BIT DRILL STD CANN Q/C 2.7MM","code_information":[{"code":"Sx00-2360-171","type":"CDM"},{"code":"272","type":"RC"},{"code":"193551","type":"LOCAL"},{"code":"312612","type":"LOCAL"}],"standard_charges":[{"gross_charge":334.78,"discounted_cash":251.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 193551 = Hospital System Supply Identifier | 312612 = Lawson ID"}]},{"description":"BIT DRILL STD CANN 2.0MM","code_information":[{"code":"Sx00-2360-175","type":"CDM"},{"code":"272","type":"RC"},{"code":"178409","type":"LOCAL"},{"code":"337133","type":"LOCAL"}],"standard_charges":[{"gross_charge":271.28,"discounted_cash":203.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 178409 = Hospital System Supply Identifier | 337133 = Lawson ID"}]},{"description":"BIT DRILL STD CANN 2.7MM","code_information":[{"code":"Sx00-2360-205","type":"CDM"},{"code":"272","type":"RC"},{"code":"178308","type":"LOCAL"},{"code":"312608","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.07,"discounted_cash":112.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 178308 = Hospital System Supply Identifier | 312608 = Lawson ID"}]},{"description":"BIT DRILL STD CANN 3.7MM","code_information":[{"code":"Sx00-2360-225","type":"CDM"},{"code":"272","type":"RC"},{"code":"153603","type":"LOCAL"},{"code":"294680","type":"LOCAL"}],"standard_charges":[{"gross_charge":288.6,"discounted_cash":216.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 153603 = Hospital System Supply Identifier | 294680 = Lawson ID"}]},{"description":"NO USAGE - BIT DRILL AO 1.8X45MM","code_information":[{"code":"Sx00-2366-030","type":"CDM"},{"code":"272","type":"RC"},{"code":"411335","type":"LOCAL"},{"code":"462085","type":"LOCAL"}],"standard_charges":[{"gross_charge":263.7,"discounted_cash":197.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 411335 = Hospital System Supply Identifier | 462085 = Lawson ID"}]},{"description":"NO USAGE - BIT DRILL AO 2.4X45MM","code_information":[{"code":"Sx00-2366-030","type":"CDM"},{"code":"272","type":"RC"},{"code":"411336","type":"LOCAL"},{"code":"462086","type":"LOCAL"}],"standard_charges":[{"gross_charge":307.65,"discounted_cash":230.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 411336 = Hospital System Supply Identifier | 462086 = Lawson ID"}]},{"description":"BIT DRILL Q/C 2.5X216MM","code_information":[{"code":"Sx00-2410-029","type":"CDM"},{"code":"272","type":"RC"},{"code":"16209","type":"LOCAL"},{"code":"129466","type":"LOCAL"}],"standard_charges":[{"gross_charge":230.88,"discounted_cash":173.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 16209 = Hospital System Supply Identifier | 129466 = Lawson ID"}]},{"description":"SCREW CANC FORTE P/T 4X10MM","code_information":[{"code":"Sx00-2480-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"17849","type":"LOCAL"},{"code":"157489","type":"LOCAL"}],"standard_charges":[{"gross_charge":69.3,"discounted_cash":51.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 17849 = Hospital System Supply Identifier | 157489 = Lawson ID"}]},{"description":"SCREW CANC FORTE P/T 4X18MM","code_information":[{"code":"Sx00-2480-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"17856","type":"LOCAL"},{"code":"157497","type":"LOCAL"}],"standard_charges":[{"gross_charge":69.3,"discounted_cash":51.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 17856 = Hospital System Supply Identifier | 157497 = Lawson ID"}]},{"description":"SCREW CANC FORTE F/T 4X18MM","code_information":[{"code":"Sx00-2480-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"17857","type":"LOCAL"},{"code":"157498","type":"LOCAL"}],"standard_charges":[{"gross_charge":69.3,"discounted_cash":51.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 17857 = Hospital System Supply Identifier | 157498 = Lawson ID"}]},{"description":"SCREW CANC FORTE F/T 4X22MM","code_information":[{"code":"Sx00-2480-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"33316","type":"LOCAL"},{"code":"157502","type":"LOCAL"}],"standard_charges":[{"gross_charge":69.3,"discounted_cash":51.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 33316 = Hospital System Supply Identifier | 157502 = Lawson ID"}]},{"description":"SCREW CANC FORTE P/T 4X22MM","code_information":[{"code":"Sx00-2480-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"33315","type":"LOCAL"},{"code":"157501","type":"LOCAL"}],"standard_charges":[{"gross_charge":69.3,"discounted_cash":51.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 33315 = Hospital System Supply Identifier | 157501 = Lawson ID"}]},{"description":"SCREW CANC FORTE P/T 4X24MM","code_information":[{"code":"Sx00-2480-024","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"34322","type":"LOCAL"},{"code":"157503","type":"LOCAL"}],"standard_charges":[{"gross_charge":69.3,"discounted_cash":51.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 34322 = Hospital System Supply Identifier | 157503 = Lawson ID"}]},{"description":"SCREW CANC FORTE P/T 4X26MM","code_information":[{"code":"Sx00-2480-026","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"33317","type":"LOCAL"},{"code":"157505","type":"LOCAL"}],"standard_charges":[{"gross_charge":69.3,"discounted_cash":51.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 33317 = Hospital System Supply Identifier | 157505 = Lawson ID"}]},{"description":"SCREW CANC FORTE P/T 4X28MM","code_information":[{"code":"Sx00-2480-028","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"33319","type":"LOCAL"},{"code":"157507","type":"LOCAL"}],"standard_charges":[{"gross_charge":69.3,"discounted_cash":51.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 33319 = Hospital System Supply Identifier | 157507 = Lawson ID"}]},{"description":"SCREW CANC FORTE P/T 4X30MM","code_information":[{"code":"Sx00-2480-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"17860","type":"LOCAL"},{"code":"157509","type":"LOCAL"}],"standard_charges":[{"gross_charge":69.3,"discounted_cash":51.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 17860 = Hospital System Supply Identifier | 157509 = Lawson ID"}]},{"description":"SCREW CANC FORTE P/T 4X32MM","code_information":[{"code":"Sx00-2480-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"33322","type":"LOCAL"},{"code":"157511","type":"LOCAL"}],"standard_charges":[{"gross_charge":69.3,"discounted_cash":51.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 33322 = Hospital System Supply Identifier | 157511 = Lawson ID"}]},{"description":"SCREW CANC FORTE F/T 4X32MM","code_information":[{"code":"Sx00-2480-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"33323","type":"LOCAL"},{"code":"157512","type":"LOCAL"}],"standard_charges":[{"gross_charge":69.3,"discounted_cash":51.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 33323 = Hospital System Supply Identifier | 157512 = Lawson ID"}]},{"description":"SCREW CANC FORTE P/T 4X34MM","code_information":[{"code":"Sx00-2480-034","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"33324","type":"LOCAL"},{"code":"157513","type":"LOCAL"}],"standard_charges":[{"gross_charge":69.3,"discounted_cash":51.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 33324 = Hospital System Supply Identifier | 157513 = Lawson ID"}]},{"description":"SCREW CANC FORTE P/T 4X36MM","code_information":[{"code":"Sx00-2480-036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"33326","type":"LOCAL"},{"code":"157515","type":"LOCAL"}],"standard_charges":[{"gross_charge":69.3,"discounted_cash":51.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 33326 = Hospital System Supply Identifier | 157515 = Lawson ID"}]},{"description":"SCREW CANC FORTE F/T 4X36MM","code_information":[{"code":"Sx00-2480-036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"33327","type":"LOCAL"},{"code":"157516","type":"LOCAL"}],"standard_charges":[{"gross_charge":69.3,"discounted_cash":51.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 33327 = Hospital System Supply Identifier | 157516 = Lawson ID"}]},{"description":"SCREW CANC FORTE F/T 4X38MM","code_information":[{"code":"Sx00-2480-038","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"33329","type":"LOCAL"},{"code":"157518","type":"LOCAL"}],"standard_charges":[{"gross_charge":69.3,"discounted_cash":51.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 33329 = Hospital System Supply Identifier | 157518 = Lawson ID"}]},{"description":"SCREW CANC FORTE P/T 4X38MM","code_information":[{"code":"Sx00-2480-038","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"33328","type":"LOCAL"},{"code":"157517","type":"LOCAL"}],"standard_charges":[{"gross_charge":69.3,"discounted_cash":51.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 33328 = Hospital System Supply Identifier | 157517 = Lawson ID"}]},{"description":"PIN THRD 3X305MM","code_information":[{"code":"Sx00-2490-012","type":"CDM"},{"code":"272","type":"RC"},{"code":"360769","type":"LOCAL"},{"code":"389703","type":"LOCAL"}],"standard_charges":[{"gross_charge":246.44,"discounted_cash":184.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 360769 = Hospital System Supply Identifier | 389703 = Lawson ID"}]},{"description":"BIT DRILL CANN FEMUR RF 4.9MM","code_information":[{"code":"Sx00-2490-034","type":"CDM"},{"code":"272","type":"RC"},{"code":"409358","type":"LOCAL"},{"code":"395456","type":"LOCAL"}],"standard_charges":[{"gross_charge":1053.15,"discounted_cash":789.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 409358 = Hospital System Supply Identifier | 395456 = Lawson ID"}]},{"description":"PIN NAT N-THRD 3.0X355MM","code_information":[{"code":"Sx00-2490-047","type":"CDM"},{"code":"272","type":"RC"},{"code":"409151","type":"LOCAL"},{"code":"393312","type":"LOCAL"}],"standard_charges":[{"gross_charge":255.96,"discounted_cash":191.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 409151 = Hospital System Supply Identifier | 393312 = Lawson ID"}]},{"description":"DRILL FREE HAND 4.3MM RED","code_information":[{"code":"Sx00-2490-075","type":"CDM"},{"code":"272","type":"RC"},{"code":"360773","type":"LOCAL"},{"code":"391784","type":"LOCAL"}],"standard_charges":[{"gross_charge":209.78,"discounted_cash":157.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 360773 = Hospital System Supply Identifier | 391784 = Lawson ID"}]},{"description":"PLATE LOK PROX ULNA 7H RT","code_information":[{"code":"Sx00-2538-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"743176","type":"LOCAL"},{"code":"574913","type":"LOCAL"}],"standard_charges":[{"gross_charge":1958.18,"discounted_cash":1468.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 743176 = Hospital System Supply Identifier | 574913 = Lawson ID"}]},{"description":"PIN STNMN THRD STYLE 5 2.0X229","code_information":[{"code":"Sx00-2620-033","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"725565","type":"LOCAL"},{"code":"737012","type":"LOCAL"}],"standard_charges":[{"gross_charge":49.86,"discounted_cash":37.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 725565 = Hospital System Supply Identifier | 737012 = Lawson ID"}]},{"description":"PLATE L1 ORTHANC FLAT TAB 4H","code_information":[{"code":"Sx00-301-12-0","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"779933","type":"LOCAL"},{"code":"773378","type":"LOCAL"}],"standard_charges":[{"gross_charge":548.84,"discounted_cash":411.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 779933 = Hospital System Supply Identifier | 773378 = Lawson ID"}]},{"description":"PLATE L1 ORTHANC FLAT TAB 4H","code_information":[{"code":"Sx00-301-14-0","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"779934","type":"LOCAL"},{"code":"773379","type":"LOCAL"}],"standard_charges":[{"gross_charge":541.25,"discounted_cash":405.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 779934 = Hospital System Supply Identifier | 773379 = Lawson ID"}]},{"description":"PLATE L1 ORTHANC FLAT TAB 4H","code_information":[{"code":"Sx00-301-17-0","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"779935","type":"LOCAL"},{"code":"773380","type":"LOCAL"}],"standard_charges":[{"gross_charge":541.25,"discounted_cash":405.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 779935 = Hospital System Supply Identifier | 773380 = Lawson ID"}]},{"description":"FLEXFOAM STRIP 3INX25YD","code_information":[{"code":"Sx00-3861-002","type":"CDM"},{"code":"272","type":"RC"},{"code":"391624","type":"LOCAL"},{"code":"255268","type":"LOCAL"}],"standard_charges":[{"gross_charge":159.94,"discounted_cash":119.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 391624 = Hospital System Supply Identifier | 255268 = Lawson ID"}]},{"description":"IMP HIP FEM STEM RNL 125DX13","code_information":[{"code":"Sx00-4088-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302815","type":"LOCAL"},{"code":"521759","type":"LOCAL"}],"standard_charges":[{"gross_charge":5685.5,"discounted_cash":4264.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302815 = Hospital System Supply Identifier | 521759 = Lawson ID"}]},{"description":"IMP HIP FEM STEM RNL 125DX14","code_information":[{"code":"Sx00-4088-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302821","type":"LOCAL"},{"code":"521765","type":"LOCAL"}],"standard_charges":[{"gross_charge":5685.5,"discounted_cash":4264.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302821 = Hospital System Supply Identifier | 521765 = Lawson ID"}]},{"description":"IMP HIP FEM STEM LM EXT 15MM","code_information":[{"code":"Sx00-4088-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302825","type":"LOCAL"},{"code":"521769","type":"LOCAL"}],"standard_charges":[{"gross_charge":7752.0,"discounted_cash":5814.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302825 = Hospital System Supply Identifier | 521769 = Lawson ID"}]},{"description":"IMP HIP FEM STEM RNL 135DX15","code_information":[{"code":"Sx00-4088-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302827","type":"LOCAL"},{"code":"521771","type":"LOCAL"}],"standard_charges":[{"gross_charge":7752.0,"discounted_cash":5814.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302827 = Hospital System Supply Identifier | 521771 = Lawson ID"}]},{"description":"IMP HIP FEM STEM RNL 125DX15","code_information":[{"code":"Sx00-4088-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302828","type":"LOCAL"},{"code":"521772","type":"LOCAL"}],"standard_charges":[{"gross_charge":5685.5,"discounted_cash":4264.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302828 = Hospital System Supply Identifier | 521772 = Lawson ID"}]},{"description":"IMP HIP FEM STEM LM EXT 16MM","code_information":[{"code":"Sx00-4088-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302832","type":"LOCAL"},{"code":"521776","type":"LOCAL"}],"standard_charges":[{"gross_charge":7752.0,"discounted_cash":5814.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302832 = Hospital System Supply Identifier | 521776 = Lawson ID"}]},{"description":"IMP HIP FEM STEM RNL 135DX16","code_information":[{"code":"Sx00-4088-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302834","type":"LOCAL"},{"code":"521778","type":"LOCAL"}],"standard_charges":[{"gross_charge":7752.0,"discounted_cash":5814.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302834 = Hospital System Supply Identifier | 521778 = Lawson ID"}]},{"description":"IMP HIP FEM STEM RNL 125DX16","code_information":[{"code":"Sx00-4088-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302835","type":"LOCAL"},{"code":"521779","type":"LOCAL"}],"standard_charges":[{"gross_charge":7752.0,"discounted_cash":5814.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302835 = Hospital System Supply Identifier | 521779 = Lawson ID"}]},{"description":"IMP HIP FEM STEM RNL 125DX17","code_information":[{"code":"Sx00-4088-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302842","type":"LOCAL"},{"code":"521786","type":"LOCAL"}],"standard_charges":[{"gross_charge":5685.5,"discounted_cash":4264.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302842 = Hospital System Supply Identifier | 521786 = Lawson ID"}]},{"description":"IMP HIP FEM STEM LM EXT 17MM","code_information":[{"code":"Sx00-4088-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302839","type":"LOCAL"},{"code":"521783","type":"LOCAL"}],"standard_charges":[{"gross_charge":7752.0,"discounted_cash":5814.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302839 = Hospital System Supply Identifier | 521783 = Lawson ID"}]},{"description":"IMP HIP FEM STEM RNL 135DX17","code_information":[{"code":"Sx00-4088-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302841","type":"LOCAL"},{"code":"521785","type":"LOCAL"}],"standard_charges":[{"gross_charge":7752.0,"discounted_cash":5814.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302841 = Hospital System Supply Identifier | 521785 = Lawson ID"}]},{"description":"IMP HIP FEM STEM LM EXT 18MM","code_information":[{"code":"Sx00-4088-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302846","type":"LOCAL"},{"code":"521790","type":"LOCAL"}],"standard_charges":[{"gross_charge":7752.0,"discounted_cash":5814.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302846 = Hospital System Supply Identifier | 521790 = Lawson ID"}]},{"description":"IMP HIP FEM STEM RNL 135DX18","code_information":[{"code":"Sx00-4088-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302848","type":"LOCAL"},{"code":"521792","type":"LOCAL"}],"standard_charges":[{"gross_charge":7752.0,"discounted_cash":5814.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302848 = Hospital System Supply Identifier | 521792 = Lawson ID"}]},{"description":"IMP HIP FEM STEM RNL 125DX18","code_information":[{"code":"Sx00-4088-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302849","type":"LOCAL"},{"code":"521793","type":"LOCAL"}],"standard_charges":[{"gross_charge":7752.0,"discounted_cash":5814.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302849 = Hospital System Supply Identifier | 521793 = Lawson ID"}]},{"description":"IMP HIP FEM STEM RNL 135DX19","code_information":[{"code":"Sx00-4088-019","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302852","type":"LOCAL"},{"code":"521796","type":"LOCAL"}],"standard_charges":[{"gross_charge":7752.0,"discounted_cash":5814.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302852 = Hospital System Supply Identifier | 521796 = Lawson ID"}]},{"description":"IMP HIP FEM STEM RNL 125DX19","code_information":[{"code":"Sx00-4088-019","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302853","type":"LOCAL"},{"code":"521797","type":"LOCAL"}],"standard_charges":[{"gross_charge":7752.0,"discounted_cash":5814.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302853 = Hospital System Supply Identifier | 521797 = Lawson ID"}]},{"description":"IMP HIP FEM STEM RNL 125DX20","code_information":[{"code":"Sx00-4088-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302857","type":"LOCAL"},{"code":"521801","type":"LOCAL"}],"standard_charges":[{"gross_charge":7752.0,"discounted_cash":5814.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302857 = Hospital System Supply Identifier | 521801 = Lawson ID"}]},{"description":"IMP HIP FEM STEM RNL 135DX20","code_information":[{"code":"Sx00-4088-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302856","type":"LOCAL"},{"code":"521800","type":"LOCAL"}],"standard_charges":[{"gross_charge":7752.0,"discounted_cash":5814.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302856 = Hospital System Supply Identifier | 521800 = Lawson ID"}]},{"description":"RESTRICTOR CEM ACET TM 26MM","code_information":[{"code":"Sx00-4199-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"330133","type":"LOCAL"},{"code":"418233","type":"LOCAL"}],"standard_charges":[{"gross_charge":2577.96,"discounted_cash":1933.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 330133 = Hospital System Supply Identifier | 418233 = Lawson ID"}]},{"description":"RESTRICTOR CEMENT 32MM STRL TRABECULAR METAL HIP ACETABULAR","code_information":[{"code":"Sx00-4199-001","type":"CDM"},{"code":"272","type":"RC"},{"code":"314881","type":"LOCAL"},{"code":"530002","type":"LOCAL"}],"standard_charges":[{"gross_charge":2232.0,"discounted_cash":1674.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 314881 = Hospital System Supply Identifier | 530002 = Lawson ID"}]},{"description":"IMP HIP ACET RSTRCT 38MM","code_information":[{"code":"Sx00-4199-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326713","type":"LOCAL"},{"code":"408140","type":"LOCAL"}],"standard_charges":[{"gross_charge":2577.96,"discounted_cash":1933.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 326713 = Hospital System Supply Identifier | 408140 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM STEM6X60MM","code_information":[{"code":"Sx00-4300-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302862","type":"LOCAL"},{"code":"521806","type":"LOCAL"}],"standard_charges":[{"gross_charge":4757.55,"discounted_cash":3568.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302862 = Hospital System Supply Identifier | 521806 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM STEM6X130MM","code_information":[{"code":"Sx00-4300-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302863","type":"LOCAL"},{"code":"521807","type":"LOCAL"}],"standard_charges":[{"gross_charge":4757.55,"discounted_cash":3568.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302863 = Hospital System Supply Identifier | 521807 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM STEM 7X130MM","code_information":[{"code":"Sx00-4300-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"323283","type":"LOCAL"},{"code":"153980","type":"LOCAL"}],"standard_charges":[{"gross_charge":4757.55,"discounted_cash":3568.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 323283 = Hospital System Supply Identifier | 153980 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM STEM BGLN 7","code_information":[{"code":"Sx00-4300-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"86088","type":"LOCAL"},{"code":"305404","type":"LOCAL"}],"standard_charges":[{"gross_charge":4757.55,"discounted_cash":3568.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 86088 = Hospital System Supply Identifier | 305404 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM STEM 8X130MM","code_information":[{"code":"Sx00-4300-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"166657","type":"LOCAL"},{"code":"147867","type":"LOCAL"}],"standard_charges":[{"gross_charge":4757.55,"discounted_cash":3568.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 166657 = Hospital System Supply Identifier | 147867 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM STEM8X170MM","code_information":[{"code":"Sx00-4300-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302864","type":"LOCAL"},{"code":"521808","type":"LOCAL"}],"standard_charges":[{"gross_charge":4757.55,"discounted_cash":3568.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302864 = Hospital System Supply Identifier | 521808 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM STEM8X200MM","code_information":[{"code":"Sx00-4300-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302865","type":"LOCAL"},{"code":"521809","type":"LOCAL"}],"standard_charges":[{"gross_charge":7408.0,"discounted_cash":5556.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302865 = Hospital System Supply Identifier | 521809 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM STEM 9X130MM","code_information":[{"code":"Sx00-4300-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"35400","type":"LOCAL"},{"code":"153062","type":"LOCAL"}],"standard_charges":[{"gross_charge":4757.55,"discounted_cash":3568.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 35400 = Hospital System Supply Identifier | 153062 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM STEM10X200MM","code_information":[{"code":"Sx00-4300-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302866","type":"LOCAL"},{"code":"521810","type":"LOCAL"}],"standard_charges":[{"gross_charge":7408.0,"discounted_cash":5556.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302866 = Hospital System Supply Identifier | 521810 = Lawson ID"}]},{"description":"IMP SHLDR-T HUM STEM 10X170","code_information":[{"code":"Sx00-4300-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329906","type":"LOCAL"},{"code":"398068","type":"LOCAL"}],"standard_charges":[{"gross_charge":4757.55,"discounted_cash":3568.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329906 = Hospital System Supply Identifier | 398068 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM STEM 10X130","code_information":[{"code":"Sx00-4300-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"35393","type":"LOCAL"},{"code":"151511","type":"LOCAL"}],"standard_charges":[{"gross_charge":4757.55,"discounted_cash":3568.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 35393 = Hospital System Supply Identifier | 151511 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM STEM 11X130","code_information":[{"code":"Sx00-4300-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"35425","type":"LOCAL"},{"code":"156812","type":"LOCAL"}],"standard_charges":[{"gross_charge":4757.55,"discounted_cash":3568.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 35425 = Hospital System Supply Identifier | 156812 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM STEM 12X130","code_information":[{"code":"Sx00-4300-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"92890","type":"LOCAL"},{"code":"148416","type":"LOCAL"}],"standard_charges":[{"gross_charge":4757.55,"discounted_cash":3568.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 92890 = Hospital System Supply Identifier | 148416 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM STEM 12X170","code_information":[{"code":"Sx00-4300-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326233","type":"LOCAL"},{"code":"391786","type":"LOCAL"}],"standard_charges":[{"gross_charge":4757.55,"discounted_cash":3568.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 326233 = Hospital System Supply Identifier | 391786 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM STEM12X200MM","code_information":[{"code":"Sx00-4300-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302867","type":"LOCAL"},{"code":"521811","type":"LOCAL"}],"standard_charges":[{"gross_charge":7408.0,"discounted_cash":5556.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302867 = Hospital System Supply Identifier | 521811 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM STEM BGLN 13","code_information":[{"code":"Sx00-4300-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"94002","type":"LOCAL"},{"code":"232672","type":"LOCAL"}],"standard_charges":[{"gross_charge":4757.55,"discounted_cash":3568.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 94002 = Hospital System Supply Identifier | 232672 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM STEM BGLN 14","code_information":[{"code":"Sx00-4300-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"149470","type":"LOCAL"},{"code":"236852","type":"LOCAL"}],"standard_charges":[{"gross_charge":4757.55,"discounted_cash":3568.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 149470 = Hospital System Supply Identifier | 236852 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM STEM14X170MM","code_information":[{"code":"Sx00-4300-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302868","type":"LOCAL"},{"code":"521812","type":"LOCAL"}],"standard_charges":[{"gross_charge":4757.55,"discounted_cash":3568.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302868 = Hospital System Supply Identifier | 521812 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM STEM14X200MM","code_information":[{"code":"Sx00-4300-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302869","type":"LOCAL"},{"code":"521813","type":"LOCAL"}],"standard_charges":[{"gross_charge":7408.0,"discounted_cash":5556.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302869 = Hospital System Supply Identifier | 521813 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM STEM 15X130","code_information":[{"code":"Sx00-4300-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"35482","type":"LOCAL"},{"code":"158629","type":"LOCAL"}],"standard_charges":[{"gross_charge":4757.55,"discounted_cash":3568.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 35482 = Hospital System Supply Identifier | 158629 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM STEM 16X130","code_information":[{"code":"Sx00-4300-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"150051","type":"LOCAL"},{"code":"237743","type":"LOCAL"}],"standard_charges":[{"gross_charge":4757.55,"discounted_cash":3568.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 150051 = Hospital System Supply Identifier | 237743 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM STEM17X130MM","code_information":[{"code":"Sx00-4300-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302870","type":"LOCAL"},{"code":"521814","type":"LOCAL"}],"standard_charges":[{"gross_charge":4757.55,"discounted_cash":3568.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302870 = Hospital System Supply Identifier | 521814 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM STEM18X130MM","code_information":[{"code":"Sx00-4300-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302871","type":"LOCAL"},{"code":"521815","type":"LOCAL"}],"standard_charges":[{"gross_charge":4757.55,"discounted_cash":3568.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302871 = Hospital System Supply Identifier | 521815 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD 40X24MM","code_information":[{"code":"Sx00-4300-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"323285","type":"LOCAL"},{"code":"160249","type":"LOCAL"}],"standard_charges":[{"gross_charge":2473.33,"discounted_cash":1855.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 323285 = Hospital System Supply Identifier | 160249 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD BGLN 40","code_information":[{"code":"Sx00-4300-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"149556","type":"LOCAL"},{"code":"236968","type":"LOCAL"}],"standard_charges":[{"gross_charge":2473.33,"discounted_cash":1855.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 149556 = Hospital System Supply Identifier | 236968 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM STEM BGLN 40","code_information":[{"code":"Sx00-4300-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"151456","type":"LOCAL"},{"code":"254477","type":"LOCAL"}],"standard_charges":[{"gross_charge":2473.33,"discounted_cash":1855.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 151456 = Hospital System Supply Identifier | 254477 = Lawson ID"}]},{"description":"IMP GLEN COMP 46MM W/KEEL","code_information":[{"code":"Sx00-4300-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"324794","type":"LOCAL"},{"code":"323988","type":"LOCAL"}],"standard_charges":[{"gross_charge":2206.4,"discounted_cash":1654.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 324794 = Hospital System Supply Identifier | 323988 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD 15X40MM","code_information":[{"code":"Sx00-4300-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302872","type":"LOCAL"},{"code":"521816","type":"LOCAL"}],"standard_charges":[{"gross_charge":2473.33,"discounted_cash":1855.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302872 = Hospital System Supply Identifier | 521816 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD 27X40MM","code_information":[{"code":"Sx00-4300-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302873","type":"LOCAL"},{"code":"521817","type":"LOCAL"}],"standard_charges":[{"gross_charge":2473.33,"discounted_cash":1855.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302873 = Hospital System Supply Identifier | 521817 = Lawson ID"}]},{"description":"IMP GLEN COMP 40MM W/KEEL","code_information":[{"code":"Sx00-4300-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302878","type":"LOCAL"},{"code":"521822","type":"LOCAL"}],"standard_charges":[{"gross_charge":2206.4,"discounted_cash":1654.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302878 = Hospital System Supply Identifier | 521822 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD 33X46MM","code_information":[{"code":"Sx00-4300-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302877","type":"LOCAL"},{"code":"521821","type":"LOCAL"}],"standard_charges":[{"gross_charge":2473.33,"discounted_cash":1855.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302877 = Hospital System Supply Identifier | 521821 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD 30X46MM","code_information":[{"code":"Sx00-4300-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302876","type":"LOCAL"},{"code":"521820","type":"LOCAL"}],"standard_charges":[{"gross_charge":2473.33,"discounted_cash":1855.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302876 = Hospital System Supply Identifier | 521820 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD 27X46MM","code_information":[{"code":"Sx00-4300-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302875","type":"LOCAL"},{"code":"521819","type":"LOCAL"}],"standard_charges":[{"gross_charge":2473.33,"discounted_cash":1855.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302875 = Hospital System Supply Identifier | 521819 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD 46X15MM","code_information":[{"code":"Sx00-4300-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"84819","type":"LOCAL"},{"code":"236915","type":"LOCAL"}],"standard_charges":[{"gross_charge":2473.33,"discounted_cash":1855.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 84819 = Hospital System Supply Identifier | 236915 = Lawson ID"}]},{"description":"IMP GLEN COMP 52MM W/KEEL","code_information":[{"code":"Sx00-4300-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"324795","type":"LOCAL"},{"code":"323989","type":"LOCAL"}],"standard_charges":[{"gross_charge":2206.4,"discounted_cash":1654.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 324795 = Hospital System Supply Identifier | 323989 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD 46X18MM","code_information":[{"code":"Sx00-4300-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"328899","type":"LOCAL"},{"code":"153742","type":"LOCAL"}],"standard_charges":[{"gross_charge":2473.33,"discounted_cash":1855.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 328899 = Hospital System Supply Identifier | 153742 = Lawson ID"}]},{"description":"HEAD HUMERAL","code_information":[{"code":"Sx00-4300-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"92891","type":"LOCAL"},{"code":"148417","type":"LOCAL"}],"standard_charges":[{"gross_charge":2473.33,"discounted_cash":1855.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 92891 = Hospital System Supply Identifier | 148417 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD 24X46MM","code_information":[{"code":"Sx00-4300-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302874","type":"LOCAL"},{"code":"521818","type":"LOCAL"}],"standard_charges":[{"gross_charge":2473.33,"discounted_cash":1855.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302874 = Hospital System Supply Identifier | 521818 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD 36X52MM","code_information":[{"code":"Sx00-4300-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302882","type":"LOCAL"},{"code":"521826","type":"LOCAL"}],"standard_charges":[{"gross_charge":2473.33,"discounted_cash":1855.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302882 = Hospital System Supply Identifier | 521826 = Lawson ID"}]},{"description":"IMP SHLDR GLEN 52MM 56MM SURF","code_information":[{"code":"Sx00-4300-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302884","type":"LOCAL"},{"code":"521828","type":"LOCAL"}],"standard_charges":[{"gross_charge":2206.4,"discounted_cash":1654.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302884 = Hospital System Supply Identifier | 521828 = Lawson ID"}]},{"description":"IMP SHLDR GLEN 52MM 46MM SURF","code_information":[{"code":"Sx00-4300-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302883","type":"LOCAL"},{"code":"521827","type":"LOCAL"}],"standard_charges":[{"gross_charge":2206.4,"discounted_cash":1654.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302883 = Hospital System Supply Identifier | 521827 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD 33X52MM","code_information":[{"code":"Sx00-4300-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302881","type":"LOCAL"},{"code":"521825","type":"LOCAL"}],"standard_charges":[{"gross_charge":2473.33,"discounted_cash":1855.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302881 = Hospital System Supply Identifier | 521825 = Lawson ID"}]},{"description":"IMP HEAD STD GLEN 52X18MM","code_information":[{"code":"Sx00-4300-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326247","type":"LOCAL"},{"code":"392780","type":"LOCAL"}],"standard_charges":[{"gross_charge":2473.33,"discounted_cash":1855.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 326247 = Hospital System Supply Identifier | 392780 = Lawson ID"}]},{"description":"IMP SHLDR HUM HD 27X52MM","code_information":[{"code":"Sx00-4300-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302879","type":"LOCAL"},{"code":"521823","type":"LOCAL"}],"standard_charges":[{"gross_charge":2473.33,"discounted_cash":1855.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302879 = Hospital System Supply Identifier | 521823 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD 52X24MM","code_information":[{"code":"Sx00-4300-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"167071","type":"LOCAL"},{"code":"157719","type":"LOCAL"}],"standard_charges":[{"gross_charge":2473.33,"discounted_cash":1855.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 167071 = Hospital System Supply Identifier | 157719 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD 30X52MM","code_information":[{"code":"Sx00-4300-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302880","type":"LOCAL"},{"code":"521824","type":"LOCAL"}],"standard_charges":[{"gross_charge":2473.33,"discounted_cash":1855.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302880 = Hospital System Supply Identifier | 521824 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD 52X21MM","code_information":[{"code":"Sx00-4300-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329144","type":"LOCAL"},{"code":"253622","type":"LOCAL"}],"standard_charges":[{"gross_charge":2473.33,"discounted_cash":1855.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329144 = Hospital System Supply Identifier | 253622 = Lawson ID"}]},{"description":"IMP SHLDR HUM HD 30X56MM","code_information":[{"code":"Sx00-4300-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302885","type":"LOCAL"},{"code":"521829","type":"LOCAL"}],"standard_charges":[{"gross_charge":2473.33,"discounted_cash":1855.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302885 = Hospital System Supply Identifier | 521829 = Lawson ID"}]},{"description":"IMP SHLDR HUM HD 33X56MM","code_information":[{"code":"Sx00-4300-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302886","type":"LOCAL"},{"code":"521830","type":"LOCAL"}],"standard_charges":[{"gross_charge":2473.33,"discounted_cash":1855.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302886 = Hospital System Supply Identifier | 521830 = Lawson ID"}]},{"description":"IMP SHLDR HUM HD 36X56MM","code_information":[{"code":"Sx00-4300-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302887","type":"LOCAL"},{"code":"521831","type":"LOCAL"}],"standard_charges":[{"gross_charge":2473.33,"discounted_cash":1855.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302887 = Hospital System Supply Identifier | 521831 = Lawson ID"}]},{"description":"IMP SHLDR HUM HD 39X56MM","code_information":[{"code":"Sx00-4300-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302888","type":"LOCAL"},{"code":"521832","type":"LOCAL"}],"standard_charges":[{"gross_charge":2473.33,"discounted_cash":1855.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302888 = Hospital System Supply Identifier | 521832 = Lawson ID"}]},{"description":"IMP SHLDR HUM HD 42X56MM","code_information":[{"code":"Sx00-4300-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302889","type":"LOCAL"},{"code":"521833","type":"LOCAL"}],"standard_charges":[{"gross_charge":2473.33,"discounted_cash":1855.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302889 = Hospital System Supply Identifier | 521833 = Lawson ID"}]},{"description":"IMP SHLDR GLEN KEEL 40MM","code_information":[{"code":"Sx00-4300-080","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302890","type":"LOCAL"},{"code":"521834","type":"LOCAL"}],"standard_charges":[{"gross_charge":2206.4,"discounted_cash":1654.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302890 = Hospital System Supply Identifier | 521834 = Lawson ID"}]},{"description":"IMP SHLDR-T GLEN BGFW 46MM","code_information":[{"code":"Sx00-4300-081","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329887","type":"LOCAL"},{"code":"395459","type":"LOCAL"}],"standard_charges":[{"gross_charge":2206.4,"discounted_cash":1654.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329887 = Hospital System Supply Identifier | 395459 = Lawson ID"}]},{"description":"IMP SHLDR TOT GLEN BGFW 52MM","code_information":[{"code":"Sx00-4300-082","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325542","type":"LOCAL"},{"code":"353753","type":"LOCAL"}],"standard_charges":[{"gross_charge":2206.4,"discounted_cash":1654.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 325542 = Hospital System Supply Identifier | 353753 = Lawson ID"}]},{"description":"IMP SHLDR GLEN COMP BGLN 85MM","code_information":[{"code":"Sx00-4300-085","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"145802","type":"LOCAL"},{"code":"237455","type":"LOCAL"}],"standard_charges":[{"gross_charge":2206.4,"discounted_cash":1654.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 145802 = Hospital System Supply Identifier | 237455 = Lawson ID"}]},{"description":"IMP SHLDR GLEN COMP BGLN 86MM","code_information":[{"code":"Sx00-4300-086","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"169816","type":"LOCAL"},{"code":"329977","type":"LOCAL"}],"standard_charges":[{"gross_charge":2206.4,"discounted_cash":1654.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 169816 = Hospital System Supply Identifier | 329977 = Lawson ID"}]},{"description":"IMP SHLDR GLEN COMP BGLN 52MM","code_information":[{"code":"Sx00-4300-087","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"145775","type":"LOCAL"},{"code":"236851","type":"LOCAL"}],"standard_charges":[{"gross_charge":2206.4,"discounted_cash":1654.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 145775 = Hospital System Supply Identifier | 236851 = Lawson ID"}]},{"description":"PIN ALIGN SMTH BLNT SS 3X300MM","code_information":[{"code":"Sx00-4301-002","type":"CDM"},{"code":"272","type":"RC"},{"code":"35338","type":"LOCAL"},{"code":"147898","type":"LOCAL"}],"standard_charges":[{"gross_charge":215.88,"discounted_cash":161.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 35338 = Hospital System Supply Identifier | 147898 = Lawson ID"}]},{"description":"SCREW BONE CANC F/T 6.5X80MM","code_information":[{"code":"Sx00-4301-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"302900","type":"LOCAL"},{"code":"521844","type":"LOCAL"}],"standard_charges":[{"gross_charge":219.75,"discounted_cash":164.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302900 = Hospital System Supply Identifier | 521844 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD OFF 24X40","code_information":[{"code":"Sx00-4302-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302902","type":"LOCAL"},{"code":"521846","type":"LOCAL"}],"standard_charges":[{"gross_charge":2473.33,"discounted_cash":1855.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302902 = Hospital System Supply Identifier | 521846 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD OFF 15X40","code_information":[{"code":"Sx00-4302-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302901","type":"LOCAL"},{"code":"521845","type":"LOCAL"}],"standard_charges":[{"gross_charge":2473.33,"discounted_cash":1855.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302901 = Hospital System Supply Identifier | 521845 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD OFF 27X40","code_information":[{"code":"Sx00-4302-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302903","type":"LOCAL"},{"code":"521847","type":"LOCAL"}],"standard_charges":[{"gross_charge":2473.33,"discounted_cash":1855.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302903 = Hospital System Supply Identifier | 521847 = Lawson ID"}]},{"description":"HEAD HUM OFFSET 18X40MM","code_information":[{"code":"Sx00-4302-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"166038","type":"LOCAL"},{"code":"386846","type":"LOCAL"}],"standard_charges":[{"gross_charge":2473.33,"discounted_cash":1855.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 166038 = Hospital System Supply Identifier | 386846 = Lawson ID"}]},{"description":"IMP SHLDR GLEN HD BGLN 40X46MM","code_information":[{"code":"Sx00-4302-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"145772","type":"LOCAL"},{"code":"236653","type":"LOCAL"}],"standard_charges":[{"gross_charge":2206.4,"discounted_cash":1654.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 145772 = Hospital System Supply Identifier | 236653 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD OFF 40X21","code_information":[{"code":"Sx00-4302-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"145918","type":"LOCAL"},{"code":"294860","type":"LOCAL"}],"standard_charges":[{"gross_charge":2473.33,"discounted_cash":1855.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 145918 = Hospital System Supply Identifier | 294860 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD OFF 30X46","code_information":[{"code":"Sx00-4302-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302905","type":"LOCAL"},{"code":"521849","type":"LOCAL"}],"standard_charges":[{"gross_charge":2473.33,"discounted_cash":1855.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302905 = Hospital System Supply Identifier | 521849 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD OFF 27X46","code_information":[{"code":"Sx00-4302-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302904","type":"LOCAL"},{"code":"521848","type":"LOCAL"}],"standard_charges":[{"gross_charge":2473.33,"discounted_cash":1855.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302904 = Hospital System Supply Identifier | 521848 = Lawson ID"}]},{"description":"IMP SHLDR GLEN PEG BF 46MM","code_information":[{"code":"Sx00-4302-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"171789","type":"LOCAL"},{"code":"439192","type":"LOCAL"}],"standard_charges":[{"gross_charge":2206.4,"discounted_cash":1654.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 171789 = Hospital System Supply Identifier | 439192 = Lawson ID"}]},{"description":"IMP SHLDR HUM HD BGFW 24X46MM","code_information":[{"code":"Sx00-4302-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326290","type":"LOCAL"},{"code":"395461","type":"LOCAL"}],"standard_charges":[{"gross_charge":2473.33,"discounted_cash":1855.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 326290 = Hospital System Supply Identifier | 395461 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD OFF 46X23","code_information":[{"code":"Sx00-4302-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"94782","type":"LOCAL"},{"code":"294264","type":"LOCAL"}],"standard_charges":[{"gross_charge":2473.33,"discounted_cash":1855.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 94782 = Hospital System Supply Identifier | 294264 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD OFF 46X15","code_information":[{"code":"Sx00-4302-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325140","type":"LOCAL"},{"code":"338927","type":"LOCAL"}],"standard_charges":[{"gross_charge":2473.33,"discounted_cash":1855.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 325140 = Hospital System Supply Identifier | 338927 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD OFF 46X17","code_information":[{"code":"Sx00-4302-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"145738","type":"LOCAL"},{"code":"235655","type":"LOCAL"}],"standard_charges":[{"gross_charge":2473.33,"discounted_cash":1855.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 145738 = Hospital System Supply Identifier | 235655 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD OFF 46X19","code_information":[{"code":"Sx00-4302-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"147838","type":"LOCAL"},{"code":"232671","type":"LOCAL"}],"standard_charges":[{"gross_charge":2473.33,"discounted_cash":1855.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 147838 = Hospital System Supply Identifier | 232671 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD OFF 46X21","code_information":[{"code":"Sx00-4302-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"145617","type":"LOCAL"},{"code":"154319","type":"LOCAL"}],"standard_charges":[{"gross_charge":2473.33,"discounted_cash":1855.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 145617 = Hospital System Supply Identifier | 154319 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD OFF 46X18","code_information":[{"code":"Sx00-4302-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"35406","type":"LOCAL"},{"code":"153981","type":"LOCAL"}],"standard_charges":[{"gross_charge":2473.33,"discounted_cash":1855.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 35406 = Hospital System Supply Identifier | 153981 = Lawson ID"}]},{"description":"IMP SHLDR GLEN BGLN PEGS 46X52","code_information":[{"code":"Sx00-4302-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"145763","type":"LOCAL"},{"code":"236319","type":"LOCAL"}],"standard_charges":[{"gross_charge":2206.4,"discounted_cash":1654.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 145763 = Hospital System Supply Identifier | 236319 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD OFF 52X27","code_information":[{"code":"Sx00-4302-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"161396","type":"LOCAL"},{"code":"357149","type":"LOCAL"}],"standard_charges":[{"gross_charge":2473.33,"discounted_cash":1855.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 161396 = Hospital System Supply Identifier | 357149 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD OFF 33X52","code_information":[{"code":"Sx00-4302-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302906","type":"LOCAL"},{"code":"521850","type":"LOCAL"}],"standard_charges":[{"gross_charge":2473.33,"discounted_cash":1855.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302906 = Hospital System Supply Identifier | 521850 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD OFF 52X30","code_information":[{"code":"Sx00-4302-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"328644","type":"LOCAL"},{"code":"462716","type":"LOCAL"}],"standard_charges":[{"gross_charge":2473.33,"discounted_cash":1855.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 328644 = Hospital System Supply Identifier | 462716 = Lawson ID"}]},{"description":"IMP SHLDR GLEN COMP W/PEG 52MM","code_information":[{"code":"Sx00-4302-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"171776","type":"LOCAL"},{"code":"425659","type":"LOCAL"}],"standard_charges":[{"gross_charge":2206.4,"discounted_cash":1654.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 171776 = Hospital System Supply Identifier | 425659 = Lawson ID"}]},{"description":"IMP SHLDR GLEN COMP W/PEG 46MM","code_information":[{"code":"Sx00-4302-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"146146","type":"LOCAL"},{"code":"337461","type":"LOCAL"}],"standard_charges":[{"gross_charge":2206.4,"discounted_cash":1654.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 146146 = Hospital System Supply Identifier | 337461 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD OFF 52X23","code_information":[{"code":"Sx00-4302-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"145818","type":"LOCAL"},{"code":"237742","type":"LOCAL"}],"standard_charges":[{"gross_charge":2473.33,"discounted_cash":1855.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 145818 = Hospital System Supply Identifier | 237742 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD OFF 52X19","code_information":[{"code":"Sx00-4302-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"145762","type":"LOCAL"},{"code":"236316","type":"LOCAL"}],"standard_charges":[{"gross_charge":2473.33,"discounted_cash":1855.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 145762 = Hospital System Supply Identifier | 236316 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD OFF 52X21","code_information":[{"code":"Sx00-4302-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"94073","type":"LOCAL"},{"code":"236039","type":"LOCAL"}],"standard_charges":[{"gross_charge":2473.33,"discounted_cash":1855.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 94073 = Hospital System Supply Identifier | 236039 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD OFF 52X18","code_information":[{"code":"Sx00-4302-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"145748","type":"LOCAL"},{"code":"235970","type":"LOCAL"}],"standard_charges":[{"gross_charge":2473.33,"discounted_cash":1855.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 145748 = Hospital System Supply Identifier | 235970 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD OFF 52X24","code_information":[{"code":"Sx00-4302-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"167143","type":"LOCAL"},{"code":"158630","type":"LOCAL"}],"standard_charges":[{"gross_charge":2473.33,"discounted_cash":1855.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 167143 = Hospital System Supply Identifier | 158630 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD OFF 56X21","code_information":[{"code":"Sx00-4302-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"170077","type":"LOCAL"},{"code":"380776","type":"LOCAL"}],"standard_charges":[{"gross_charge":2473.33,"discounted_cash":1855.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 170077 = Hospital System Supply Identifier | 380776 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD OFF 56X19","code_information":[{"code":"Sx00-4302-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329809","type":"LOCAL"},{"code":"382420","type":"LOCAL"}],"standard_charges":[{"gross_charge":2473.33,"discounted_cash":1855.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329809 = Hospital System Supply Identifier | 382420 = Lawson ID"}]},{"description":"IMP SHLDR HUM HD OFF BF 23X56","code_information":[{"code":"Sx00-4302-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326196","type":"LOCAL"},{"code":"386279","type":"LOCAL"}],"standard_charges":[{"gross_charge":2473.33,"discounted_cash":1855.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 326196 = Hospital System Supply Identifier | 386279 = Lawson ID"}]},{"description":"IMP SHLDR HUM HD OFFS 24X56MM","code_information":[{"code":"Sx00-4302-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"171790","type":"LOCAL"},{"code":"439193","type":"LOCAL"}],"standard_charges":[{"gross_charge":2473.33,"discounted_cash":1855.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 171790 = Hospital System Supply Identifier | 439193 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD OFF 56X27","code_information":[{"code":"Sx00-4302-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"330494","type":"LOCAL"},{"code":"455945","type":"LOCAL"}],"standard_charges":[{"gross_charge":2473.33,"discounted_cash":1855.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 330494 = Hospital System Supply Identifier | 455945 = Lawson ID"}]},{"description":"PIN FIXATION NSTRL HEAD CAPTUR","code_information":[{"code":"Sx00-4303-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"936272","type":"LOCAL"},{"code":"820755","type":"LOCAL"}],"standard_charges":[{"gross_charge":259.74,"discounted_cash":194.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 936272 = Hospital System Supply Identifier | 820755 = Lawson ID"}]},{"description":"REAMER SURG STR 52NSTRL SPOKE","code_information":[{"code":"Sx00-4307-030","type":"CDM"},{"code":"272","type":"RC"},{"code":"939145","type":"LOCAL"},{"code":"823668","type":"LOCAL"}],"standard_charges":[{"gross_charge":1861.66,"discounted_cash":1396.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 939145 = Hospital System Supply Identifier | 823668 = Lawson ID"}]},{"description":"BIT DRILL BIGLIANI FLATOW TRABECULAR METAL 00430704200 2.5MM","code_information":[{"code":"Sx00-4307-042","type":"CDM"},{"code":"272","type":"RC"},{"code":"1446394","type":"LOCAL"},{"code":"1002289","type":"LOCAL"}],"standard_charges":[{"gross_charge":850.21,"discounted_cash":637.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1446394 = Hospital System Supply Identifier | 1002289 = Lawson ID"}]},{"description":"BIT DRILL BIGLIANI FLATOW TRABECULAR METAL 00430704300 2.5MM","code_information":[{"code":"Sx00-4307-043","type":"CDM"},{"code":"272","type":"RC"},{"code":"1446396","type":"LOCAL"},{"code":"1002296","type":"LOCAL"}],"standard_charges":[{"gross_charge":1305.51,"discounted_cash":979.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1446396 = Hospital System Supply Identifier | 1002296 = Lawson ID"}]},{"description":"ROD THRD ALIGN TM","code_information":[{"code":"Sx00-4309-009","type":"CDM"},{"code":"272","type":"RC"},{"code":"842102","type":"LOCAL"},{"code":"705155","type":"LOCAL"}],"standard_charges":[{"gross_charge":253.97,"discounted_cash":190.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 842102 = Hospital System Supply Identifier | 705155 = Lawson ID"}]},{"description":"BIT DRILL TRABECULAR METAL 00430904515 7.5X15MM","code_information":[{"code":"Sx00-4309-045","type":"CDM"},{"code":"272","type":"RC"},{"code":"1446397","type":"LOCAL"},{"code":"1002366","type":"LOCAL"}],"standard_charges":[{"gross_charge":519.48,"discounted_cash":389.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1446397 = Hospital System Supply Identifier | 1002366 = Lawson ID"}]},{"description":"BIT DRILL TRABECULAR METAL 00430904530 7.5X30MM","code_information":[{"code":"Sx00-4309-045","type":"CDM"},{"code":"272","type":"RC"},{"code":"1446398","type":"LOCAL"},{"code":"1002389","type":"LOCAL"}],"standard_charges":[{"gross_charge":519.48,"discounted_cash":389.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1446398 = Hospital System Supply Identifier | 1002389 = Lawson ID"}]},{"description":"BIT DRILL CANNULATED REVERSE TRABECULAR METAL 00430904615 7.5X15MM","code_information":[{"code":"Sx00-4309-046","type":"CDM"},{"code":"272","type":"RC"},{"code":"1414749","type":"LOCAL"},{"code":"1089894","type":"LOCAL"}],"standard_charges":[{"gross_charge":519.48,"discounted_cash":389.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1414749 = Hospital System Supply Identifier | 1089894 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM 42D 6X130MM","code_information":[{"code":"Sx00-4342-106","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302925","type":"LOCAL"},{"code":"521869","type":"LOCAL"}],"standard_charges":[{"gross_charge":4943.48,"discounted_cash":3707.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302925 = Hospital System Supply Identifier | 521869 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM 42D 8X130MM","code_information":[{"code":"Sx00-4342-108","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302926","type":"LOCAL"},{"code":"521870","type":"LOCAL"}],"standard_charges":[{"gross_charge":4943.48,"discounted_cash":3707.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302926 = Hospital System Supply Identifier | 521870 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM 42D 8X170MM","code_information":[{"code":"Sx00-4342-108","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302927","type":"LOCAL"},{"code":"521871","type":"LOCAL"}],"standard_charges":[{"gross_charge":4943.48,"discounted_cash":3707.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302927 = Hospital System Supply Identifier | 521871 = Lawson ID"}]},{"description":"IMP SHLDR FEM STEM TM 9X130MM","code_information":[{"code":"Sx00-4342-109","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326292","type":"LOCAL"},{"code":"395464","type":"LOCAL"}],"standard_charges":[{"gross_charge":4943.48,"discounted_cash":3707.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 326292 = Hospital System Supply Identifier | 395464 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM 42D 10X130","code_information":[{"code":"Sx00-4342-110","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326293","type":"LOCAL"},{"code":"395465","type":"LOCAL"}],"standard_charges":[{"gross_charge":4943.48,"discounted_cash":3707.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 326293 = Hospital System Supply Identifier | 395465 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM 42D 10X170","code_information":[{"code":"Sx00-4342-110","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302928","type":"LOCAL"},{"code":"521872","type":"LOCAL"}],"standard_charges":[{"gross_charge":4943.48,"discounted_cash":3707.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302928 = Hospital System Supply Identifier | 521872 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM 42D 11X130","code_information":[{"code":"Sx00-4342-111","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"154624","type":"LOCAL"},{"code":"298394","type":"LOCAL"}],"standard_charges":[{"gross_charge":4943.48,"discounted_cash":3707.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 154624 = Hospital System Supply Identifier | 298394 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM 42D 12X130","code_information":[{"code":"Sx00-4342-112","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"178416","type":"LOCAL"},{"code":"337466","type":"LOCAL"}],"standard_charges":[{"gross_charge":4943.48,"discounted_cash":3707.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 178416 = Hospital System Supply Identifier | 337466 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM 42D 12X170","code_information":[{"code":"Sx00-4342-112","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"330224","type":"LOCAL"},{"code":"427929","type":"LOCAL"}],"standard_charges":[{"gross_charge":4943.48,"discounted_cash":3707.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 330224 = Hospital System Supply Identifier | 427929 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM 42D 12X130","code_information":[{"code":"Sx00-4342-113","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325118","type":"LOCAL"},{"code":"337467","type":"LOCAL"}],"standard_charges":[{"gross_charge":4943.48,"discounted_cash":3707.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 325118 = Hospital System Supply Identifier | 337467 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM 42D 14X130","code_information":[{"code":"Sx00-4342-114","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325119","type":"LOCAL"},{"code":"337468","type":"LOCAL"}],"standard_charges":[{"gross_charge":4943.48,"discounted_cash":3707.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 325119 = Hospital System Supply Identifier | 337468 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM 42D 14X170","code_information":[{"code":"Sx00-4342-114","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302929","type":"LOCAL"},{"code":"521873","type":"LOCAL"}],"standard_charges":[{"gross_charge":4943.48,"discounted_cash":3707.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302929 = Hospital System Supply Identifier | 521873 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM 42D 15X130","code_information":[{"code":"Sx00-4342-115","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"439879","type":"LOCAL"},{"code":"329976","type":"LOCAL"}],"standard_charges":[{"gross_charge":4943.48,"discounted_cash":3707.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 439879 = Hospital System Supply Identifier | 329976 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM 42D 16X170","code_information":[{"code":"Sx00-4342-116","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325541","type":"LOCAL"},{"code":"353752","type":"LOCAL"}],"standard_charges":[{"gross_charge":4943.48,"discounted_cash":3707.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 325541 = Hospital System Supply Identifier | 353752 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM 42D 17X130","code_information":[{"code":"Sx00-4342-117","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302930","type":"LOCAL"},{"code":"521874","type":"LOCAL"}],"standard_charges":[{"gross_charge":4943.48,"discounted_cash":3707.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302930 = Hospital System Supply Identifier | 521874 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM 42D 18X130","code_information":[{"code":"Sx00-4342-118","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"170076","type":"LOCAL"},{"code":"380775","type":"LOCAL"}],"standard_charges":[{"gross_charge":4943.48,"discounted_cash":3707.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 170076 = Hospital System Supply Identifier | 380775 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM 48D 6X130MM","code_information":[{"code":"Sx00-4348-106","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302931","type":"LOCAL"},{"code":"521875","type":"LOCAL"}],"standard_charges":[{"gross_charge":4943.48,"discounted_cash":3707.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302931 = Hospital System Supply Identifier | 521875 = Lawson ID"}]},{"description":"IMP SHLDR FEM STEM TM 8X130M","code_information":[{"code":"Sx00-4348-108","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325444","type":"LOCAL"},{"code":"347343","type":"LOCAL"}],"standard_charges":[{"gross_charge":4943.48,"discounted_cash":3707.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 325444 = Hospital System Supply Identifier | 347343 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM 48D 8X170MM","code_information":[{"code":"Sx00-4348-108","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302932","type":"LOCAL"},{"code":"521876","type":"LOCAL"}],"standard_charges":[{"gross_charge":4943.48,"discounted_cash":3707.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302932 = Hospital System Supply Identifier | 521876 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM TM 9X130","code_information":[{"code":"Sx00-4348-109","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"153645","type":"LOCAL"},{"code":"294859","type":"LOCAL"}],"standard_charges":[{"gross_charge":4943.48,"discounted_cash":3707.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 153645 = Hospital System Supply Identifier | 294859 = Lawson ID"}]},{"description":"IMP SHLDR STEM HUM TM 10X130","code_information":[{"code":"Sx00-4348-110","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"146191","type":"LOCAL"},{"code":"353527","type":"LOCAL"}],"standard_charges":[{"gross_charge":4943.48,"discounted_cash":3707.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 146191 = Hospital System Supply Identifier | 353527 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM 48D 10X170","code_information":[{"code":"Sx00-4348-110","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302933","type":"LOCAL"},{"code":"521877","type":"LOCAL"}],"standard_charges":[{"gross_charge":4943.48,"discounted_cash":3707.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302933 = Hospital System Supply Identifier | 521877 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM TM 48DEG 11","code_information":[{"code":"Sx00-4348-111","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326084","type":"LOCAL"},{"code":"382516","type":"LOCAL"}],"standard_charges":[{"gross_charge":4943.48,"discounted_cash":3707.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 326084 = Hospital System Supply Identifier | 382516 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM 48D 12X170","code_information":[{"code":"Sx00-4348-112","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302934","type":"LOCAL"},{"code":"521878","type":"LOCAL"}],"standard_charges":[{"gross_charge":4943.48,"discounted_cash":3707.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302934 = Hospital System Supply Identifier | 521878 = Lawson ID"}]},{"description":"IMP SHLDR STEM HUM TM 12X130","code_information":[{"code":"Sx00-4348-112","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"146255","type":"LOCAL"},{"code":"362853","type":"LOCAL"}],"standard_charges":[{"gross_charge":4943.48,"discounted_cash":3707.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 146255 = Hospital System Supply Identifier | 362853 = Lawson ID"}]},{"description":"IMP SHLDR STEM HUM TM 13X130","code_information":[{"code":"Sx00-4348-113","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"146073","type":"LOCAL"},{"code":"315005","type":"LOCAL"}],"standard_charges":[{"gross_charge":4943.48,"discounted_cash":3707.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 146073 = Hospital System Supply Identifier | 315005 = Lawson ID"}]},{"description":"IMP SHLDR STEM HUM TM 14X130","code_information":[{"code":"Sx00-4348-114","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326193","type":"LOCAL"},{"code":"384917","type":"LOCAL"}],"standard_charges":[{"gross_charge":4943.48,"discounted_cash":3707.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 326193 = Hospital System Supply Identifier | 384917 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM 48D 14X170","code_information":[{"code":"Sx00-4348-114","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302935","type":"LOCAL"},{"code":"521879","type":"LOCAL"}],"standard_charges":[{"gross_charge":4943.48,"discounted_cash":3707.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302935 = Hospital System Supply Identifier | 521879 = Lawson ID"}]},{"description":"IMP SHLDR STEM HUM TM 15X130","code_information":[{"code":"Sx00-4348-115","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"145909","type":"LOCAL"},{"code":"294265","type":"LOCAL"}],"standard_charges":[{"gross_charge":4943.48,"discounted_cash":3707.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 145909 = Hospital System Supply Identifier | 294265 = Lawson ID"}]},{"description":"IMP SHLD HUM STEM 16X130 48DEG","code_information":[{"code":"Sx00-4348-116","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"146213","type":"LOCAL"},{"code":"357148","type":"LOCAL"}],"standard_charges":[{"gross_charge":4943.48,"discounted_cash":3707.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 146213 = Hospital System Supply Identifier | 357148 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM 48DEG 17MM","code_information":[{"code":"Sx00-4348-117","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325934","type":"LOCAL"},{"code":"372115","type":"LOCAL"}],"standard_charges":[{"gross_charge":4943.48,"discounted_cash":3707.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 325934 = Hospital System Supply Identifier | 372115 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM TM 48DEG 18","code_information":[{"code":"Sx00-4348-118","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326082","type":"LOCAL"},{"code":"382419","type":"LOCAL"}],"standard_charges":[{"gross_charge":4943.48,"discounted_cash":3707.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 326082 = Hospital System Supply Identifier | 382419 = Lawson ID"}]},{"description":"IMP SHLDR STEM REV TM 8X130MM","code_information":[{"code":"Sx00-4349-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329888","type":"LOCAL"},{"code":"395466","type":"LOCAL"}],"standard_charges":[{"gross_charge":7340.95,"discounted_cash":5505.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329888 = Hospital System Supply Identifier | 395466 = Lawson ID"}]},{"description":"IMP STEM HUM REV TM 8X170MM","code_information":[{"code":"Sx00-4349-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"181640","type":"LOCAL"},{"code":"453439","type":"LOCAL"}],"standard_charges":[{"gross_charge":7340.95,"discounted_cash":5505.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 181640 = Hospital System Supply Identifier | 453439 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM REV 10X170","code_information":[{"code":"Sx00-4349-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302936","type":"LOCAL"},{"code":"521880","type":"LOCAL"}],"standard_charges":[{"gross_charge":7340.95,"discounted_cash":5505.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302936 = Hospital System Supply Identifier | 521880 = Lawson ID"}]},{"description":"IMP HUM STEM REV 10X130MM","code_information":[{"code":"Sx00-4349-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"178417","type":"LOCAL"},{"code":"337469","type":"LOCAL"}],"standard_charges":[{"gross_charge":7340.95,"discounted_cash":5505.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 178417 = Hospital System Supply Identifier | 337469 = Lawson ID"}]},{"description":"IMP SHLDR STEM REV TM 12X130MM","code_information":[{"code":"Sx00-4349-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"178418","type":"LOCAL"},{"code":"337470","type":"LOCAL"}],"standard_charges":[{"gross_charge":7340.95,"discounted_cash":5505.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 178418 = Hospital System Supply Identifier | 337470 = Lawson ID"}]},{"description":"IMP SHLDR STEM REV TM 12X170MM","code_information":[{"code":"Sx00-4349-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325120","type":"LOCAL"},{"code":"337471","type":"LOCAL"}],"standard_charges":[{"gross_charge":7340.95,"discounted_cash":5505.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 325120 = Hospital System Supply Identifier | 337471 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM STEM 14MM","code_information":[{"code":"Sx00-4349-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"146148","type":"LOCAL"},{"code":"337472","type":"LOCAL"}],"standard_charges":[{"gross_charge":7340.95,"discounted_cash":5505.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 146148 = Hospital System Supply Identifier | 337472 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM REV 14X170","code_information":[{"code":"Sx00-4349-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302937","type":"LOCAL"},{"code":"521881","type":"LOCAL"}],"standard_charges":[{"gross_charge":7340.95,"discounted_cash":5505.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302937 = Hospital System Supply Identifier | 521881 = Lawson ID"}]},{"description":"IMP SHLDR CAP BSPLT TM 15MM","code_information":[{"code":"Sx00-4349-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"178831","type":"LOCAL"},{"code":"416161","type":"LOCAL"}],"standard_charges":[{"gross_charge":2679.46,"discounted_cash":2009.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 178831 = Hospital System Supply Identifier | 416161 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM REV 16X130","code_information":[{"code":"Sx00-4349-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302938","type":"LOCAL"},{"code":"521882","type":"LOCAL"}],"standard_charges":[{"gross_charge":7340.95,"discounted_cash":5505.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302938 = Hospital System Supply Identifier | 521882 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM REV 16X170","code_information":[{"code":"Sx00-4349-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302939","type":"LOCAL"},{"code":"521883","type":"LOCAL"}],"standard_charges":[{"gross_charge":7340.95,"discounted_cash":5505.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302939 = Hospital System Supply Identifier | 521883 = Lawson ID"}]},{"description":"IMP SHLDR REV STEM TM 18X130MM","code_information":[{"code":"Sx00-4349-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"328540","type":"LOCAL"},{"code":"458212","type":"LOCAL"}],"standard_charges":[{"gross_charge":7340.95,"discounted_cash":5505.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 328540 = Hospital System Supply Identifier | 458212 = Lawson ID"}]},{"description":"IMP SHLDR BSPLT REV 25MM POS","code_information":[{"code":"Sx00-4349-025","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302940","type":"LOCAL"},{"code":"521884","type":"LOCAL"}],"standard_charges":[{"gross_charge":2679.46,"discounted_cash":2009.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302940 = Hospital System Supply Identifier | 521884 = Lawson ID"}]},{"description":"IMP SHLDR BSPLT REV 30MM POS","code_information":[{"code":"Sx00-4349-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302941","type":"LOCAL"},{"code":"521885","type":"LOCAL"}],"standard_charges":[{"gross_charge":2679.46,"discounted_cash":2009.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302941 = Hospital System Supply Identifier | 521885 = Lawson ID"}]},{"description":"IMP LNR HUM INS TM REV 36MM","code_information":[{"code":"Sx00-4349-036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"146149","type":"LOCAL"},{"code":"337473","type":"LOCAL"}],"standard_charges":[{"gross_charge":1861.66,"discounted_cash":1396.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 146149 = Hospital System Supply Identifier | 337473 = Lawson ID"}]},{"description":"IMP LNR HUM INS TM PLS 36MM","code_information":[{"code":"Sx00-4349-036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"178419","type":"LOCAL"},{"code":"337474","type":"LOCAL"}],"standard_charges":[{"gross_charge":1861.66,"discounted_cash":1396.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 178419 = Hospital System Supply Identifier | 337474 = Lawson ID"}]},{"description":"IMP LNR HUM INS TM REV 36X6MM","code_information":[{"code":"Sx00-4349-036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"178420","type":"LOCAL"},{"code":"337475","type":"LOCAL"}],"standard_charges":[{"gross_charge":1861.66,"discounted_cash":1396.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 178420 = Hospital System Supply Identifier | 337475 = Lawson ID"}]},{"description":"IMP SHLDR GLEN 36MM","code_information":[{"code":"Sx00-4349-036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"146150","type":"LOCAL"},{"code":"337476","type":"LOCAL"}],"standard_charges":[{"gross_charge":2473.33,"discounted_cash":1855.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 146150 = Hospital System Supply Identifier | 337476 = Lawson ID"}]},{"description":"IMP SHLDR HUM INS 37X0MM","code_information":[{"code":"Sx00-4349-037","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325121","type":"LOCAL"},{"code":"337477","type":"LOCAL"}],"standard_charges":[{"gross_charge":1861.66,"discounted_cash":1396.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 325121 = Hospital System Supply Identifier | 337477 = Lawson ID"}]},{"description":"IMP SHLDR BSPLT TM REV STRL","code_information":[{"code":"Sx00-4349-038","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"146151","type":"LOCAL"},{"code":"337478","type":"LOCAL"}],"standard_charges":[{"gross_charge":5617.0,"discounted_cash":4212.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 146151 = Hospital System Supply Identifier | 337478 = Lawson ID"}]},{"description":"IMP SHLDR SPCR TRAB MTL 9MM","code_information":[{"code":"Sx00-4349-039","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"146152","type":"LOCAL"},{"code":"337479","type":"LOCAL"}],"standard_charges":[{"gross_charge":1111.08,"discounted_cash":833.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 146152 = Hospital System Supply Identifier | 337479 = Lawson ID"}]},{"description":"IMP SPCR TRABCLR MTL 12MM","code_information":[{"code":"Sx00-4349-039","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"169959","type":"LOCAL"},{"code":"360582","type":"LOCAL"}],"standard_charges":[{"gross_charge":1111.08,"discounted_cash":833.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 169959 = Hospital System Supply Identifier | 360582 = Lawson ID"}]},{"description":"IMP SHLDR REV LNR PLS6 40MM","code_information":[{"code":"Sx00-4349-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302943","type":"LOCAL"},{"code":"521887","type":"LOCAL"}],"standard_charges":[{"gross_charge":1861.66,"discounted_cash":1396.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302943 = Hospital System Supply Identifier | 521887 = Lawson ID"}]},{"description":"IMP SHLDR REV LNR PLS3 40MM","code_information":[{"code":"Sx00-4349-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302942","type":"LOCAL"},{"code":"521886","type":"LOCAL"}],"standard_charges":[{"gross_charge":1861.66,"discounted_cash":1396.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302942 = Hospital System Supply Identifier | 521886 = Lawson ID"}]},{"description":"IMP SHLDR GLEN TM REV 40MM","code_information":[{"code":"Sx00-4349-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325638","type":"LOCAL"},{"code":"360583","type":"LOCAL"}],"standard_charges":[{"gross_charge":2473.33,"discounted_cash":1855.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 325638 = Hospital System Supply Identifier | 360583 = Lawson ID"}]},{"description":"IMP SHLDR REV LNR PLS 40X0MM","code_information":[{"code":"Sx00-4349-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326390","type":"LOCAL"},{"code":"398116","type":"LOCAL"}],"standard_charges":[{"gross_charge":1861.66,"discounted_cash":1396.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 326390 = Hospital System Supply Identifier | 398116 = Lawson ID"}]},{"description":"IMP LNR TM REV POLY 36MM 3","code_information":[{"code":"Sx00-4349-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325640","type":"LOCAL"},{"code":"360586","type":"LOCAL"}],"standard_charges":[{"gross_charge":1861.66,"discounted_cash":1396.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 325640 = Hospital System Supply Identifier | 360586 = Lawson ID"}]},{"description":"IMP SHLDR REV LNR PLS 6 65D 36","code_information":[{"code":"Sx00-4349-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325641","type":"LOCAL"},{"code":"360587","type":"LOCAL"}],"standard_charges":[{"gross_charge":1861.66,"discounted_cash":1396.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 325641 = Hospital System Supply Identifier | 360587 = Lawson ID"}]},{"description":"IMP SHLDR REV LNR PLS0 65D 36M","code_information":[{"code":"Sx00-4349-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"786996","type":"LOCAL"},{"code":"459002","type":"LOCAL"}],"standard_charges":[{"gross_charge":1861.66,"discounted_cash":1396.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 786996 = Hospital System Supply Identifier | 459002 = Lawson ID"}]},{"description":"IMP SHLDR REV LNR PLS3 65D 40","code_information":[{"code":"Sx00-4349-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302944","type":"LOCAL"},{"code":"521888","type":"LOCAL"}],"standard_charges":[{"gross_charge":1861.66,"discounted_cash":1396.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302944 = Hospital System Supply Identifier | 521888 = Lawson ID"}]},{"description":"IMP SHLDR REV LNR PLS0 65D 40M","code_information":[{"code":"Sx00-4349-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"841469","type":"LOCAL"},{"code":"459445","type":"LOCAL"}],"standard_charges":[{"gross_charge":1861.66,"discounted_cash":1396.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 841469 = Hospital System Supply Identifier | 459445 = Lawson ID"}]},{"description":"IMP SHLDR REV LNR PLS6 65D 40","code_information":[{"code":"Sx00-4349-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302945","type":"LOCAL"},{"code":"521889","type":"LOCAL"}],"standard_charges":[{"gross_charge":1861.66,"discounted_cash":1396.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302945 = Hospital System Supply Identifier | 521889 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM REV 6X13","code_information":[{"code":"Sx00-4350-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302946","type":"LOCAL"},{"code":"521890","type":"LOCAL"}],"standard_charges":[{"gross_charge":7340.95,"discounted_cash":5505.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302946 = Hospital System Supply Identifier | 521890 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM REV 8X13","code_information":[{"code":"Sx00-4350-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302947","type":"LOCAL"},{"code":"521891","type":"LOCAL"}],"standard_charges":[{"gross_charge":7340.95,"discounted_cash":5505.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302947 = Hospital System Supply Identifier | 521891 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM REV 8X20","code_information":[{"code":"Sx00-4350-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302948","type":"LOCAL"},{"code":"521892","type":"LOCAL"}],"standard_charges":[{"gross_charge":7340.95,"discounted_cash":5505.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302948 = Hospital System Supply Identifier | 521892 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM REV 9X13","code_information":[{"code":"Sx00-4350-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302949","type":"LOCAL"},{"code":"521893","type":"LOCAL"}],"standard_charges":[{"gross_charge":7340.95,"discounted_cash":5505.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302949 = Hospital System Supply Identifier | 521893 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM REV 10X1","code_information":[{"code":"Sx00-4350-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302950","type":"LOCAL"},{"code":"521894","type":"LOCAL"}],"standard_charges":[{"gross_charge":7340.95,"discounted_cash":5505.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302950 = Hospital System Supply Identifier | 521894 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM REV 10X20","code_information":[{"code":"Sx00-4350-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302951","type":"LOCAL"},{"code":"521895","type":"LOCAL"}],"standard_charges":[{"gross_charge":7340.95,"discounted_cash":5505.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302951 = Hospital System Supply Identifier | 521895 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM REV 11X1","code_information":[{"code":"Sx00-4350-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302952","type":"LOCAL"},{"code":"521896","type":"LOCAL"}],"standard_charges":[{"gross_charge":7340.95,"discounted_cash":5505.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302952 = Hospital System Supply Identifier | 521896 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM REV 12X1","code_information":[{"code":"Sx00-4350-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302953","type":"LOCAL"},{"code":"521897","type":"LOCAL"}],"standard_charges":[{"gross_charge":7340.95,"discounted_cash":5505.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302953 = Hospital System Supply Identifier | 521897 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM REV 12X20","code_information":[{"code":"Sx00-4350-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302954","type":"LOCAL"},{"code":"521898","type":"LOCAL"}],"standard_charges":[{"gross_charge":7340.95,"discounted_cash":5505.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302954 = Hospital System Supply Identifier | 521898 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM REV 13X1","code_information":[{"code":"Sx00-4350-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302955","type":"LOCAL"},{"code":"521899","type":"LOCAL"}],"standard_charges":[{"gross_charge":7340.95,"discounted_cash":5505.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302955 = Hospital System Supply Identifier | 521899 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM REV 14X20","code_information":[{"code":"Sx00-4350-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302957","type":"LOCAL"},{"code":"521901","type":"LOCAL"}],"standard_charges":[{"gross_charge":7340.95,"discounted_cash":5505.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302957 = Hospital System Supply Identifier | 521901 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM REV 14X1","code_information":[{"code":"Sx00-4350-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302956","type":"LOCAL"},{"code":"521900","type":"LOCAL"}],"standard_charges":[{"gross_charge":7340.95,"discounted_cash":5505.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302956 = Hospital System Supply Identifier | 521900 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM REV 15X1","code_information":[{"code":"Sx00-4350-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302958","type":"LOCAL"},{"code":"521902","type":"LOCAL"}],"standard_charges":[{"gross_charge":7340.95,"discounted_cash":5505.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302958 = Hospital System Supply Identifier | 521902 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM REV 16X1","code_information":[{"code":"Sx00-4350-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302959","type":"LOCAL"},{"code":"521903","type":"LOCAL"}],"standard_charges":[{"gross_charge":7340.95,"discounted_cash":5505.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302959 = Hospital System Supply Identifier | 521903 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM REV 16X20","code_information":[{"code":"Sx00-4350-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302960","type":"LOCAL"},{"code":"521904","type":"LOCAL"}],"standard_charges":[{"gross_charge":7340.95,"discounted_cash":5505.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302960 = Hospital System Supply Identifier | 521904 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM REV 18X1","code_information":[{"code":"Sx00-4350-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302961","type":"LOCAL"},{"code":"521905","type":"LOCAL"}],"standard_charges":[{"gross_charge":7340.95,"discounted_cash":5505.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 302961 = Hospital System Supply Identifier | 521905 = Lawson ID"}]},{"description":"IMP SHLDR LNR XLNK POLY 35MM","code_information":[{"code":"Sx00-4350-036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"841946","type":"LOCAL"},{"code":"663511","type":"LOCAL"}],"standard_charges":[{"gross_charge":1861.66,"discounted_cash":1396.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 841946 = Hospital System Supply Identifier | 663511 = Lawson ID"}]},{"description":"IMP SHLDR LNR XLNK PLS 336MM","code_information":[{"code":"Sx00-4350-036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"841947","type":"LOCAL"},{"code":"665299","type":"LOCAL"}],"standard_charges":[{"gross_charge":1861.66,"discounted_cash":1396.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 841947 = Hospital System Supply Identifier | 665299 = Lawson ID"}]},{"description":"IMP SHLDR LNR VIT E 36MM PLS6","code_information":[{"code":"Sx00-4350-036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"842103","type":"LOCAL"},{"code":"705156","type":"LOCAL"}],"standard_charges":[{"gross_charge":1861.66,"discounted_cash":1396.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 842103 = Hospital System Supply Identifier | 705156 = Lawson ID"}]},{"description":"IMP SHLDR LNR VIT E 40MM PLS6","code_information":[{"code":"Sx00-4350-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"842106","type":"LOCAL"},{"code":"705159","type":"LOCAL"}],"standard_charges":[{"gross_charge":1861.66,"discounted_cash":1396.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 842106 = Hospital System Supply Identifier | 705159 = Lawson ID"}]},{"description":"IMP SHLDR LNR VIT E 40MM PLS3","code_information":[{"code":"Sx00-4350-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"842105","type":"LOCAL"},{"code":"705158","type":"LOCAL"}],"standard_charges":[{"gross_charge":1861.66,"discounted_cash":1396.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 842105 = Hospital System Supply Identifier | 705158 = Lawson ID"}]},{"description":"IMP SHLDR LNR VIT E 40MM PLS0","code_information":[{"code":"Sx00-4350-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"842104","type":"LOCAL"},{"code":"705157","type":"LOCAL"}],"standard_charges":[{"gross_charge":1861.66,"discounted_cash":1396.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 842104 = Hospital System Supply Identifier | 705157 = Lawson ID"}]},{"description":"IMP SHLDR REV LNR 3MM OFFSET","code_information":[{"code":"Sx00-4350-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"841945","type":"LOCAL"},{"code":"659495","type":"LOCAL"}],"standard_charges":[{"gross_charge":1861.66,"discounted_cash":1396.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 841945 = Hospital System Supply Identifier | 659495 = Lawson ID"}]},{"description":"IMP LNR 65D RET VIT E 36MM PL0","code_information":[{"code":"Sx00-4350-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"842107","type":"LOCAL"},{"code":"705160","type":"LOCAL"}],"standard_charges":[{"gross_charge":1861.66,"discounted_cash":1396.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 842107 = Hospital System Supply Identifier | 705160 = Lawson ID"}]},{"description":"IMP LNR 65D RET VIT E 36MM PL6","code_information":[{"code":"Sx00-4350-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"842108","type":"LOCAL"},{"code":"705161","type":"LOCAL"}],"standard_charges":[{"gross_charge":1861.66,"discounted_cash":1396.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 842108 = Hospital System Supply Identifier | 705161 = Lawson ID"}]},{"description":"IMP LNR 65D RET VIT E 40MM PL0","code_information":[{"code":"Sx00-4350-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"842109","type":"LOCAL"},{"code":"705162","type":"LOCAL"}],"standard_charges":[{"gross_charge":1861.66,"discounted_cash":1396.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 842109 = Hospital System Supply Identifier | 705162 = Lawson ID"}]},{"description":"IMP LNR 65D RET VIT E 40MM PL3","code_information":[{"code":"Sx00-4350-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"842110","type":"LOCAL"},{"code":"705163","type":"LOCAL"}],"standard_charges":[{"gross_charge":1861.66,"discounted_cash":1396.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 842110 = Hospital System Supply Identifier | 705163 = Lawson ID"}]},{"description":"IMP LNR 65D RET VIT E 40MM PL6","code_information":[{"code":"Sx00-4350-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"842111","type":"LOCAL"},{"code":"705164","type":"LOCAL"}],"standard_charges":[{"gross_charge":1861.66,"discounted_cash":1396.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 842111 = Hospital System Supply Identifier | 705164 = Lawson ID"}]},{"description":"COMP GLENOSPHR PLS0MM 36MM","code_information":[{"code":"Sx00-4360-036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"842115","type":"LOCAL"},{"code":"777519","type":"LOCAL"}],"standard_charges":[{"gross_charge":2473.33,"discounted_cash":1855.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 842115 = Hospital System Supply Identifier | 777519 = Lawson ID"}]},{"description":"COMP GLENOSPHR PLS2MM 36MM","code_information":[{"code":"Sx00-4360-036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"842116","type":"LOCAL"},{"code":"777520","type":"LOCAL"}],"standard_charges":[{"gross_charge":2473.33,"discounted_cash":1855.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 842116 = Hospital System Supply Identifier | 777520 = Lawson ID"}]},{"description":"COMP GLENOSPHR PLS2.5MM 40MM","code_information":[{"code":"Sx00-4360-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"842118","type":"LOCAL"},{"code":"777522","type":"LOCAL"}],"standard_charges":[{"gross_charge":2473.33,"discounted_cash":1855.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 842118 = Hospital System Supply Identifier | 777522 = Lawson ID"}]},{"description":"COMP GLENOSPHR PLS0MM 40MM","code_information":[{"code":"Sx00-4360-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"842117","type":"LOCAL"},{"code":"777521","type":"LOCAL"}],"standard_charges":[{"gross_charge":2473.33,"discounted_cash":1855.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 842117 = Hospital System Supply Identifier | 777521 = Lawson ID"}]},{"description":"BIT DRILL TRABECULAR METAL REVERSE PLUS 00436104525 7.5X25MM","code_information":[{"code":"Sx00-4361-045","type":"CDM"},{"code":"272","type":"RC"},{"code":"1446400","type":"LOCAL"},{"code":"1002281","type":"LOCAL"}],"standard_charges":[{"gross_charge":827.91,"discounted_cash":620.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1446400 = Hospital System Supply Identifier | 1002281 = Lawson ID"}]},{"description":"BIT DRILL TRABECULAR METAL REVERSE PLUS 00436104515 7.5X15MM","code_information":[{"code":"Sx00-4361-045","type":"CDM"},{"code":"272","type":"RC"},{"code":"1446399","type":"LOCAL"},{"code":"1002374","type":"LOCAL"}],"standard_charges":[{"gross_charge":827.91,"discounted_cash":620.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1446399 = Hospital System Supply Identifier | 1002374 = Lawson ID"}]},{"description":"BIT DRILL REVERSE SHOULDER TRABECULAR METAL 00436107330 7.5X30MM","code_information":[{"code":"Sx00-4361-073","type":"CDM"},{"code":"272","type":"RC"},{"code":"1414750","type":"LOCAL"},{"code":"1089674","type":"LOCAL"}],"standard_charges":[{"gross_charge":428.57,"discounted_cash":321.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1414750 = Hospital System Supply Identifier | 1089674 = Lawson ID"}]},{"description":"BIT DRILL REVERSE SHOULDER TRABECULAR METAL 00436107325 7.5X25MM","code_information":[{"code":"Sx00-4361-073","type":"CDM"},{"code":"272","type":"RC"},{"code":"1414751","type":"LOCAL"},{"code":"1089841","type":"LOCAL"}],"standard_charges":[{"gross_charge":428.57,"discounted_cash":321.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1414751 = Hospital System Supply Identifier | 1089841 = Lawson ID"}]},{"description":"BIT DRILL REVERSE SHOULDER TRABECULAR METAL 00436107320 7.5X20MM","code_information":[{"code":"Sx00-4361-073","type":"CDM"},{"code":"272","type":"RC"},{"code":"1414753","type":"LOCAL"},{"code":"1089856","type":"LOCAL"}],"standard_charges":[{"gross_charge":428.57,"discounted_cash":321.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1414753 = Hospital System Supply Identifier | 1089856 = Lawson ID"}]},{"description":"BIT DRILL TRABECULAR METAL 00436107315 7.5X15MM","code_information":[{"code":"Sx00-4361-073","type":"CDM"},{"code":"272","type":"RC"},{"code":"1414754","type":"LOCAL"},{"code":"1090098","type":"LOCAL"}],"standard_charges":[{"gross_charge":428.57,"discounted_cash":321.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1414754 = Hospital System Supply Identifier | 1090098 = Lawson ID"}]},{"description":"BASEPLATE GLEN REV 15X26MM","code_information":[{"code":"Sx00-4362-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"842119","type":"LOCAL"},{"code":"777523","type":"LOCAL"}],"standard_charges":[{"gross_charge":2679.46,"discounted_cash":2009.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 842119 = Hospital System Supply Identifier | 777523 = Lawson ID"}]},{"description":"BASEPLATE GLEN REV 20X26MM","code_information":[{"code":"Sx00-4362-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"842120","type":"LOCAL"},{"code":"777524","type":"LOCAL"}],"standard_charges":[{"gross_charge":2679.46,"discounted_cash":2009.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 842120 = Hospital System Supply Identifier | 777524 = Lawson ID"}]},{"description":"BASEPLATE GLEN REV 25X26MM","code_information":[{"code":"Sx00-4362-025","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"842121","type":"LOCAL"},{"code":"777525","type":"LOCAL"}],"standard_charges":[{"gross_charge":2679.46,"discounted_cash":2009.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 842121 = Hospital System Supply Identifier | 777525 = Lawson ID"}]},{"description":"BASEPLATE GLEN REV 30X26MM","code_information":[{"code":"Sx00-4362-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"842122","type":"LOCAL"},{"code":"777526","type":"LOCAL"}],"standard_charges":[{"gross_charge":2679.46,"discounted_cash":2009.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 842122 = Hospital System Supply Identifier | 777526 = Lawson ID"}]},{"description":"COMP GLENOSPHR PLS3MM 36MM","code_information":[{"code":"Sx00-4363-036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"842123","type":"LOCAL"},{"code":"777527","type":"LOCAL"}],"standard_charges":[{"gross_charge":2473.33,"discounted_cash":1855.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 842123 = Hospital System Supply Identifier | 777527 = Lawson ID"}]},{"description":"COMP GLENOSPHR PLS3MM ECC 36MM","code_information":[{"code":"Sx00-4363-036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"842124","type":"LOCAL"},{"code":"777528","type":"LOCAL"}],"standard_charges":[{"gross_charge":2473.33,"discounted_cash":1855.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 842124 = Hospital System Supply Identifier | 777528 = Lawson ID"}]},{"description":"COMP GLENOSPHR PLS3MM 40MM","code_information":[{"code":"Sx00-4363-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"842125","type":"LOCAL"},{"code":"777529","type":"LOCAL"}],"standard_charges":[{"gross_charge":2473.33,"discounted_cash":1855.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 842125 = Hospital System Supply Identifier | 777529 = Lawson ID"}]},{"description":"COMP GLENOSPHR PLS3MM ECC 40MM","code_information":[{"code":"Sx00-4363-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"842126","type":"LOCAL"},{"code":"777530","type":"LOCAL"}],"standard_charges":[{"gross_charge":2473.33,"discounted_cash":1855.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 842126 = Hospital System Supply Identifier | 777530 = Lawson ID"}]},{"description":"COMP GLENOSPHR PLS5MM 36MM","code_information":[{"code":"Sx00-4365-036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"842127","type":"LOCAL"},{"code":"777531","type":"LOCAL"}],"standard_charges":[{"gross_charge":2473.33,"discounted_cash":1855.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 842127 = Hospital System Supply Identifier | 777531 = Lawson ID"}]},{"description":"COMP GLENOSPHR PLS5MM ECC 36MM","code_information":[{"code":"Sx00-4365-036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"842128","type":"LOCAL"},{"code":"777532","type":"LOCAL"}],"standard_charges":[{"gross_charge":2473.33,"discounted_cash":1855.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 842128 = Hospital System Supply Identifier | 777532 = Lawson ID"}]},{"description":"COMP GLENOSPHR PLS5MM 40MM","code_information":[{"code":"Sx00-4365-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"842129","type":"LOCAL"},{"code":"777533","type":"LOCAL"}],"standard_charges":[{"gross_charge":2473.33,"discounted_cash":1855.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 842129 = Hospital System Supply Identifier | 777533 = Lawson ID"}]},{"description":"COMP GLENOSPHR PLS5MM ECC 40MM","code_information":[{"code":"Sx00-4365-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"842130","type":"LOCAL"},{"code":"777534","type":"LOCAL"}],"standard_charges":[{"gross_charge":2473.33,"discounted_cash":1855.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 842130 = Hospital System Supply Identifier | 777534 = Lawson ID"}]},{"description":"IMP HIP ACET LNR TM 36MM 0","code_information":[{"code":"Sx00-4390-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325639","type":"LOCAL"},{"code":"360584","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 325639 = Hospital System Supply Identifier | 360584 = Lawson ID"}]},{"description":"ANKLE JOINT TALAR COMPONENT TRABECULAR METAL 00450001100 SIZE 1","code_information":[{"code":"Sx00-4500-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1482088","type":"LOCAL"},{"code":"1100786","type":"LOCAL"}],"standard_charges":[{"gross_charge":15544.0,"discounted_cash":11658.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1482088 = Hospital System Supply Identifier | 1100786 = Lawson ID"}]},{"description":"ANKLE JOINT TALAR COMPONENT TRABECULAR METAL 00450001400 SIZE 4","code_information":[{"code":"Sx00-4500-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1482069","type":"LOCAL"},{"code":"1100803","type":"LOCAL"}],"standard_charges":[{"gross_charge":15544.0,"discounted_cash":11658.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1482069 = Hospital System Supply Identifier | 1100803 = Lawson ID"}]},{"description":"ANKLE JOINT TALAR COMPONENT TRABECULAR METAL 00450001500 SIZE 5","code_information":[{"code":"Sx00-4500-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1482087","type":"LOCAL"},{"code":"1100782","type":"LOCAL"}],"standard_charges":[{"gross_charge":15544.0,"discounted_cash":11658.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1482087 = Hospital System Supply Identifier | 1100782 = Lawson ID"}]},{"description":"ANKLE JOINT TALAR COMPONENT TRABECULAR METAL 00450001600 SIZE 6","code_information":[{"code":"Sx00-4500-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1482067","type":"LOCAL"},{"code":"1100806","type":"LOCAL"}],"standard_charges":[{"gross_charge":15544.0,"discounted_cash":11658.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1482067 = Hospital System Supply Identifier | 1100806 = Lawson ID"}]},{"description":"ANKLE JOINT TALAR COMPONENT TRABECULAR METAL 00450002100 SIZE 1","code_information":[{"code":"Sx00-4500-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1482095","type":"LOCAL"},{"code":"1100784","type":"LOCAL"}],"standard_charges":[{"gross_charge":15544.0,"discounted_cash":11658.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1482095 = Hospital System Supply Identifier | 1100784 = Lawson ID"}]},{"description":"ANKLE JOINT TALAR COMPONENT TRABECULAR METAL 00450002200 SIZE 2","code_information":[{"code":"Sx00-4500-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1482099","type":"LOCAL"},{"code":"1100789","type":"LOCAL"}],"standard_charges":[{"gross_charge":15544.0,"discounted_cash":11658.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1482099 = Hospital System Supply Identifier | 1100789 = Lawson ID"}]},{"description":"ANKLE JOINT TALAR COMPONENT TRABECULAR METAL 00450002300 SIZE 3","code_information":[{"code":"Sx00-4500-023","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1482066","type":"LOCAL"},{"code":"1100792","type":"LOCAL"}],"standard_charges":[{"gross_charge":15544.0,"discounted_cash":11658.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1482066 = Hospital System Supply Identifier | 1100792 = Lawson ID"}]},{"description":"ANKLE JOINT TALAR COMPONENT TRABECULAR METAL 00450002400 SIZE 4","code_information":[{"code":"Sx00-4500-024","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1482079","type":"LOCAL"},{"code":"1100817","type":"LOCAL"}],"standard_charges":[{"gross_charge":15544.0,"discounted_cash":11658.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1482079 = Hospital System Supply Identifier | 1100817 = Lawson ID"}]},{"description":"ANKLE JOINT TALAR COMPONENT TRABECULAR METAL 00450002500 SIZE 5","code_information":[{"code":"Sx00-4500-025","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1482092","type":"LOCAL"},{"code":"1100801","type":"LOCAL"}],"standard_charges":[{"gross_charge":15544.0,"discounted_cash":11658.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1482092 = Hospital System Supply Identifier | 1100801 = Lawson ID"}]},{"description":"ANKLE JOINT TALAR COMPONENT TRABECULAR METAL 00450002600 SIZE 6","code_information":[{"code":"Sx00-4500-026","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1482072","type":"LOCAL"},{"code":"1100813","type":"LOCAL"}],"standard_charges":[{"gross_charge":15544.0,"discounted_cash":11658.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1482072 = Hospital System Supply Identifier | 1100813 = Lawson ID"}]},{"description":"ANKLE JOINT TIBIAL COMPONENT TRABECULAR METAL 00450004100 SIZE 1","code_information":[{"code":"Sx00-4500-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1482061","type":"LOCAL"},{"code":"1100797","type":"LOCAL"}],"standard_charges":[{"gross_charge":11836.0,"discounted_cash":8877.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1482061 = Hospital System Supply Identifier | 1100797 = Lawson ID"}]},{"description":"ANKLE JOINT TIBIAL COMPONENT TRABECULAR METAL 00450004400 SIZE 4","code_information":[{"code":"Sx00-4500-044","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1482077","type":"LOCAL"},{"code":"1100808","type":"LOCAL"}],"standard_charges":[{"gross_charge":11836.0,"discounted_cash":8877.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1482077 = Hospital System Supply Identifier | 1100808 = Lawson ID"}]},{"description":"ANKLE JOINT TIBIAL COMPONENT TRABECULAR METAL 00450004500 SIZE 5","code_information":[{"code":"Sx00-4500-045","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1482063","type":"LOCAL"},{"code":"1100780","type":"LOCAL"}],"standard_charges":[{"gross_charge":11836.0,"discounted_cash":8877.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1482063 = Hospital System Supply Identifier | 1100780 = Lawson ID"}]},{"description":"ANKLE JOINT TIBIAL COMPONENT TRABECULAR METAL 00450004600 SIZE 6","code_information":[{"code":"Sx00-4500-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1482093","type":"LOCAL"},{"code":"1100810","type":"LOCAL"}],"standard_charges":[{"gross_charge":11836.0,"discounted_cash":8877.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1482093 = Hospital System Supply Identifier | 1100810 = Lawson ID"}]},{"description":"ANKLE JOINT INSERT TRABECULAR METAL PROLONG 00450005102 2 SIZE 1","code_information":[{"code":"Sx00-4500-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1482085","type":"LOCAL"},{"code":"1100804","type":"LOCAL"}],"standard_charges":[{"gross_charge":6279.0,"discounted_cash":4709.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1482085 = Hospital System Supply Identifier | 1100804 = Lawson ID"}]},{"description":"ANKLE JOINT INSERT TRABECULAR METAL PROLONG 00450005104 4 SIZE 1","code_information":[{"code":"Sx00-4500-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1482097","type":"LOCAL"},{"code":"1100812","type":"LOCAL"}],"standard_charges":[{"gross_charge":6279.0,"discounted_cash":4709.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1482097 = Hospital System Supply Identifier | 1100812 = Lawson ID"}]},{"description":"ANKLE JOINT INSERT TRABECULAR METAL PROLONG 00450005100 0 SIZE 1","code_information":[{"code":"Sx00-4500-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1482101","type":"LOCAL"},{"code":"1100824","type":"LOCAL"}],"standard_charges":[{"gross_charge":6279.0,"discounted_cash":4709.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1482101 = Hospital System Supply Identifier | 1100824 = Lawson ID"}]},{"description":"ANKLE JOINT INSERT TRABECULAR METAL PROLONG 00450005202 2 SIZE 2","code_information":[{"code":"Sx00-4500-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1482081","type":"LOCAL"},{"code":"1100791","type":"LOCAL"}],"standard_charges":[{"gross_charge":6279.0,"discounted_cash":4709.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1482081 = Hospital System Supply Identifier | 1100791 = Lawson ID"}]},{"description":"ANKLE JOINT INSERT TRABECULAR METAL PROLONG 00450005204 4 SIZE 2","code_information":[{"code":"Sx00-4500-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1482064","type":"LOCAL"},{"code":"1100805","type":"LOCAL"}],"standard_charges":[{"gross_charge":6279.0,"discounted_cash":4709.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1482064 = Hospital System Supply Identifier | 1100805 = Lawson ID"}]},{"description":"ANKLE JOINT INSERT TRABECULAR METAL PROLONG 00450005302 2 SIZE 3","code_information":[{"code":"Sx00-4500-053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1482078","type":"LOCAL"},{"code":"1100820","type":"LOCAL"}],"standard_charges":[{"gross_charge":6279.0,"discounted_cash":4709.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1482078 = Hospital System Supply Identifier | 1100820 = Lawson ID"}]},{"description":"ANKLE JOINT INSERT TRABECULAR METAL PROLONG 00450005304 4 SIZE 3","code_information":[{"code":"Sx00-4500-053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1482086","type":"LOCAL"},{"code":"1100821","type":"LOCAL"}],"standard_charges":[{"gross_charge":6279.0,"discounted_cash":4709.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1482086 = Hospital System Supply Identifier | 1100821 = Lawson ID"}]},{"description":"ANKLE JOINT INSERT TRABECULAR METAL PROLONG 00450005404 4 SIZE 4","code_information":[{"code":"Sx00-4500-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1482096","type":"LOCAL"},{"code":"1100811","type":"LOCAL"}],"standard_charges":[{"gross_charge":6279.0,"discounted_cash":4709.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1482096 = Hospital System Supply Identifier | 1100811 = Lawson ID"}]},{"description":"ANKLE JOINT INSERT TRABECULAR METAL PROLONG 00450005402 2 SIZE 4","code_information":[{"code":"Sx00-4500-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1482089","type":"LOCAL"},{"code":"1100785","type":"LOCAL"}],"standard_charges":[{"gross_charge":6279.0,"discounted_cash":4709.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1482089 = Hospital System Supply Identifier | 1100785 = Lawson ID"}]},{"description":"ANKLE JOINT INSERT TRABECULAR METAL PROLONG 00450005400 0 SIZE 4","code_information":[{"code":"Sx00-4500-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1482091","type":"LOCAL"},{"code":"1100790","type":"LOCAL"}],"standard_charges":[{"gross_charge":6279.0,"discounted_cash":4709.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1482091 = Hospital System Supply Identifier | 1100790 = Lawson ID"}]},{"description":"ANKLE JOINT INSERT TRABECULAR METAL PROLONG 00450005500 0 SIZE 5","code_information":[{"code":"Sx00-4500-055","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1482074","type":"LOCAL"},{"code":"1100779","type":"LOCAL"}],"standard_charges":[{"gross_charge":6279.0,"discounted_cash":4709.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1482074 = Hospital System Supply Identifier | 1100779 = Lawson ID"}]},{"description":"ANKLE JOINT INSERT TRABECULAR METAL PROLONG 00450005502 2 SIZE 5","code_information":[{"code":"Sx00-4500-055","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1482057","type":"LOCAL"},{"code":"1100781","type":"LOCAL"}],"standard_charges":[{"gross_charge":6279.0,"discounted_cash":4709.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1482057 = Hospital System Supply Identifier | 1100781 = Lawson ID"}]},{"description":"ANKLE JOINT INSERT TRABECULAR METAL PROLONG 00450005504 4 SIZE 5","code_information":[{"code":"Sx00-4500-055","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1482075","type":"LOCAL"},{"code":"1100787","type":"LOCAL"}],"standard_charges":[{"gross_charge":6279.0,"discounted_cash":4709.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1482075 = Hospital System Supply Identifier | 1100787 = Lawson ID"}]},{"description":"ANKLE JOINT INSERT TRABECULAR METAL PROLONG 00450005604 4 SIZE 6","code_information":[{"code":"Sx00-4500-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1482058","type":"LOCAL"},{"code":"1100783","type":"LOCAL"}],"standard_charges":[{"gross_charge":6279.0,"discounted_cash":4709.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1482058 = Hospital System Supply Identifier | 1100783 = Lawson ID"}]},{"description":"ANKLE JOINT INSERT TRABECULAR METAL PROLONG 00450005600 0 SIZE 6","code_information":[{"code":"Sx00-4500-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1482065","type":"LOCAL"},{"code":"1100788","type":"LOCAL"}],"standard_charges":[{"gross_charge":6279.0,"discounted_cash":4709.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1482065 = Hospital System Supply Identifier | 1100788 = Lawson ID"}]},{"description":"ANKLE JOINT INSERT TRABECULAR METAL PROLONG 00450005602 2 SIZE 6","code_information":[{"code":"Sx00-4500-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1482090","type":"LOCAL"},{"code":"1100799","type":"LOCAL"}],"standard_charges":[{"gross_charge":6279.0,"discounted_cash":4709.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1482090 = Hospital System Supply Identifier | 1100799 = Lawson ID"}]},{"description":"K-WIRE FIX TEMP 1.6MM","code_information":[{"code":"Sx00-4501-040","type":"CDM"},{"code":"272","type":"RC"},{"code":"499631","type":"LOCAL"},{"code":"607569","type":"LOCAL"}],"standard_charges":[{"gross_charge":161.15,"discounted_cash":120.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 499631 = Hospital System Supply Identifier | 607569 = Lawson ID"}]},{"description":"PIN FIX EXTR TRAB MTL ANK 200X","code_information":[{"code":"Sx00-4501-040","type":"CDM"},{"code":"272","type":"RC"},{"code":"499633","type":"LOCAL"},{"code":"607571","type":"LOCAL"}],"standard_charges":[{"gross_charge":336.95,"discounted_cash":252.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 499633 = Hospital System Supply Identifier | 607571 = Lawson ID"}]},{"description":"DRILL SURGICAL SLEEVE","code_information":[{"code":"Sx00-4501-041","type":"CDM"},{"code":"272","type":"RC"},{"code":"499634","type":"LOCAL"},{"code":"607572","type":"LOCAL"}],"standard_charges":[{"gross_charge":366.25,"discounted_cash":274.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 499634 = Hospital System Supply Identifier | 607572 = Lawson ID"}]},{"description":"BIT DRILL ZPS QC 1.1X60MM","code_information":[{"code":"Sx00-4806-060","type":"CDM"},{"code":"272","type":"RC"},{"code":"450399","type":"LOCAL"},{"code":"345074","type":"LOCAL"}],"standard_charges":[{"gross_charge":152.97,"discounted_cash":114.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 450399 = Hospital System Supply Identifier | 345074 = Lawson ID"}]},{"description":"BIT DRILL ZPS QC 1.5X85MM","code_information":[{"code":"Sx00-4806-085","type":"CDM"},{"code":"272","type":"RC"},{"code":"450400","type":"LOCAL"},{"code":"345075","type":"LOCAL"}],"standard_charges":[{"gross_charge":152.97,"discounted_cash":114.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 450400 = Hospital System Supply Identifier | 345075 = Lawson ID"}]},{"description":"BIT DRILL Q-C 2.0MM","code_information":[{"code":"Sx00-4806-100","type":"CDM"},{"code":"272","type":"RC"},{"code":"17826","type":"LOCAL"},{"code":"157437","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.07,"discounted_cash":112.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 17826 = Hospital System Supply Identifier | 157437 = Lawson ID"}]},{"description":"BIT DRILL Q-C 2.7MM","code_information":[{"code":"Sx00-4806-100","type":"CDM"},{"code":"272","type":"RC"},{"code":"81985","type":"LOCAL"},{"code":"157438","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.07,"discounted_cash":112.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 81985 = Hospital System Supply Identifier | 157438 = Lawson ID"}]},{"description":"BIT DRILL Q-C 2.5MM","code_information":[{"code":"Sx00-4806-110","type":"CDM"},{"code":"272","type":"RC"},{"code":"17827","type":"LOCAL"},{"code":"157439","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.07,"discounted_cash":112.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 17827 = Hospital System Supply Identifier | 157439 = Lawson ID"}]},{"description":"BIT DRILL Q-C 3.5X110MM","code_information":[{"code":"Sx00-4806-110","type":"CDM"},{"code":"272","type":"RC"},{"code":"17828","type":"LOCAL"},{"code":"157440","type":"LOCAL"}],"standard_charges":[{"gross_charge":288.6,"discounted_cash":216.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 17828 = Hospital System Supply Identifier | 157440 = Lawson ID"}]},{"description":"BIT DRILL 3.2MM","code_information":[{"code":"Sx00-4806-145","type":"CDM"},{"code":"272","type":"RC"},{"code":"149585","type":"LOCAL"},{"code":"237007","type":"LOCAL"}],"standard_charges":[{"gross_charge":224.14,"discounted_cash":168.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 149585 = Hospital System Supply Identifier | 237007 = Lawson ID"}]},{"description":"BIT DRILL 4.5X145MM QC VERSA","code_information":[{"code":"Sx00-4806-145","type":"CDM"},{"code":"272","type":"RC"},{"code":"450394","type":"LOCAL"},{"code":"317331","type":"LOCAL"}],"standard_charges":[{"gross_charge":249.05,"discounted_cash":186.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 450394 = Hospital System Supply Identifier | 317331 = Lawson ID"}]},{"description":"BIT DRILL QC NS REUSE 3.5X195","code_information":[{"code":"Sx00-4806-195","type":"CDM"},{"code":"272","type":"RC"},{"code":"196719","type":"LOCAL"},{"code":"417234","type":"LOCAL"}],"standard_charges":[{"gross_charge":288.6,"discounted_cash":216.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 196719 = Hospital System Supply Identifier | 417234 = Lawson ID"}]},{"description":"BIT DRILL Q/C 3.2X195MM","code_information":[{"code":"Sx00-4806-195","type":"CDM"},{"code":"272","type":"RC"},{"code":"153609","type":"LOCAL"},{"code":"294693","type":"LOCAL"}],"standard_charges":[{"gross_charge":224.14,"discounted_cash":168.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 153609 = Hospital System Supply Identifier | 294693 = Lawson ID"}]},{"description":"BIT DRILL Q-C 3-FLUT","code_information":[{"code":"Sx00-4807-180","type":"CDM"},{"code":"272","type":"RC"},{"code":"191884","type":"LOCAL"},{"code":"157441","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.07,"discounted_cash":112.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 191884 = Hospital System Supply Identifier | 157441 = Lawson ID"}]},{"description":"TAP SURG BONE Q/C 2.7MM SCRW","code_information":[{"code":"Sx00-4811-100","type":"CDM"},{"code":"272","type":"RC"},{"code":"17830","type":"LOCAL"},{"code":"157446","type":"LOCAL"}],"standard_charges":[{"gross_charge":159.47,"discounted_cash":119.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 17830 = Hospital System Supply Identifier | 157446 = Lawson ID"}]},{"description":"TAP SURG BONE Q/C 3.5MM SCRW","code_information":[{"code":"Sx00-4811-110","type":"CDM"},{"code":"272","type":"RC"},{"code":"191886","type":"LOCAL"},{"code":"157447","type":"LOCAL"}],"standard_charges":[{"gross_charge":159.47,"discounted_cash":119.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 191886 = Hospital System Supply Identifier | 157447 = Lawson ID"}]},{"description":"BIT SCREWDRIVER","code_information":[{"code":"Sx00-4812-045","type":"CDM"},{"code":"272","type":"RC"},{"code":"149580","type":"LOCAL"},{"code":"236996","type":"LOCAL"}],"standard_charges":[{"gross_charge":247.05,"discounted_cash":185.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 149580 = Hospital System Supply Identifier | 236996 = Lawson ID"}]},{"description":"SCREW CORT MINI-FRAG 1.5X6MM","code_information":[{"code":"Sx00-4815-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408965","type":"LOCAL"},{"code":"345079","type":"LOCAL"}],"standard_charges":[{"gross_charge":111.69,"discounted_cash":83.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408965 = Hospital System Supply Identifier | 345079 = Lawson ID"}]},{"description":"SCREW CORT 1.5X6MM","code_information":[{"code":"Sx00-4815-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409410","type":"LOCAL"},{"code":"398070","type":"LOCAL"}],"standard_charges":[{"gross_charge":111.69,"discounted_cash":83.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 409410 = Hospital System Supply Identifier | 398070 = Lawson ID"}]},{"description":"SCREW CORT MINI SLF-TP 1.5X6MM","code_information":[{"code":"Sx00-4815-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409890","type":"LOCAL"},{"code":"407448","type":"LOCAL"}],"standard_charges":[{"gross_charge":111.69,"discounted_cash":83.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 409890 = Hospital System Supply Identifier | 407448 = Lawson ID"}]},{"description":"SCREW CORT 1.5X7MM","code_information":[{"code":"Sx00-4815-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409411","type":"LOCAL"},{"code":"398071","type":"LOCAL"}],"standard_charges":[{"gross_charge":111.69,"discounted_cash":83.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 409411 = Hospital System Supply Identifier | 398071 = Lawson ID"}]},{"description":"SCREW CORT MINI SLF-TP 1.5X7MM","code_information":[{"code":"Sx00-4815-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409891","type":"LOCAL"},{"code":"407449","type":"LOCAL"}],"standard_charges":[{"gross_charge":111.69,"discounted_cash":83.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 409891 = Hospital System Supply Identifier | 407449 = Lawson ID"}]},{"description":"SCREW CORT MINI-FRAG 1.5X7MM","code_information":[{"code":"Sx00-4815-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408966","type":"LOCAL"},{"code":"345080","type":"LOCAL"}],"standard_charges":[{"gross_charge":111.69,"discounted_cash":83.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408966 = Hospital System Supply Identifier | 345080 = Lawson ID"}]},{"description":"SCREW CORT MINI-FRAG 1.5X8MM","code_information":[{"code":"Sx00-4815-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408967","type":"LOCAL"},{"code":"345081","type":"LOCAL"}],"standard_charges":[{"gross_charge":111.69,"discounted_cash":83.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408967 = Hospital System Supply Identifier | 345081 = Lawson ID"}]},{"description":"SCREW CORT 1.5X8MM","code_information":[{"code":"Sx00-4815-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409412","type":"LOCAL"},{"code":"398072","type":"LOCAL"}],"standard_charges":[{"gross_charge":111.69,"discounted_cash":83.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 409412 = Hospital System Supply Identifier | 398072 = Lawson ID"}]},{"description":"SCREW CORT MINI SLF-TP 1.5X8MM","code_information":[{"code":"Sx00-4815-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409892","type":"LOCAL"},{"code":"407450","type":"LOCAL"}],"standard_charges":[{"gross_charge":111.69,"discounted_cash":83.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 409892 = Hospital System Supply Identifier | 407450 = Lawson ID"}]},{"description":"SCREW CORT MINI-FRAG 1.5X9MM","code_information":[{"code":"Sx00-4815-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408637","type":"LOCAL"},{"code":"339148","type":"LOCAL"}],"standard_charges":[{"gross_charge":111.69,"discounted_cash":83.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408637 = Hospital System Supply Identifier | 339148 = Lawson ID"}]},{"description":"SCREW CORT 1.5X9MM","code_information":[{"code":"Sx00-4815-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409413","type":"LOCAL"},{"code":"398073","type":"LOCAL"}],"standard_charges":[{"gross_charge":111.69,"discounted_cash":83.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 409413 = Hospital System Supply Identifier | 398073 = Lawson ID"}]},{"description":"SCREW CORT MINI SLF-TP 1.5X9MM","code_information":[{"code":"Sx00-4815-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409893","type":"LOCAL"},{"code":"407451","type":"LOCAL"}],"standard_charges":[{"gross_charge":111.69,"discounted_cash":83.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 409893 = Hospital System Supply Identifier | 407451 = Lawson ID"}]},{"description":"SCREW CORT MINI SLF-TP 1.5X10M","code_information":[{"code":"Sx00-4815-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"174739","type":"LOCAL"},{"code":"407452","type":"LOCAL"}],"standard_charges":[{"gross_charge":111.69,"discounted_cash":83.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 174739 = Hospital System Supply Identifier | 407452 = Lawson ID"}]},{"description":"DISC - SCREW CORT 1.5X10MM","code_information":[{"code":"Sx00-4815-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409414","type":"LOCAL"},{"code":"398074","type":"LOCAL"}],"standard_charges":[{"gross_charge":59.85,"discounted_cash":44.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 409414 = Hospital System Supply Identifier | 398074 = Lawson ID"}]},{"description":"SCREW CORT MINI-FRAG 1.5X10MM","code_information":[{"code":"Sx00-4815-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408638","type":"LOCAL"},{"code":"339149","type":"LOCAL"}],"standard_charges":[{"gross_charge":111.69,"discounted_cash":83.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408638 = Hospital System Supply Identifier | 339149 = Lawson ID"}]},{"description":"SCREW CORT MINI-FRAG 1.5X11MM","code_information":[{"code":"Sx00-4815-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408639","type":"LOCAL"},{"code":"339150","type":"LOCAL"}],"standard_charges":[{"gross_charge":111.69,"discounted_cash":83.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408639 = Hospital System Supply Identifier | 339150 = Lawson ID"}]},{"description":"SCREW CORT 1.5X11MM","code_information":[{"code":"Sx00-4815-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409415","type":"LOCAL"},{"code":"398075","type":"LOCAL"}],"standard_charges":[{"gross_charge":111.69,"discounted_cash":83.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 409415 = Hospital System Supply Identifier | 398075 = Lawson ID"}]},{"description":"SCREW CORT MINI SLF-TP 1.5X11M","code_information":[{"code":"Sx00-4815-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409894","type":"LOCAL"},{"code":"407453","type":"LOCAL"}],"standard_charges":[{"gross_charge":111.69,"discounted_cash":83.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 409894 = Hospital System Supply Identifier | 407453 = Lawson ID"}]},{"description":"SCREW CORT MINI-FRAG 1.5X12MM","code_information":[{"code":"Sx00-4815-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408968","type":"LOCAL"},{"code":"345082","type":"LOCAL"}],"standard_charges":[{"gross_charge":111.69,"discounted_cash":83.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408968 = Hospital System Supply Identifier | 345082 = Lawson ID"}]},{"description":"SCREW CORT 1.5X12MM","code_information":[{"code":"Sx00-4815-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409416","type":"LOCAL"},{"code":"398076","type":"LOCAL"}],"standard_charges":[{"gross_charge":111.69,"discounted_cash":83.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 409416 = Hospital System Supply Identifier | 398076 = Lawson ID"}]},{"description":"SCREW CORT MINI SLF-TP 1.5X12M","code_information":[{"code":"Sx00-4815-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409895","type":"LOCAL"},{"code":"407454","type":"LOCAL"}],"standard_charges":[{"gross_charge":111.69,"discounted_cash":83.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 409895 = Hospital System Supply Identifier | 407454 = Lawson ID"}]},{"description":"SCREW CORT 1.5X14MM","code_information":[{"code":"Sx00-4815-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409417","type":"LOCAL"},{"code":"398077","type":"LOCAL"}],"standard_charges":[{"gross_charge":111.69,"discounted_cash":83.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 409417 = Hospital System Supply Identifier | 398077 = Lawson ID"}]},{"description":"SCREW CORT MINI SLF-TP 1.5X14M","code_information":[{"code":"Sx00-4815-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409896","type":"LOCAL"},{"code":"407455","type":"LOCAL"}],"standard_charges":[{"gross_charge":111.69,"discounted_cash":83.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 409896 = Hospital System Supply Identifier | 407455 = Lawson ID"}]},{"description":"SCREW CORT MINI-FRAG 1.5X14MM","code_information":[{"code":"Sx00-4815-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408969","type":"LOCAL"},{"code":"345083","type":"LOCAL"}],"standard_charges":[{"gross_charge":111.69,"discounted_cash":83.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408969 = Hospital System Supply Identifier | 345083 = Lawson ID"}]},{"description":"SCREW CORT 1.5X16MM","code_information":[{"code":"Sx00-4815-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409418","type":"LOCAL"},{"code":"398078","type":"LOCAL"}],"standard_charges":[{"gross_charge":111.69,"discounted_cash":83.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 409418 = Hospital System Supply Identifier | 398078 = Lawson ID"}]},{"description":"SCREW CORT MINI SLF-TP 1.5X16M","code_information":[{"code":"Sx00-4815-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409897","type":"LOCAL"},{"code":"407456","type":"LOCAL"}],"standard_charges":[{"gross_charge":111.69,"discounted_cash":83.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 409897 = Hospital System Supply Identifier | 407456 = Lawson ID"}]},{"description":"SCREW CORT MINI-FRAG 1.5X16MM","code_information":[{"code":"Sx00-4815-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408640","type":"LOCAL"},{"code":"339151","type":"LOCAL"}],"standard_charges":[{"gross_charge":111.69,"discounted_cash":83.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408640 = Hospital System Supply Identifier | 339151 = Lawson ID"}]},{"description":"SCREW CORT MINI-FRAG 1.5X18MM","code_information":[{"code":"Sx00-4815-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408641","type":"LOCAL"},{"code":"339152","type":"LOCAL"}],"standard_charges":[{"gross_charge":111.69,"discounted_cash":83.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408641 = Hospital System Supply Identifier | 339152 = Lawson ID"}]},{"description":"SCREW CORT MINI-FRAG 1.5X18MM","code_information":[{"code":"Sx00-4815-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408898","type":"LOCAL"},{"code":"342351","type":"LOCAL"}],"standard_charges":[{"gross_charge":111.69,"discounted_cash":83.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408898 = Hospital System Supply Identifier | 342351 = Lawson ID"}]},{"description":"SCREW CORT MINI 1.5X18MM","code_information":[{"code":"Sx00-4815-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409898","type":"LOCAL"},{"code":"407457","type":"LOCAL"}],"standard_charges":[{"gross_charge":111.69,"discounted_cash":83.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 409898 = Hospital System Supply Identifier | 407457 = Lawson ID"}]},{"description":"SCREW CORT MINI-FRAG 1.5X20MM","code_information":[{"code":"Sx00-4815-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408642","type":"LOCAL"},{"code":"339153","type":"LOCAL"}],"standard_charges":[{"gross_charge":111.69,"discounted_cash":83.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408642 = Hospital System Supply Identifier | 339153 = Lawson ID"}]},{"description":"SCREW CORT MINI-FRAG 1.5X20MM","code_information":[{"code":"Sx00-4815-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408899","type":"LOCAL"},{"code":"342352","type":"LOCAL"}],"standard_charges":[{"gross_charge":111.69,"discounted_cash":83.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408899 = Hospital System Supply Identifier | 342352 = Lawson ID"}]},{"description":"SCREW CORT MINI 1.5X20MM","code_information":[{"code":"Sx00-4815-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"174740","type":"LOCAL"},{"code":"407458","type":"LOCAL"}],"standard_charges":[{"gross_charge":111.69,"discounted_cash":83.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 174740 = Hospital System Supply Identifier | 407458 = Lawson ID"}]},{"description":"SCREW CORT MINI 1.5X22MM","code_information":[{"code":"Sx00-4815-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409899","type":"LOCAL"},{"code":"407459","type":"LOCAL"}],"standard_charges":[{"gross_charge":111.69,"discounted_cash":83.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 409899 = Hospital System Supply Identifier | 407459 = Lawson ID"}]},{"description":"SCREW CORT MINI-FRAG 1.5X22MM","code_information":[{"code":"Sx00-4815-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408643","type":"LOCAL"},{"code":"339154","type":"LOCAL"}],"standard_charges":[{"gross_charge":111.69,"discounted_cash":83.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408643 = Hospital System Supply Identifier | 339154 = Lawson ID"}]},{"description":"SCREW CORT MINI SLF-TP 1.5X22M","code_information":[{"code":"Sx00-4815-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409900","type":"LOCAL"},{"code":"407460","type":"LOCAL"}],"standard_charges":[{"gross_charge":111.69,"discounted_cash":83.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 409900 = Hospital System Supply Identifier | 407460 = Lawson ID"}]},{"description":"SCREW CORT MINI 1.5X24MM","code_information":[{"code":"Sx00-4815-024","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409901","type":"LOCAL"},{"code":"407461","type":"LOCAL"}],"standard_charges":[{"gross_charge":111.69,"discounted_cash":83.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 409901 = Hospital System Supply Identifier | 407461 = Lawson ID"}]},{"description":"SCREW CORT MINI-FRAG 1.5X24MM","code_information":[{"code":"Sx00-4815-024","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408644","type":"LOCAL"},{"code":"339155","type":"LOCAL"}],"standard_charges":[{"gross_charge":111.69,"discounted_cash":83.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408644 = Hospital System Supply Identifier | 339155 = Lawson ID"}]},{"description":"SCREW CORT MINI-FRAG 1.5X24MM","code_information":[{"code":"Sx00-4815-024","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408900","type":"LOCAL"},{"code":"342353","type":"LOCAL"}],"standard_charges":[{"gross_charge":111.69,"discounted_cash":83.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408900 = Hospital System Supply Identifier | 342353 = Lawson ID"}]},{"description":"SCREW CORT MINI-FRAG 2.0X16MM","code_information":[{"code":"Sx00-4820-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409906","type":"LOCAL"},{"code":"407468","type":"LOCAL"}],"standard_charges":[{"gross_charge":64.26,"discounted_cash":48.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 409906 = Hospital System Supply Identifier | 407468 = Lawson ID"}]},{"description":"BIT DRILL 2.5MM","code_information":[{"code":"Sx00-4836-205","type":"CDM"},{"code":"272","type":"RC"},{"code":"193562","type":"LOCAL"},{"code":"314279","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.07,"discounted_cash":112.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 193562 = Hospital System Supply Identifier | 314279 = Lawson ID"}]},{"description":"IMP HIP ACET AUG SZ50 30","code_information":[{"code":"Sx00-4893-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321674","type":"LOCAL"},{"code":"534888","type":"LOCAL"}],"standard_charges":[{"gross_charge":6188.36,"discounted_cash":4641.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321674 = Hospital System Supply Identifier | 534888 = Lawson ID"}]},{"description":"IMP HIP ACET AUG SZ52 30","code_information":[{"code":"Sx00-4893-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321675","type":"LOCAL"},{"code":"534889","type":"LOCAL"}],"standard_charges":[{"gross_charge":6188.36,"discounted_cash":4641.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321675 = Hospital System Supply Identifier | 534889 = Lawson ID"}]},{"description":"IMP HIP ACET AUG SZ58 30","code_information":[{"code":"Sx00-4893-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321677","type":"LOCAL"},{"code":"534891","type":"LOCAL"}],"standard_charges":[{"gross_charge":6188.36,"discounted_cash":4641.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321677 = Hospital System Supply Identifier | 534891 = Lawson ID"}]},{"description":"IMP HIP ACET AUG SZ58 10","code_information":[{"code":"Sx00-4893-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321676","type":"LOCAL"},{"code":"534890","type":"LOCAL"}],"standard_charges":[{"gross_charge":6188.36,"discounted_cash":4641.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321676 = Hospital System Supply Identifier | 534890 = Lawson ID"}]},{"description":"IMP ACET AUG ACET SZ58 20MM","code_information":[{"code":"Sx00-4893-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325143","type":"LOCAL"},{"code":"340008","type":"LOCAL"}],"standard_charges":[{"gross_charge":6188.36,"discounted_cash":4641.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 325143 = Hospital System Supply Identifier | 340008 = Lawson ID"}]},{"description":"IMP HIP BTRES AUG STR SZ58","code_information":[{"code":"Sx00-4894-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321680","type":"LOCAL"},{"code":"534894","type":"LOCAL"}],"standard_charges":[{"gross_charge":4812.5,"discounted_cash":3609.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321680 = Hospital System Supply Identifier | 534894 = Lawson ID"}]},{"description":"IMP HIP BTRES AUG STR SZ54","code_information":[{"code":"Sx00-4894-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321679","type":"LOCAL"},{"code":"534893","type":"LOCAL"}],"standard_charges":[{"gross_charge":4812.5,"discounted_cash":3609.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321679 = Hospital System Supply Identifier | 534893 = Lawson ID"}]},{"description":"IMP ACET AUG SHIM 5DEG","code_information":[{"code":"Sx00-4894-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"316780","type":"LOCAL"},{"code":"324048","type":"LOCAL"}],"standard_charges":[{"gross_charge":4812.5,"discounted_cash":3609.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 316780 = Hospital System Supply Identifier | 324048 = Lawson ID"}]},{"description":"IMP HIP ACET REV AUG 15X50MM","code_information":[{"code":"Sx00-4894-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202215","type":"LOCAL"},{"code":"452313","type":"LOCAL"}],"standard_charges":[{"gross_charge":4812.5,"discounted_cash":3609.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 202215 = Hospital System Supply Identifier | 452313 = Lawson ID"}]},{"description":"IMP ACET AUG SHIM 10D","code_information":[{"code":"Sx00-4894-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321678","type":"LOCAL"},{"code":"534892","type":"LOCAL"}],"standard_charges":[{"gross_charge":4812.5,"discounted_cash":3609.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321678 = Hospital System Supply Identifier | 534892 = Lawson ID"}]},{"description":"IMP ACET AUG ACET SZ50 20MM","code_information":[{"code":"Sx00-4894-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"194102","type":"LOCAL"},{"code":"329786","type":"LOCAL"}],"standard_charges":[{"gross_charge":4812.5,"discounted_cash":3609.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 194102 = Hospital System Supply Identifier | 329786 = Lawson ID"}]},{"description":"IMP ACET AUG ACET SZ50 10MM","code_information":[{"code":"Sx00-4894-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326255","type":"LOCAL"},{"code":"393661","type":"LOCAL"}],"standard_charges":[{"gross_charge":4812.5,"discounted_cash":3609.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 326255 = Hospital System Supply Identifier | 393661 = Lawson ID"}]},{"description":"IMP HIP ACET REV AUG 15X50MM","code_information":[{"code":"Sx00-4894-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"196706","type":"LOCAL"},{"code":"416867","type":"LOCAL"}],"standard_charges":[{"gross_charge":4812.5,"discounted_cash":3609.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 196706 = Hospital System Supply Identifier | 416867 = Lawson ID"}]},{"description":"IMP HIP ACET REV AUG 50X30MM","code_information":[{"code":"Sx00-4894-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"327989","type":"LOCAL"},{"code":"433896","type":"LOCAL"}],"standard_charges":[{"gross_charge":4812.5,"discounted_cash":3609.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 327989 = Hospital System Supply Identifier | 433896 = Lawson ID"}]},{"description":"IMP HIP REV ACET 54MM","code_information":[{"code":"Sx00-4894-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326953","type":"LOCAL"},{"code":"408142","type":"LOCAL"}],"standard_charges":[{"gross_charge":4812.5,"discounted_cash":3609.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 326953 = Hospital System Supply Identifier | 408142 = Lawson ID"}]},{"description":"IMP HIP ACET REV AUG 15X54MM","code_information":[{"code":"Sx00-4894-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"196707","type":"LOCAL"},{"code":"416868","type":"LOCAL"}],"standard_charges":[{"gross_charge":4812.5,"discounted_cash":3609.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 196707 = Hospital System Supply Identifier | 416868 = Lawson ID"}]},{"description":"IMP HIP ACET AUG TM SZ54 20MM","code_information":[{"code":"Sx00-4894-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202208","type":"LOCAL"},{"code":"452305","type":"LOCAL"}],"standard_charges":[{"gross_charge":4812.5,"discounted_cash":3609.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 202208 = Hospital System Supply Identifier | 452305 = Lawson ID"}]},{"description":"IMP HIP ACET REV AUG SZ54 30","code_information":[{"code":"Sx00-4894-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321681","type":"LOCAL"},{"code":"534895","type":"LOCAL"}],"standard_charges":[{"gross_charge":4812.5,"discounted_cash":3609.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321681 = Hospital System Supply Identifier | 534895 = Lawson ID"}]},{"description":"IMP HIP ACET REV AUG SZ58 30","code_information":[{"code":"Sx00-4894-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321682","type":"LOCAL"},{"code":"534896","type":"LOCAL"}],"standard_charges":[{"gross_charge":4812.5,"discounted_cash":3609.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321682 = Hospital System Supply Identifier | 534896 = Lawson ID"}]},{"description":"IMP HIP ACET REV AUG 10X58MM","code_information":[{"code":"Sx00-4894-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"327301","type":"LOCAL"},{"code":"416869","type":"LOCAL"}],"standard_charges":[{"gross_charge":4812.5,"discounted_cash":3609.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 327301 = Hospital System Supply Identifier | 416869 = Lawson ID"}]},{"description":"IMP HIP ACET REV AUG 15X58MM","code_information":[{"code":"Sx00-4894-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"327865","type":"LOCAL"},{"code":"428862","type":"LOCAL"}],"standard_charges":[{"gross_charge":4812.5,"discounted_cash":3609.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 327865 = Hospital System Supply Identifier | 428862 = Lawson ID"}]},{"description":"IMP HIP ACET AUG TM SZ58 20MM","code_information":[{"code":"Sx00-4894-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202209","type":"LOCAL"},{"code":"452306","type":"LOCAL"}],"standard_charges":[{"gross_charge":4812.5,"discounted_cash":3609.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 202209 = Hospital System Supply Identifier | 452306 = Lawson ID"}]},{"description":"IMP HIP ACET AUG TM SZ62 15MM","code_information":[{"code":"Sx00-4894-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202210","type":"LOCAL"},{"code":"452307","type":"LOCAL"}],"standard_charges":[{"gross_charge":4812.5,"discounted_cash":3609.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 202210 = Hospital System Supply Identifier | 452307 = Lawson ID"}]},{"description":"IMP HIP ACET REV AUG SZ62 30","code_information":[{"code":"Sx00-4894-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321683","type":"LOCAL"},{"code":"534897","type":"LOCAL"}],"standard_charges":[{"gross_charge":4812.5,"discounted_cash":3609.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321683 = Hospital System Supply Identifier | 534897 = Lawson ID"}]},{"description":"IMP HIP ACET REV AUG 10X62MM","code_information":[{"code":"Sx00-4894-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"327302","type":"LOCAL"},{"code":"416870","type":"LOCAL"}],"standard_charges":[{"gross_charge":4812.5,"discounted_cash":3609.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 327302 = Hospital System Supply Identifier | 416870 = Lawson ID"}]},{"description":"IMP HIP ACET REV AUG 20X66MM","code_information":[{"code":"Sx00-4894-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"327303","type":"LOCAL"},{"code":"416871","type":"LOCAL"}],"standard_charges":[{"gross_charge":4812.5,"discounted_cash":3609.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 327303 = Hospital System Supply Identifier | 416871 = Lawson ID"}]},{"description":"IMP HIP ACET REV AUG SZ66 30","code_information":[{"code":"Sx00-4894-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321685","type":"LOCAL"},{"code":"534899","type":"LOCAL"}],"standard_charges":[{"gross_charge":4812.5,"discounted_cash":3609.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321685 = Hospital System Supply Identifier | 534899 = Lawson ID"}]},{"description":"IMP HIP ACET REV AUG SZ66 20","code_information":[{"code":"Sx00-4894-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321684","type":"LOCAL"},{"code":"534898","type":"LOCAL"}],"standard_charges":[{"gross_charge":4812.5,"discounted_cash":3609.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321684 = Hospital System Supply Identifier | 534898 = Lawson ID"}]},{"description":"IMP HIP ACET REV AUG 15X66MM","code_information":[{"code":"Sx00-4894-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"327305","type":"LOCAL"},{"code":"416873","type":"LOCAL"}],"standard_charges":[{"gross_charge":4812.5,"discounted_cash":3609.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 327305 = Hospital System Supply Identifier | 416873 = Lawson ID"}]},{"description":"IMP HIP ACET REV AUG 10X66MM","code_information":[{"code":"Sx00-4894-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"327304","type":"LOCAL"},{"code":"416872","type":"LOCAL"}],"standard_charges":[{"gross_charge":4812.5,"discounted_cash":3609.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 327304 = Hospital System Supply Identifier | 416872 = Lawson ID"}]},{"description":"IMP HIP ACET REV AUG SZ70 10","code_information":[{"code":"Sx00-4894-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321686","type":"LOCAL"},{"code":"534900","type":"LOCAL"}],"standard_charges":[{"gross_charge":4812.5,"discounted_cash":3609.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321686 = Hospital System Supply Identifier | 534900 = Lawson ID"}]},{"description":"IMP HIP ACET REV AUG SZ70 15","code_information":[{"code":"Sx00-4894-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321687","type":"LOCAL"},{"code":"534901","type":"LOCAL"}],"standard_charges":[{"gross_charge":4812.5,"discounted_cash":3609.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321687 = Hospital System Supply Identifier | 534901 = Lawson ID"}]},{"description":"IMP HIP BTRES AUG LT POST RT","code_information":[{"code":"Sx00-4894-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321688","type":"LOCAL"},{"code":"534902","type":"LOCAL"}],"standard_charges":[{"gross_charge":4812.5,"discounted_cash":3609.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321688 = Hospital System Supply Identifier | 534902 = Lawson ID"}]},{"description":"BUTTRESS COLUMN REV RT POST LT","code_information":[{"code":"Sx00-4894-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"196976","type":"LOCAL"},{"code":"432039","type":"LOCAL"}],"standard_charges":[{"gross_charge":4812.5,"discounted_cash":3609.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 196976 = Hospital System Supply Identifier | 432039 = Lawson ID"}]},{"description":"PLATE MINI FRAG CNDYL 37 7H LT","code_information":[{"code":"Sx00-4915-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410202","type":"LOCAL"},{"code":"410451","type":"LOCAL"}],"standard_charges":[{"gross_charge":721.98,"discounted_cash":541.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410202 = Hospital System Supply Identifier | 410451 = Lawson ID"}]},{"description":"PLATE MINI FRAG CNDYL 37 7H RT","code_information":[{"code":"Sx00-4915-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410203","type":"LOCAL"},{"code":"410452","type":"LOCAL"}],"standard_charges":[{"gross_charge":721.98,"discounted_cash":541.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410203 = Hospital System Supply Identifier | 410452 = Lawson ID"}]},{"description":"PLATE MINI FRAG STR 1.5 20H","code_information":[{"code":"Sx00-4915-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408889","type":"LOCAL"},{"code":"342129","type":"LOCAL"}],"standard_charges":[{"gross_charge":721.98,"discounted_cash":541.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408889 = Hospital System Supply Identifier | 342129 = Lawson ID"}]},{"description":"PLATE MINI FRAG T 49MM 3H/9H","code_information":[{"code":"Sx00-4915-039","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410204","type":"LOCAL"},{"code":"410453","type":"LOCAL"}],"standard_charges":[{"gross_charge":375.77,"discounted_cash":281.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410204 = Hospital System Supply Identifier | 410453 = Lawson ID"}]},{"description":"PLATE MINI FRAG T 49MM 4H/9H","code_information":[{"code":"Sx00-4915-049","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410205","type":"LOCAL"},{"code":"410454","type":"LOCAL"}],"standard_charges":[{"gross_charge":390.8,"discounted_cash":293.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410205 = Hospital System Supply Identifier | 410454 = Lawson ID"}]},{"description":"PLATE MINI FRAG CNDYL 2.0 LT","code_information":[{"code":"Sx00-4920-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408855","type":"LOCAL"},{"code":"340009","type":"LOCAL"}],"standard_charges":[{"gross_charge":721.98,"discounted_cash":541.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408855 = Hospital System Supply Identifier | 340009 = Lawson ID"}]},{"description":"PLATE MINI FRAG L 2.0 18MM LT","code_information":[{"code":"Sx00-4920-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408856","type":"LOCAL"},{"code":"340010","type":"LOCAL"}],"standard_charges":[{"gross_charge":259.74,"discounted_cash":194.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408856 = Hospital System Supply Identifier | 340010 = Lawson ID"}]},{"description":"PLATE MINI FRAG L 2.0 18MM RT","code_information":[{"code":"Sx00-4920-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408857","type":"LOCAL"},{"code":"340011","type":"LOCAL"}],"standard_charges":[{"gross_charge":259.74,"discounted_cash":194.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408857 = Hospital System Supply Identifier | 340011 = Lawson ID"}]},{"description":"PLATE MINI FRAG L OBLQ 2.0 LT","code_information":[{"code":"Sx00-4920-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408858","type":"LOCAL"},{"code":"340012","type":"LOCAL"}],"standard_charges":[{"gross_charge":259.74,"discounted_cash":194.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408858 = Hospital System Supply Identifier | 340012 = Lawson ID"}]},{"description":"PLATE MINI FRAG L OBLQ 2.0 RT","code_information":[{"code":"Sx00-4920-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408859","type":"LOCAL"},{"code":"340013","type":"LOCAL"}],"standard_charges":[{"gross_charge":259.74,"discounted_cash":194.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408859 = Hospital System Supply Identifier | 340013 = Lawson ID"}]},{"description":"PLATE MINI FRAG CNDYL 2.0 RT","code_information":[{"code":"Sx00-4920-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408860","type":"LOCAL"},{"code":"340014","type":"LOCAL"}],"standard_charges":[{"gross_charge":721.98,"discounted_cash":541.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408860 = Hospital System Supply Identifier | 340014 = Lawson ID"}]},{"description":"PLATE MINI FRAG T 2.0 18MM","code_information":[{"code":"Sx00-4920-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409007","type":"LOCAL"},{"code":"345121","type":"LOCAL"}],"standard_charges":[{"gross_charge":259.74,"discounted_cash":194.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 409007 = Hospital System Supply Identifier | 345121 = Lawson ID"}]},{"description":"PLATE MINI FRAG STR 2.0 3H 17M","code_information":[{"code":"Sx00-4920-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409008","type":"LOCAL"},{"code":"345122","type":"LOCAL"}],"standard_charges":[{"gross_charge":404.04,"discounted_cash":303.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 409008 = Hospital System Supply Identifier | 345122 = Lawson ID"}]},{"description":"PLATE MINI FRAG H 2.0 4H 12MM","code_information":[{"code":"Sx00-4920-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408890","type":"LOCAL"},{"code":"342130","type":"LOCAL"}],"standard_charges":[{"gross_charge":602.11,"discounted_cash":451.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408890 = Hospital System Supply Identifier | 342130 = Lawson ID"}]},{"description":"PLATE MINI FRAG COMPR 2.0 4H","code_information":[{"code":"Sx00-4920-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408673","type":"LOCAL"},{"code":"339189","type":"LOCAL"}],"standard_charges":[{"gross_charge":820.7,"discounted_cash":615.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408673 = Hospital System Supply Identifier | 339189 = Lawson ID"}]},{"description":"PLATE MINI FRAG STR 4.0 3H 23M","code_information":[{"code":"Sx00-4920-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408674","type":"LOCAL"},{"code":"339190","type":"LOCAL"}],"standard_charges":[{"gross_charge":432.9,"discounted_cash":324.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408674 = Hospital System Supply Identifier | 339190 = Lawson ID"}]},{"description":"PLATE MINI FRAG COMPR 2.0 5H","code_information":[{"code":"Sx00-4920-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408675","type":"LOCAL"},{"code":"339191","type":"LOCAL"}],"standard_charges":[{"gross_charge":820.7,"discounted_cash":615.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408675 = Hospital System Supply Identifier | 339191 = Lawson ID"}]},{"description":"PLATE MINI FRAG STR 2.0 5H 29M","code_information":[{"code":"Sx00-4920-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409009","type":"LOCAL"},{"code":"345123","type":"LOCAL"}],"standard_charges":[{"gross_charge":461.76,"discounted_cash":346.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 409009 = Hospital System Supply Identifier | 345123 = Lawson ID"}]},{"description":"PLATE MINI FRAG COMPR 2.0 6H","code_information":[{"code":"Sx00-4920-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408676","type":"LOCAL"},{"code":"339192","type":"LOCAL"}],"standard_charges":[{"gross_charge":820.7,"discounted_cash":615.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408676 = Hospital System Supply Identifier | 339192 = Lawson ID"}]},{"description":"PLATE MINI FRAG STR 2.0 6H 35M","code_information":[{"code":"Sx00-4920-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409010","type":"LOCAL"},{"code":"345124","type":"LOCAL"}],"standard_charges":[{"gross_charge":490.62,"discounted_cash":367.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 409010 = Hospital System Supply Identifier | 345124 = Lawson ID"}]},{"description":"PLATE MINI FRAG COMPR 2.0 7H","code_information":[{"code":"Sx00-4920-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408677","type":"LOCAL"},{"code":"339193","type":"LOCAL"}],"standard_charges":[{"gross_charge":820.7,"discounted_cash":615.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408677 = Hospital System Supply Identifier | 339193 = Lawson ID"}]},{"description":"PLATE MINI FRAG COMPR 2.0 8H","code_information":[{"code":"Sx00-4920-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408861","type":"LOCAL"},{"code":"340015","type":"LOCAL"}],"standard_charges":[{"gross_charge":820.7,"discounted_cash":615.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408861 = Hospital System Supply Identifier | 340015 = Lawson ID"}]},{"description":"PLATE MINI FRAG COMPR 2.0 10H","code_information":[{"code":"Sx00-4920-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408862","type":"LOCAL"},{"code":"340016","type":"LOCAL"}],"standard_charges":[{"gross_charge":820.7,"discounted_cash":615.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408862 = Hospital System Supply Identifier | 340016 = Lawson ID"}]},{"description":"PLATE MINI FRAG COMPR 2.0 12H","code_information":[{"code":"Sx00-4920-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408863","type":"LOCAL"},{"code":"340017","type":"LOCAL"}],"standard_charges":[{"gross_charge":820.7,"discounted_cash":615.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408863 = Hospital System Supply Identifier | 340017 = Lawson ID"}]},{"description":"PLATE MINI FRAG STR 20H 100MM","code_information":[{"code":"Sx00-4920-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408864","type":"LOCAL"},{"code":"340018","type":"LOCAL"}],"standard_charges":[{"gross_charge":721.98,"discounted_cash":541.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408864 = Hospital System Supply Identifier | 340018 = Lawson ID"}]},{"description":"PLATE MINI FRAG T 2.0 3H HD 9H","code_information":[{"code":"Sx00-4920-039","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408865","type":"LOCAL"},{"code":"340019","type":"LOCAL"}],"standard_charges":[{"gross_charge":602.11,"discounted_cash":451.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408865 = Hospital System Supply Identifier | 340019 = Lawson ID"}]},{"description":"PLATE MINI FRAG T 2.0 4H HD 9H","code_information":[{"code":"Sx00-4920-049","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408866","type":"LOCAL"},{"code":"340020","type":"LOCAL"}],"standard_charges":[{"gross_charge":602.11,"discounted_cash":451.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408866 = Hospital System Supply Identifier | 340020 = Lawson ID"}]},{"description":"PLATE BONE 4 HOLE CONDYLAR LEFT 00492700119 STAINLESS STEEL 2..7X57MM","code_information":[{"code":"Sx00-4927-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1262964","type":"LOCAL"},{"code":"1062919","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.86,"discounted_cash":562.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1262964 = Hospital System Supply Identifier | 1062919 = Lawson ID"}]},{"description":"PLATE MINI FRAG CNDYL 2.7 LT","code_information":[{"code":"Sx00-4927-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408868","type":"LOCAL"},{"code":"340022","type":"LOCAL"}],"standard_charges":[{"gross_charge":518.58,"discounted_cash":388.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408868 = Hospital System Supply Identifier | 340022 = Lawson ID"}]},{"description":"PLATE BONE 4 HOLE CONDYLAR RIGHT 00492700219 STAINLESS STEEL 2.7X57MM","code_information":[{"code":"Sx00-4927-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1262965","type":"LOCAL"},{"code":"1062862","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.86,"discounted_cash":562.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1262965 = Hospital System Supply Identifier | 1062862 = Lawson ID"}]},{"description":"PLATE MINI FRAG CNDYL 2.7 RT","code_information":[{"code":"Sx00-4927-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408870","type":"LOCAL"},{"code":"340024","type":"LOCAL"}],"standard_charges":[{"gross_charge":518.58,"discounted_cash":388.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408870 = Hospital System Supply Identifier | 340024 = Lawson ID"}]},{"description":"PLATE MINI FRAG 1/4 TBLR 3H","code_information":[{"code":"Sx00-4927-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409011","type":"LOCAL"},{"code":"345125","type":"LOCAL"}],"standard_charges":[{"gross_charge":461.76,"discounted_cash":346.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 409011 = Hospital System Supply Identifier | 345125 = Lawson ID"}]},{"description":"PLATE MINI FRAG 1/4 TBLR 4H","code_information":[{"code":"Sx00-4927-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409012","type":"LOCAL"},{"code":"345126","type":"LOCAL"}],"standard_charges":[{"gross_charge":461.76,"discounted_cash":346.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 409012 = Hospital System Supply Identifier | 345126 = Lawson ID"}]},{"description":"PLATE MINI FRAG 1/4 TBLR 5H","code_information":[{"code":"Sx00-4927-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409013","type":"LOCAL"},{"code":"345127","type":"LOCAL"}],"standard_charges":[{"gross_charge":519.48,"discounted_cash":389.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 409013 = Hospital System Supply Identifier | 345127 = Lawson ID"}]},{"description":"PLATE MINI FRAG 1/4 TBLR 6H","code_information":[{"code":"Sx00-4927-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408564","type":"LOCAL"},{"code":"332731","type":"LOCAL"}],"standard_charges":[{"gross_charge":577.21,"discounted_cash":432.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408564 = Hospital System Supply Identifier | 332731 = Lawson ID"}]},{"description":"PLATE MINI FRAG MLT 2.7 7H","code_information":[{"code":"Sx00-4927-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408877","type":"LOCAL"},{"code":"340031","type":"LOCAL"}],"standard_charges":[{"gross_charge":147.07,"discounted_cash":110.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408877 = Hospital System Supply Identifier | 340031 = Lawson ID"}]},{"description":"PLATE MINI FRAG 1/4 TBLR 7H","code_information":[{"code":"Sx00-4927-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409014","type":"LOCAL"},{"code":"345128","type":"LOCAL"}],"standard_charges":[{"gross_charge":577.21,"discounted_cash":432.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 409014 = Hospital System Supply Identifier | 345128 = Lawson ID"}]},{"description":"PLATE MINI FRAG 1/4 TBLR 8H","code_information":[{"code":"Sx00-4927-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409015","type":"LOCAL"},{"code":"345129","type":"LOCAL"}],"standard_charges":[{"gross_charge":577.21,"discounted_cash":432.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 409015 = Hospital System Supply Identifier | 345129 = Lawson ID"}]},{"description":"PLATE SM FRAG COMPR 2H 25MM","code_information":[{"code":"Sx00-4935-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410234","type":"LOCAL"},{"code":"410486","type":"LOCAL"}],"standard_charges":[{"gross_charge":217.96,"discounted_cash":163.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410234 = Hospital System Supply Identifier | 410486 = Lawson ID"}]},{"description":"PLATE SM FRAG CLVRLF 3.5 3H","code_information":[{"code":"Sx00-4935-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408711","type":"LOCAL"},{"code":"339257","type":"LOCAL"}],"standard_charges":[{"gross_charge":225.46,"discounted_cash":169.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408711 = Hospital System Supply Identifier | 339257 = Lawson ID"}]},{"description":"PLATE SM FRAG 3.5MM 4H 49MM","code_information":[{"code":"Sx00-4935-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"35709","type":"LOCAL"},{"code":"216791","type":"LOCAL"}],"standard_charges":[{"gross_charge":232.99,"discounted_cash":174.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 35709 = Hospital System Supply Identifier | 216791 = Lawson ID"}]},{"description":"PLATE SM FRAG 3.5MM 5H 61MM","code_information":[{"code":"Sx00-4935-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"35710","type":"LOCAL"},{"code":"216792","type":"LOCAL"}],"standard_charges":[{"gross_charge":240.49,"discounted_cash":180.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 35710 = Hospital System Supply Identifier | 216792 = Lawson ID"}]},{"description":"PLATE SM FRAG CLVRLF 120MM 5H","code_information":[{"code":"Sx00-4935-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410235","type":"LOCAL"},{"code":"410490","type":"LOCAL"}],"standard_charges":[{"gross_charge":653.3,"discounted_cash":489.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410235 = Hospital System Supply Identifier | 410490 = Lawson ID"}]},{"description":"PLATE SM FRAG CLVRLF 3.5 6H","code_information":[{"code":"Sx00-4935-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408888","type":"LOCAL"},{"code":"342118","type":"LOCAL"}],"standard_charges":[{"gross_charge":711.37,"discounted_cash":533.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408888 = Hospital System Supply Identifier | 342118 = Lawson ID"}]},{"description":"PLATE SM FRAG CLVRLF 152MM 7H","code_information":[{"code":"Sx00-4935-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410236","type":"LOCAL"},{"code":"410491","type":"LOCAL"}],"standard_charges":[{"gross_charge":754.93,"discounted_cash":566.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410236 = Hospital System Supply Identifier | 410491 = Lawson ID"}]},{"description":"PLATE SM FRAG CLVRLF 168MM 8H","code_information":[{"code":"Sx00-4935-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410237","type":"LOCAL"},{"code":"410492","type":"LOCAL"}],"standard_charges":[{"gross_charge":805.75,"discounted_cash":604.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410237 = Hospital System Supply Identifier | 410492 = Lawson ID"}]},{"description":"PLATE SM FRAG CLVRLF 200MM 10H","code_information":[{"code":"Sx00-4935-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410238","type":"LOCAL"},{"code":"410493","type":"LOCAL"}],"standard_charges":[{"gross_charge":871.07,"discounted_cash":653.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410238 = Hospital System Supply Identifier | 410493 = Lawson ID"}]},{"description":"PLATE SM FRAG 3.5MM 12H 145MM","code_information":[{"code":"Sx00-4935-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"35716","type":"LOCAL"},{"code":"216798","type":"LOCAL"}],"standard_charges":[{"gross_charge":330.67,"discounted_cash":248.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 35716 = Hospital System Supply Identifier | 216798 = Lawson ID"}]},{"description":"PLATE CNTR 2COMPR 169MM 14H","code_information":[{"code":"Sx00-4935-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410239","type":"LOCAL"},{"code":"410495","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.71,"discounted_cash":435.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410239 = Hospital System Supply Identifier | 410495 = Lawson ID"}]},{"description":"PLATE SM FRAG COMPR 194MM 16H","code_information":[{"code":"Sx00-4935-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410240","type":"LOCAL"},{"code":"410497","type":"LOCAL"}],"standard_charges":[{"gross_charge":667.82,"discounted_cash":500.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410240 = Hospital System Supply Identifier | 410497 = Lawson ID"}]},{"description":"PLATE SM FRAG COMPR 217MM 18H","code_information":[{"code":"Sx00-4935-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410241","type":"LOCAL"},{"code":"410498","type":"LOCAL"}],"standard_charges":[{"gross_charge":747.68,"discounted_cash":560.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410241 = Hospital System Supply Identifier | 410498 = Lawson ID"}]},{"description":"PLATE SM FRAG COMPR 242MM 20H","code_information":[{"code":"Sx00-4935-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410242","type":"LOCAL"},{"code":"410499","type":"LOCAL"}],"standard_charges":[{"gross_charge":820.27,"discounted_cash":615.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410242 = Hospital System Supply Identifier | 410499 = Lawson ID"}]},{"description":"PLATE COMPR SM FRAG 22H","code_information":[{"code":"Sx00-4935-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410445","type":"LOCAL"},{"code":"418237","type":"LOCAL"}],"standard_charges":[{"gross_charge":885.59,"discounted_cash":664.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410445 = Hospital System Supply Identifier | 418237 = Lawson ID"}]},{"description":"PLATE SM FRAG T OBLQ 3.5 3X4H","code_information":[{"code":"Sx00-4935-034","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408565","type":"LOCAL"},{"code":"332737","type":"LOCAL"}],"standard_charges":[{"gross_charge":383.3,"discounted_cash":287.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408565 = Hospital System Supply Identifier | 332737 = Lawson ID"}]},{"description":"PLATE SM FRAG T 3.5 3X5H","code_information":[{"code":"Sx00-4935-035","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"35718","type":"LOCAL"},{"code":"216800","type":"LOCAL"}],"standard_charges":[{"gross_charge":255.52,"discounted_cash":191.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 35718 = Hospital System Supply Identifier | 216800 = Lawson ID"}]},{"description":"PLATE SM FRAG T 3.5 4X6H","code_information":[{"code":"Sx00-4935-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408892","type":"LOCAL"},{"code":"342174","type":"LOCAL"}],"standard_charges":[{"gross_charge":293.11,"discounted_cash":219.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408892 = Hospital System Supply Identifier | 342174 = Lawson ID"}]},{"description":"PLATE SM FRAG T 3.5 4X7H","code_information":[{"code":"Sx00-4935-047","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408893","type":"LOCAL"},{"code":"342175","type":"LOCAL"}],"standard_charges":[{"gross_charge":360.74,"discounted_cash":270.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 408893 = Hospital System Supply Identifier | 342175 = Lawson ID"}]},{"description":"PLATE SM FRAG T 3.5 4X8H","code_information":[{"code":"Sx00-4935-048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410123","type":"LOCAL"},{"code":"409652","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.83,"discounted_cash":304.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410123 = Hospital System Supply Identifier | 409652 = Lawson ID"}]},{"description":"PLATE SM FRAG CALCNL 60MM 15H","code_information":[{"code":"Sx00-4935-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410243","type":"LOCAL"},{"code":"410501","type":"LOCAL"}],"standard_charges":[{"gross_charge":842.03,"discounted_cash":631.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410243 = Hospital System Supply Identifier | 410501 = Lawson ID"}]},{"description":"PLATE SM FRAG CALCNL 70MM 15H","code_information":[{"code":"Sx00-4935-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410244","type":"LOCAL"},{"code":"410502","type":"LOCAL"}],"standard_charges":[{"gross_charge":849.31,"discounted_cash":636.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410244 = Hospital System Supply Identifier | 410502 = Lawson ID"}]},{"description":"PLATE SM FRAG Y 87MM 4X9H","code_information":[{"code":"Sx00-4935-087","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410245","type":"LOCAL"},{"code":"410503","type":"LOCAL"}],"standard_charges":[{"gross_charge":849.31,"discounted_cash":636.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410245 = Hospital System Supply Identifier | 410503 = Lawson ID"}]},{"description":"IMP HIP ACET SHELL BPLR 38MM","code_information":[{"code":"Sx00-5001-038","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303178","type":"LOCAL"},{"code":"522124","type":"LOCAL"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303178 = Hospital System Supply Identifier | 522124 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 38X22MM","code_information":[{"code":"Sx00-5001-038","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303179","type":"LOCAL"},{"code":"522125","type":"LOCAL"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303179 = Hospital System Supply Identifier | 522125 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 39X22MM","code_information":[{"code":"Sx00-5001-039","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303181","type":"LOCAL"},{"code":"522127","type":"LOCAL"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303181 = Hospital System Supply Identifier | 522127 = Lawson ID"}]},{"description":"IMP HIP ACET SHELL BPLR 39MM","code_information":[{"code":"Sx00-5001-039","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303180","type":"LOCAL"},{"code":"522126","type":"LOCAL"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303180 = Hospital System Supply Identifier | 522126 = Lawson ID"}]},{"description":"SHELL MULTIPOLAR 5001-40","code_information":[{"code":"Sx00-5001-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"168544","type":"LOCAL"},{"code":"208810","type":"LOCAL"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 168544 = Hospital System Supply Identifier | 208810 = Lawson ID"}]},{"description":"LINER MULTIPOLAR 5001-40-22","code_information":[{"code":"Sx00-5001-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"168554","type":"LOCAL"},{"code":"208831","type":"LOCAL"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 168554 = Hospital System Supply Identifier | 208831 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 40X26MM","code_information":[{"code":"Sx00-5001-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303182","type":"LOCAL"},{"code":"522128","type":"LOCAL"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303182 = Hospital System Supply Identifier | 522128 = Lawson ID"}]},{"description":"SHELL MULTIPOLAR 5001-41","code_information":[{"code":"Sx00-5001-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"168545","type":"LOCAL"},{"code":"208811","type":"LOCAL"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 168545 = Hospital System Supply Identifier | 208811 = Lawson ID"}]},{"description":"SHELL MULTIPOLAR 5001-42","code_information":[{"code":"Sx00-5001-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"168546","type":"LOCAL"},{"code":"208812","type":"LOCAL"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 168546 = Hospital System Supply Identifier | 208812 = Lawson ID"}]},{"description":"LINER MULTIPOLAR 5001-42-22","code_information":[{"code":"Sx00-5001-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"145660","type":"LOCAL"},{"code":"208832","type":"LOCAL"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 145660 = Hospital System Supply Identifier | 208832 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 42X26MM","code_information":[{"code":"Sx00-5001-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303183","type":"LOCAL"},{"code":"522129","type":"LOCAL"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303183 = Hospital System Supply Identifier | 522129 = Lawson ID"}]},{"description":"SHELL MULTIPOLAR 5001-43","code_information":[{"code":"Sx00-5001-043","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"145652","type":"LOCAL"},{"code":"208813","type":"LOCAL"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 145652 = Hospital System Supply Identifier | 208813 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 44X26MM","code_information":[{"code":"Sx00-5001-044","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303185","type":"LOCAL"},{"code":"522131","type":"LOCAL"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303185 = Hospital System Supply Identifier | 522131 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 44X22MM","code_information":[{"code":"Sx00-5001-044","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303184","type":"LOCAL"},{"code":"522130","type":"LOCAL"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303184 = Hospital System Supply Identifier | 522130 = Lawson ID"}]},{"description":"SHELL MULTIPOLAR 5001-44","code_information":[{"code":"Sx00-5001-044","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"145653","type":"LOCAL"},{"code":"208814","type":"LOCAL"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 145653 = Hospital System Supply Identifier | 208814 = Lawson ID"}]},{"description":"LINER MULTIPOLAR 5001-44-28","code_information":[{"code":"Sx00-5001-044","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"145661","type":"LOCAL"},{"code":"208833","type":"LOCAL"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 145661 = Hospital System Supply Identifier | 208833 = Lawson ID"}]},{"description":"SHELL MULTIPOLAR 5001-45","code_information":[{"code":"Sx00-5001-045","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"145654","type":"LOCAL"},{"code":"208815","type":"LOCAL"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 145654 = Hospital System Supply Identifier | 208815 = Lawson ID"}]},{"description":"SHELL MULTIPOLAR 5001-46","code_information":[{"code":"Sx00-5001-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"145655","type":"LOCAL"},{"code":"208816","type":"LOCAL"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 145655 = Hospital System Supply Identifier | 208816 = Lawson ID"}]},{"description":"SHELL MULTIPOLAR 5001-47","code_information":[{"code":"Sx00-5001-047","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"145656","type":"LOCAL"},{"code":"208817","type":"LOCAL"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 145656 = Hospital System Supply Identifier | 208817 = Lawson ID"}]},{"description":"LINER MULTIPOLAR 5001-47-28","code_information":[{"code":"Sx00-5001-047","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"145662","type":"LOCAL"},{"code":"208834","type":"LOCAL"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 145662 = Hospital System Supply Identifier | 208834 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 47X22MM","code_information":[{"code":"Sx00-5001-047","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303186","type":"LOCAL"},{"code":"522132","type":"LOCAL"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303186 = Hospital System Supply Identifier | 522132 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 47X26MM","code_information":[{"code":"Sx00-5001-047","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303187","type":"LOCAL"},{"code":"522133","type":"LOCAL"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303187 = Hospital System Supply Identifier | 522133 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 47X32MM","code_information":[{"code":"Sx00-5001-047","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303188","type":"LOCAL"},{"code":"522134","type":"LOCAL"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303188 = Hospital System Supply Identifier | 522134 = Lawson ID"}]},{"description":"SHELL MULTIPOLAR 5001-48","code_information":[{"code":"Sx00-5001-048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"145657","type":"LOCAL"},{"code":"208818","type":"LOCAL"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 145657 = Hospital System Supply Identifier | 208818 = Lawson ID"}]},{"description":"SHELL MULTIPOLAR 5001-49","code_information":[{"code":"Sx00-5001-049","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"168547","type":"LOCAL"},{"code":"208819","type":"LOCAL"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 168547 = Hospital System Supply Identifier | 208819 = Lawson ID"}]},{"description":"SHELL MULTIPOLAR 5001-50","code_information":[{"code":"Sx00-5001-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"145658","type":"LOCAL"},{"code":"208820","type":"LOCAL"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 145658 = Hospital System Supply Identifier | 208820 = Lawson ID"}]},{"description":"LINER MULTIPOLAR 5001-50-28","code_information":[{"code":"Sx00-5001-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"145663","type":"LOCAL"},{"code":"208835","type":"LOCAL"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 145663 = Hospital System Supply Identifier | 208835 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 50X22MM","code_information":[{"code":"Sx00-5001-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303189","type":"LOCAL"},{"code":"522135","type":"LOCAL"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303189 = Hospital System Supply Identifier | 522135 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 50X26MM","code_information":[{"code":"Sx00-5001-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303190","type":"LOCAL"},{"code":"522136","type":"LOCAL"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303190 = Hospital System Supply Identifier | 522136 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 50X32MM","code_information":[{"code":"Sx00-5001-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303191","type":"LOCAL"},{"code":"522137","type":"LOCAL"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303191 = Hospital System Supply Identifier | 522137 = Lawson ID"}]},{"description":"SHELL MULTIPOLAR 5001-51","code_information":[{"code":"Sx00-5001-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"168548","type":"LOCAL"},{"code":"208821","type":"LOCAL"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 168548 = Hospital System Supply Identifier | 208821 = Lawson ID"}]},{"description":"SHELL MULTIPOLAR 5001-52","code_information":[{"code":"Sx00-5001-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"145659","type":"LOCAL"},{"code":"208822","type":"LOCAL"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 145659 = Hospital System Supply Identifier | 208822 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 53X32MM","code_information":[{"code":"Sx00-5001-053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303194","type":"LOCAL"},{"code":"522140","type":"LOCAL"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303194 = Hospital System Supply Identifier | 522140 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 53X26MM","code_information":[{"code":"Sx00-5001-053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303193","type":"LOCAL"},{"code":"522139","type":"LOCAL"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303193 = Hospital System Supply Identifier | 522139 = Lawson ID"}]},{"description":"LINER MULTIPOLAR 5001-53-28","code_information":[{"code":"Sx00-5001-053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"168555","type":"LOCAL"},{"code":"208836","type":"LOCAL"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 168555 = Hospital System Supply Identifier | 208836 = Lawson ID"}]},{"description":"SHELL MULTIPOLAR 5001-53","code_information":[{"code":"Sx00-5001-053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"168549","type":"LOCAL"},{"code":"208823","type":"LOCAL"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 168549 = Hospital System Supply Identifier | 208823 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 53X22MM","code_information":[{"code":"Sx00-5001-053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303192","type":"LOCAL"},{"code":"522138","type":"LOCAL"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303192 = Hospital System Supply Identifier | 522138 = Lawson ID"}]},{"description":"SHELL MULTIPOLAR 5001-54","code_information":[{"code":"Sx00-5001-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"168550","type":"LOCAL"},{"code":"208824","type":"LOCAL"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 168550 = Hospital System Supply Identifier | 208824 = Lawson ID"}]},{"description":"SHELL MULTIPOLAR 5001-55","code_information":[{"code":"Sx00-5001-055","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"168551","type":"LOCAL"},{"code":"208825","type":"LOCAL"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 168551 = Hospital System Supply Identifier | 208825 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 57X32MM","code_information":[{"code":"Sx00-5001-057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303197","type":"LOCAL"},{"code":"522143","type":"LOCAL"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303197 = Hospital System Supply Identifier | 522143 = Lawson ID"}]},{"description":"SHELL MULTIPOLAR 5001-57","code_information":[{"code":"Sx00-5001-057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"168552","type":"LOCAL"},{"code":"208826","type":"LOCAL"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 168552 = Hospital System Supply Identifier | 208826 = Lawson ID"}]},{"description":"LINER MULTIPOLAR 5001-57-28","code_information":[{"code":"Sx00-5001-057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"168556","type":"LOCAL"},{"code":"208837","type":"LOCAL"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 168556 = Hospital System Supply Identifier | 208837 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 57X22MM","code_information":[{"code":"Sx00-5001-057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303195","type":"LOCAL"},{"code":"522141","type":"LOCAL"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303195 = Hospital System Supply Identifier | 522141 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 57X26MM","code_information":[{"code":"Sx00-5001-057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303196","type":"LOCAL"},{"code":"522142","type":"LOCAL"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303196 = Hospital System Supply Identifier | 522142 = Lawson ID"}]},{"description":"IMP HIP SHELL MULTIPOLAR","code_information":[{"code":"Sx00-5001-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"168553","type":"LOCAL"},{"code":"208827","type":"LOCAL"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 168553 = Hospital System Supply Identifier | 208827 = Lawson ID"}]},{"description":"SHELL MULTIPOLAR 5001-60","code_information":[{"code":"Sx00-5001-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"178233","type":"LOCAL"},{"code":"208828","type":"LOCAL"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 178233 = Hospital System Supply Identifier | 208828 = Lawson ID"}]},{"description":"LINER MULTIPOLAR 5001-60-28","code_information":[{"code":"Sx00-5001-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"178234","type":"LOCAL"},{"code":"208838","type":"LOCAL"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 178234 = Hospital System Supply Identifier | 208838 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 60X22MM","code_information":[{"code":"Sx00-5001-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303198","type":"LOCAL"},{"code":"522144","type":"LOCAL"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303198 = Hospital System Supply Identifier | 522144 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 60X26MM","code_information":[{"code":"Sx00-5001-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303199","type":"LOCAL"},{"code":"522145","type":"LOCAL"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303199 = Hospital System Supply Identifier | 522145 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 60X32MM","code_information":[{"code":"Sx00-5001-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303200","type":"LOCAL"},{"code":"522146","type":"LOCAL"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303200 = Hospital System Supply Identifier | 522146 = Lawson ID"}]},{"description":"SHELL MULTIPOLAR 5001-62","code_information":[{"code":"Sx00-5001-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"323414","type":"LOCAL"},{"code":"208829","type":"LOCAL"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 323414 = Hospital System Supply Identifier | 208829 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 64X32MM","code_information":[{"code":"Sx00-5001-064","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303202","type":"LOCAL"},{"code":"522148","type":"LOCAL"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303202 = Hospital System Supply Identifier | 522148 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 64X26MM","code_information":[{"code":"Sx00-5001-064","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303201","type":"LOCAL"},{"code":"522147","type":"LOCAL"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303201 = Hospital System Supply Identifier | 522147 = Lawson ID"}]},{"description":"SHELL MULTIPOLAR 5001-64","code_information":[{"code":"Sx00-5001-064","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"323415","type":"LOCAL"},{"code":"208830","type":"LOCAL"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 323415 = Hospital System Supply Identifier | 208830 = Lawson ID"}]},{"description":"LINER MULTIPOLAR 5001-64-28","code_information":[{"code":"Sx00-5001-064","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329021","type":"LOCAL"},{"code":"208839","type":"LOCAL"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329021 = Hospital System Supply Identifier | 208839 = Lawson ID"}]},{"description":"IMP HIP ACET SHELL BPLR 66MM","code_information":[{"code":"Sx00-5001-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303203","type":"LOCAL"},{"code":"522149","type":"LOCAL"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303203 = Hospital System Supply Identifier | 522149 = Lawson ID"}]},{"description":"IMP HIP SHELL MULTPLR 68-70","code_information":[{"code":"Sx00-5001-068","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326954","type":"LOCAL"},{"code":"408143","type":"LOCAL"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 326954 = Hospital System Supply Identifier | 408143 = Lawson ID"}]},{"description":"IMP HIP ACET SHELL BPLR 68MM","code_information":[{"code":"Sx00-5001-068","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303204","type":"LOCAL"},{"code":"522150","type":"LOCAL"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303204 = Hospital System Supply Identifier | 522150 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 68X26MM","code_information":[{"code":"Sx00-5001-068","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303205","type":"LOCAL"},{"code":"522151","type":"LOCAL"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303205 = Hospital System Supply Identifier | 522151 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 68X32MM","code_information":[{"code":"Sx00-5001-068","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303206","type":"LOCAL"},{"code":"522152","type":"LOCAL"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303206 = Hospital System Supply Identifier | 522152 = Lawson ID"}]},{"description":"IMP HIP ACET SHELL BPLR 70MM","code_information":[{"code":"Sx00-5001-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303207","type":"LOCAL"},{"code":"522153","type":"LOCAL"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303207 = Hospital System Supply Identifier | 522153 = Lawson ID"}]},{"description":"IMP HIP SHELL MULTPLR 72","code_information":[{"code":"Sx00-5001-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326955","type":"LOCAL"},{"code":"408144","type":"LOCAL"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 326955 = Hospital System Supply Identifier | 408144 = Lawson ID"}]},{"description":"IMP HIP ACET SHELL BPLR 72MM","code_information":[{"code":"Sx00-5001-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303208","type":"LOCAL"},{"code":"522154","type":"LOCAL"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303208 = Hospital System Supply Identifier | 522154 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 72X26MM","code_information":[{"code":"Sx00-5001-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303209","type":"LOCAL"},{"code":"522155","type":"LOCAL"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303209 = Hospital System Supply Identifier | 522155 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 72X32MM","code_information":[{"code":"Sx00-5001-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303210","type":"LOCAL"},{"code":"522156","type":"LOCAL"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303210 = Hospital System Supply Identifier | 522156 = Lawson ID"}]},{"description":"IMP HIP LNR PRVSNL 22 38-43MM","code_information":[{"code":"Sx00-5003-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"449578","type":"LOCAL"},{"code":"310982","type":"LOCAL"}],"standard_charges":[{"gross_charge":369.18,"discounted_cash":276.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 449578 = Hospital System Supply Identifier | 310982 = Lawson ID"}]},{"description":"IMP HIP LNR PRVSNL 28 44-49MM","code_information":[{"code":"Sx00-5003-044","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"324475","type":"LOCAL"},{"code":"310983","type":"LOCAL"}],"standard_charges":[{"gross_charge":369.18,"discounted_cash":276.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 324475 = Hospital System Supply Identifier | 310983 = Lawson ID"}]},{"description":"IMP HIP LNR PRVSNL 28 50-58MM","code_information":[{"code":"Sx00-5003-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"449579","type":"LOCAL"},{"code":"310984","type":"LOCAL"}],"standard_charges":[{"gross_charge":369.18,"discounted_cash":276.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 449579 = Hospital System Supply Identifier | 310984 = Lawson ID"}]},{"description":"IMP HIP LNR PRVSNL 28 60-72MM","code_information":[{"code":"Sx00-5003-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"449577","type":"LOCAL"},{"code":"310981","type":"LOCAL"}],"standard_charges":[{"gross_charge":369.18,"discounted_cash":276.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 449577 = Hospital System Supply Identifier | 310981 = Lawson ID"}]},{"description":"BLADE MICRO MILL 19 204","code_information":[{"code":"Sx00-5052-204","type":"CDM"},{"code":"272","type":"RC"},{"code":"72589","type":"LOCAL"},{"code":"100437","type":"LOCAL"}],"standard_charges":[{"gross_charge":282.68,"discounted_cash":212.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 72589 = Hospital System Supply Identifier | 100437 = Lawson ID"}]},{"description":"NO USAGE - BUR OTOTOME 5.0X48 CARB 144","code_information":[{"code":"Sx00-5056-144","type":"CDM"},{"code":"272","type":"RC"},{"code":"1032052","type":"LOCAL"},{"code":"100568","type":"LOCAL"}],"standard_charges":[{"gross_charge":258.89,"discounted_cash":194.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1032052 = Hospital System Supply Identifier | 100568 = Lawson ID"}]},{"description":"PIN HEX HD HLDNG","code_information":[{"code":"Sx00-5061-063","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"149980","type":"LOCAL"},{"code":"237595","type":"LOCAL"}],"standard_charges":[{"gross_charge":47.34,"discounted_cash":35.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 149980 = Hospital System Supply Identifier | 237595 = Lawson ID"}]},{"description":"SYSTEM BONE CEMENT NSTRL REMOV","code_information":[{"code":"Sx00-5061-084","type":"CDM"},{"code":"272","type":"RC"},{"code":"932071","type":"LOCAL"},{"code":"816445","type":"LOCAL"}],"standard_charges":[{"gross_charge":184.59,"discounted_cash":138.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 932071 = Hospital System Supply Identifier | 816445 = Lawson ID"}]},{"description":"BLADE EXTRACTOR EXODUS HIP STEM REMOVAL 0051040000","code_information":[{"code":"Sx00-510-400-","type":"CDM"},{"code":"272","type":"RC"},{"code":"1182618","type":"LOCAL"},{"code":"1008181","type":"LOCAL"}],"standard_charges":[{"gross_charge":4298.7,"discounted_cash":3224.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1182618 = Hospital System Supply Identifier | 1008181 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP MGII LT SZ2","code_information":[{"code":"Sx00-5110-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321727","type":"LOCAL"},{"code":"534941","type":"LOCAL"}],"standard_charges":[{"gross_charge":22911.53,"discounted_cash":17183.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321727 = Hospital System Supply Identifier | 534941 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP MGII RT SZ2","code_information":[{"code":"Sx00-5110-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321728","type":"LOCAL"},{"code":"534942","type":"LOCAL"}],"standard_charges":[{"gross_charge":22911.53,"discounted_cash":17183.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321728 = Hospital System Supply Identifier | 534942 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP MGII LT SZ3","code_information":[{"code":"Sx00-5110-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321729","type":"LOCAL"},{"code":"534943","type":"LOCAL"}],"standard_charges":[{"gross_charge":22911.53,"discounted_cash":17183.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321729 = Hospital System Supply Identifier | 534943 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP MGII RT SZ3","code_information":[{"code":"Sx00-5110-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321730","type":"LOCAL"},{"code":"534944","type":"LOCAL"}],"standard_charges":[{"gross_charge":22911.53,"discounted_cash":17183.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321730 = Hospital System Supply Identifier | 534944 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP MGII LT SZ4","code_information":[{"code":"Sx00-5110-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321731","type":"LOCAL"},{"code":"534945","type":"LOCAL"}],"standard_charges":[{"gross_charge":22911.53,"discounted_cash":17183.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321731 = Hospital System Supply Identifier | 534945 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP MGII RT SZ4","code_information":[{"code":"Sx00-5110-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321732","type":"LOCAL"},{"code":"534946","type":"LOCAL"}],"standard_charges":[{"gross_charge":22911.53,"discounted_cash":17183.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321732 = Hospital System Supply Identifier | 534946 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP MGII RT SZ5","code_information":[{"code":"Sx00-5110-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"324810","type":"LOCAL"},{"code":"324071","type":"LOCAL"}],"standard_charges":[{"gross_charge":22911.53,"discounted_cash":17183.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 324810 = Hospital System Supply Identifier | 324071 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP MGII LT SZ5","code_information":[{"code":"Sx00-5110-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321733","type":"LOCAL"},{"code":"534947","type":"LOCAL"}],"standard_charges":[{"gross_charge":22911.53,"discounted_cash":17183.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321733 = Hospital System Supply Identifier | 534947 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP MGII LT SZ6","code_information":[{"code":"Sx00-5110-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321734","type":"LOCAL"},{"code":"534948","type":"LOCAL"}],"standard_charges":[{"gross_charge":22911.53,"discounted_cash":17183.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321734 = Hospital System Supply Identifier | 534948 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP MGII RT SZ6","code_information":[{"code":"Sx00-5110-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321735","type":"LOCAL"},{"code":"534949","type":"LOCAL"}],"standard_charges":[{"gross_charge":22911.53,"discounted_cash":17183.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321735 = Hospital System Supply Identifier | 534949 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP MGII LT SZ7","code_information":[{"code":"Sx00-5110-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321736","type":"LOCAL"},{"code":"534950","type":"LOCAL"}],"standard_charges":[{"gross_charge":22911.53,"discounted_cash":17183.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321736 = Hospital System Supply Identifier | 534950 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP MGII RT SZ7","code_information":[{"code":"Sx00-5110-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321737","type":"LOCAL"},{"code":"534951","type":"LOCAL"}],"standard_charges":[{"gross_charge":22911.53,"discounted_cash":17183.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321737 = Hospital System Supply Identifier | 534951 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC MGII A B 17","code_information":[{"code":"Sx00-5110-023","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321742","type":"LOCAL"},{"code":"534956","type":"LOCAL"}],"standard_charges":[{"gross_charge":6172.66,"discounted_cash":4629.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321742 = Hospital System Supply Identifier | 534956 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC MGII A B 15","code_information":[{"code":"Sx00-5110-023","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321741","type":"LOCAL"},{"code":"534955","type":"LOCAL"}],"standard_charges":[{"gross_charge":6172.66,"discounted_cash":4629.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321741 = Hospital System Supply Identifier | 534955 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC MGII A B 20","code_information":[{"code":"Sx00-5110-023","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321743","type":"LOCAL"},{"code":"534957","type":"LOCAL"}],"standard_charges":[{"gross_charge":6172.66,"discounted_cash":4629.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321743 = Hospital System Supply Identifier | 534957 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC MGII AB 11","code_information":[{"code":"Sx00-5110-023","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321739","type":"LOCAL"},{"code":"534953","type":"LOCAL"}],"standard_charges":[{"gross_charge":6172.66,"discounted_cash":4629.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321739 = Hospital System Supply Identifier | 534953 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC MGII A/B 9","code_information":[{"code":"Sx00-5110-023","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321738","type":"LOCAL"},{"code":"534952","type":"LOCAL"}],"standard_charges":[{"gross_charge":6172.66,"discounted_cash":4629.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321738 = Hospital System Supply Identifier | 534952 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC MGII A B 13","code_information":[{"code":"Sx00-5110-023","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321740","type":"LOCAL"},{"code":"534954","type":"LOCAL"}],"standard_charges":[{"gross_charge":6172.66,"discounted_cash":4629.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321740 = Hospital System Supply Identifier | 534954 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC MGII A B 23","code_information":[{"code":"Sx00-5110-023","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321744","type":"LOCAL"},{"code":"534958","type":"LOCAL"}],"standard_charges":[{"gross_charge":6172.66,"discounted_cash":4629.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321744 = Hospital System Supply Identifier | 534958 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC MGII C D 23","code_information":[{"code":"Sx00-5110-033","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321750","type":"LOCAL"},{"code":"534964","type":"LOCAL"}],"standard_charges":[{"gross_charge":6172.66,"discounted_cash":4629.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321750 = Hospital System Supply Identifier | 534964 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC MGII C D 17","code_information":[{"code":"Sx00-5110-033","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321748","type":"LOCAL"},{"code":"534962","type":"LOCAL"}],"standard_charges":[{"gross_charge":6172.66,"discounted_cash":4629.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321748 = Hospital System Supply Identifier | 534962 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC MGII C D 15","code_information":[{"code":"Sx00-5110-033","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321747","type":"LOCAL"},{"code":"534961","type":"LOCAL"}],"standard_charges":[{"gross_charge":6172.66,"discounted_cash":4629.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321747 = Hospital System Supply Identifier | 534961 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC MGII C D 20","code_information":[{"code":"Sx00-5110-033","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321749","type":"LOCAL"},{"code":"534963","type":"LOCAL"}],"standard_charges":[{"gross_charge":6172.66,"discounted_cash":4629.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321749 = Hospital System Supply Identifier | 534963 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC MGII C D 11","code_information":[{"code":"Sx00-5110-033","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321745","type":"LOCAL"},{"code":"534959","type":"LOCAL"}],"standard_charges":[{"gross_charge":6172.66,"discounted_cash":4629.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321745 = Hospital System Supply Identifier | 534959 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC MGII C D 13","code_information":[{"code":"Sx00-5110-033","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321746","type":"LOCAL"},{"code":"534960","type":"LOCAL"}],"standard_charges":[{"gross_charge":6172.66,"discounted_cash":4629.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321746 = Hospital System Supply Identifier | 534960 = Lawson ID"}]},{"description":"IMP KNEE TIB INS SURF 9X66MM","code_information":[{"code":"Sx00-5110-033","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326818","type":"LOCAL"},{"code":"401980","type":"LOCAL"}],"standard_charges":[{"gross_charge":6172.66,"discounted_cash":4629.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 326818 = Hospital System Supply Identifier | 401980 = Lawson ID"}]},{"description":"INSERT TIBIAL KNEE FIXED LIPPED MG II 00511004313 13MM SIZE E F","code_information":[{"code":"Sx00-5110-043","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1555969","type":"LOCAL"},{"code":"1112266","type":"LOCAL"}],"standard_charges":[{"gross_charge":4607.82,"discounted_cash":3455.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1555969 = Hospital System Supply Identifier | 1112266 = Lawson ID"}]},{"description":"IMP KNEE TIB INS SURF 9X74MM","code_information":[{"code":"Sx00-5110-043","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"324811","type":"LOCAL"},{"code":"324073","type":"LOCAL"}],"standard_charges":[{"gross_charge":6172.66,"discounted_cash":4629.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 324811 = Hospital System Supply Identifier | 324073 = Lawson ID"}]},{"description":"ARTICULAR TIBIAL","code_information":[{"code":"Sx00-5110-043","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"324812","type":"LOCAL"},{"code":"324074","type":"LOCAL"}],"standard_charges":[{"gross_charge":6172.66,"discounted_cash":4629.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 324812 = Hospital System Supply Identifier | 324074 = Lawson ID"}]},{"description":"IMP KNEE TIB INS SURF 23X74MM","code_information":[{"code":"Sx00-5110-043","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325144","type":"LOCAL"},{"code":"340074","type":"LOCAL"}],"standard_charges":[{"gross_charge":6172.66,"discounted_cash":4629.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 325144 = Hospital System Supply Identifier | 340074 = Lawson ID"}]},{"description":"IMP KNEE TIB INS SURF 13X74MM","code_information":[{"code":"Sx00-5110-043","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326819","type":"LOCAL"},{"code":"401981","type":"LOCAL"}],"standard_charges":[{"gross_charge":6172.66,"discounted_cash":4629.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 326819 = Hospital System Supply Identifier | 401981 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC MGII E F 17","code_information":[{"code":"Sx00-5110-043","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321751","type":"LOCAL"},{"code":"534965","type":"LOCAL"}],"standard_charges":[{"gross_charge":6172.66,"discounted_cash":4629.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321751 = Hospital System Supply Identifier | 534965 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC MGII E F 20","code_information":[{"code":"Sx00-5110-043","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321752","type":"LOCAL"},{"code":"534966","type":"LOCAL"}],"standard_charges":[{"gross_charge":6172.66,"discounted_cash":4629.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321752 = Hospital System Supply Identifier | 534966 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC G H J K 23","code_information":[{"code":"Sx00-5110-053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321756","type":"LOCAL"},{"code":"534970","type":"LOCAL"}],"standard_charges":[{"gross_charge":6172.66,"discounted_cash":4629.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321756 = Hospital System Supply Identifier | 534970 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC G H J K 20","code_information":[{"code":"Sx00-5110-053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321755","type":"LOCAL"},{"code":"534969","type":"LOCAL"}],"standard_charges":[{"gross_charge":6172.66,"discounted_cash":4629.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321755 = Hospital System Supply Identifier | 534969 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC G H J K 17","code_information":[{"code":"Sx00-5110-053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321754","type":"LOCAL"},{"code":"534968","type":"LOCAL"}],"standard_charges":[{"gross_charge":6172.66,"discounted_cash":4629.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321754 = Hospital System Supply Identifier | 534968 = Lawson ID"}]},{"description":"TIBIAL ARTIC SURFACE 11MM","code_information":[{"code":"Sx00-5110-053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326080","type":"LOCAL"},{"code":"380806","type":"LOCAL"}],"standard_charges":[{"gross_charge":6172.66,"discounted_cash":4629.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 326080 = Hospital System Supply Identifier | 380806 = Lawson ID"}]},{"description":"IMP KNEE TIB INS NXGN BLU","code_information":[{"code":"Sx00-5110-053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"327168","type":"LOCAL"},{"code":"412361","type":"LOCAL"}],"standard_charges":[{"gross_charge":6172.66,"discounted_cash":4629.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 327168 = Hospital System Supply Identifier | 412361 = Lawson ID"}]},{"description":"IMP KNEE TIB INS SURF 9X82MM","code_information":[{"code":"Sx00-5110-053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326820","type":"LOCAL"},{"code":"401982","type":"LOCAL"}],"standard_charges":[{"gross_charge":6172.66,"discounted_cash":4629.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 326820 = Hospital System Supply Identifier | 401982 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC G H J K 15","code_information":[{"code":"Sx00-5110-053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321753","type":"LOCAL"},{"code":"534967","type":"LOCAL"}],"standard_charges":[{"gross_charge":6172.66,"discounted_cash":4629.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321753 = Hospital System Supply Identifier | 534967 = Lawson ID"}]},{"description":"SCREW BONE MGII STRL 6.5X50MM","code_information":[{"code":"Sx00-5110-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"303213","type":"LOCAL"},{"code":"522159","type":"LOCAL"}],"standard_charges":[{"gross_charge":219.75,"discounted_cash":164.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303213 = Hospital System Supply Identifier | 522159 = Lawson ID"}]},{"description":"SCREW BONE MGII STRL 6.5X60MM","code_information":[{"code":"Sx00-5110-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"303215","type":"LOCAL"},{"code":"522161","type":"LOCAL"}],"standard_charges":[{"gross_charge":219.75,"discounted_cash":164.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303215 = Hospital System Supply Identifier | 522161 = Lawson ID"}]},{"description":"SCREW BONE MGII STRL 6.5X55MM","code_information":[{"code":"Sx00-5110-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"303214","type":"LOCAL"},{"code":"522160","type":"LOCAL"}],"standard_charges":[{"gross_charge":219.75,"discounted_cash":164.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303214 = Hospital System Supply Identifier | 522160 = Lawson ID"}]},{"description":"SCREW BONE MGII STRL 6.5X45MM","code_information":[{"code":"Sx00-5110-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"303212","type":"LOCAL"},{"code":"522158","type":"LOCAL"}],"standard_charges":[{"gross_charge":219.75,"discounted_cash":164.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303212 = Hospital System Supply Identifier | 522158 = Lawson ID"}]},{"description":"SCREW BONE MGII STRL 6.5X40MM","code_information":[{"code":"Sx00-5110-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"169783","type":"LOCAL"},{"code":"324081","type":"LOCAL"}],"standard_charges":[{"gross_charge":219.75,"discounted_cash":164.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 169783 = Hospital System Supply Identifier | 324081 = Lawson ID"}]},{"description":"SCREW BONE MGII STRL 6.5X35MM","code_information":[{"code":"Sx00-5110-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"159619","type":"LOCAL"},{"code":"337166","type":"LOCAL"}],"standard_charges":[{"gross_charge":219.75,"discounted_cash":164.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 159619 = Hospital System Supply Identifier | 337166 = Lawson ID"}]},{"description":"SCREW BONE MGII STRL 6.5X20MM","code_information":[{"code":"Sx00-5110-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"329378","type":"LOCAL"},{"code":"324079","type":"LOCAL"}],"standard_charges":[{"gross_charge":219.75,"discounted_cash":164.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329378 = Hospital System Supply Identifier | 324079 = Lawson ID"}]},{"description":"SCREW BONE MGII STRL 6.5X30MM","code_information":[{"code":"Sx00-5110-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"158788","type":"LOCAL"},{"code":"317221","type":"LOCAL"}],"standard_charges":[{"gross_charge":219.75,"discounted_cash":164.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 158788 = Hospital System Supply Identifier | 317221 = Lawson ID"}]},{"description":"SCREW BONE MGII STRL 6.5X25MM","code_information":[{"code":"Sx00-5110-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"303211","type":"LOCAL"},{"code":"522157","type":"LOCAL"}],"standard_charges":[{"gross_charge":219.75,"discounted_cash":164.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303211 = Hospital System Supply Identifier | 522157 = Lawson ID"}]},{"description":"SCREW BONE MGII NS 6.5X60MM","code_information":[{"code":"Sx00-5110-075","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"303223","type":"LOCAL"},{"code":"522169","type":"LOCAL"}],"standard_charges":[{"gross_charge":219.75,"discounted_cash":164.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303223 = Hospital System Supply Identifier | 522169 = Lawson ID"}]},{"description":"SCREW BONE MGII NS 6.5X55MM","code_information":[{"code":"Sx00-5110-075","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"303222","type":"LOCAL"},{"code":"522168","type":"LOCAL"}],"standard_charges":[{"gross_charge":219.75,"discounted_cash":164.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303222 = Hospital System Supply Identifier | 522168 = Lawson ID"}]},{"description":"SCREW BONE MGII NS 6.5X50MM","code_information":[{"code":"Sx00-5110-075","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"303221","type":"LOCAL"},{"code":"522167","type":"LOCAL"}],"standard_charges":[{"gross_charge":219.75,"discounted_cash":164.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303221 = Hospital System Supply Identifier | 522167 = Lawson ID"}]},{"description":"SCREW BONE MGII NS 6.5X45MM","code_information":[{"code":"Sx00-5110-075","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"303220","type":"LOCAL"},{"code":"522166","type":"LOCAL"}],"standard_charges":[{"gross_charge":219.75,"discounted_cash":164.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303220 = Hospital System Supply Identifier | 522166 = Lawson ID"}]},{"description":"SCREW BONE MGII NS 6.5X40MM","code_information":[{"code":"Sx00-5110-075","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"303219","type":"LOCAL"},{"code":"522165","type":"LOCAL"}],"standard_charges":[{"gross_charge":219.75,"discounted_cash":164.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303219 = Hospital System Supply Identifier | 522165 = Lawson ID"}]},{"description":"SCREW BONE MGII NS 6.5X25MM","code_information":[{"code":"Sx00-5110-075","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"303217","type":"LOCAL"},{"code":"522163","type":"LOCAL"}],"standard_charges":[{"gross_charge":219.75,"discounted_cash":164.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303217 = Hospital System Supply Identifier | 522163 = Lawson ID"}]},{"description":"SCREW BONE MGII NS 6.5X20MM","code_information":[{"code":"Sx00-5110-075","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"303216","type":"LOCAL"},{"code":"522162","type":"LOCAL"}],"standard_charges":[{"gross_charge":219.75,"discounted_cash":164.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303216 = Hospital System Supply Identifier | 522162 = Lawson ID"}]},{"description":"SCREW BONE MGII NS 6.5X35MM","code_information":[{"code":"Sx00-5110-075","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"162156","type":"LOCAL"},{"code":"360372","type":"LOCAL"}],"standard_charges":[{"gross_charge":219.75,"discounted_cash":164.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 162156 = Hospital System Supply Identifier | 360372 = Lawson ID"}]},{"description":"SCREW BONE MGII NS 6.5X30MM","code_information":[{"code":"Sx00-5110-075","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"303218","type":"LOCAL"},{"code":"522164","type":"LOCAL"}],"standard_charges":[{"gross_charge":219.75,"discounted_cash":164.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303218 = Hospital System Supply Identifier | 522164 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP MGII LT SZ4","code_information":[{"code":"Sx00-5112-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321757","type":"LOCAL"},{"code":"534971","type":"LOCAL"}],"standard_charges":[{"gross_charge":17186.84,"discounted_cash":12890.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321757 = Hospital System Supply Identifier | 534971 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP MGII LT SZ5","code_information":[{"code":"Sx00-5112-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"324813","type":"LOCAL"},{"code":"324082","type":"LOCAL"}],"standard_charges":[{"gross_charge":17186.84,"discounted_cash":12890.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 324813 = Hospital System Supply Identifier | 324082 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP MGII RT SZ5","code_information":[{"code":"Sx00-5112-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321758","type":"LOCAL"},{"code":"534972","type":"LOCAL"}],"standard_charges":[{"gross_charge":17186.84,"discounted_cash":12890.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321758 = Hospital System Supply Identifier | 534972 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP MGII LT SZ6","code_information":[{"code":"Sx00-5112-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"324814","type":"LOCAL"},{"code":"324083","type":"LOCAL"}],"standard_charges":[{"gross_charge":17186.84,"discounted_cash":12890.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 324814 = Hospital System Supply Identifier | 324083 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP MGII RT SZ6","code_information":[{"code":"Sx00-5112-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321759","type":"LOCAL"},{"code":"534973","type":"LOCAL"}],"standard_charges":[{"gross_charge":17186.84,"discounted_cash":12890.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321759 = Hospital System Supply Identifier | 534973 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP MGII RT SZ7","code_information":[{"code":"Sx00-5112-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321761","type":"LOCAL"},{"code":"534975","type":"LOCAL"}],"standard_charges":[{"gross_charge":17186.84,"discounted_cash":12890.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321761 = Hospital System Supply Identifier | 534975 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP MGII 6T SZ7","code_information":[{"code":"Sx00-5112-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321760","type":"LOCAL"},{"code":"534974","type":"LOCAL"}],"standard_charges":[{"gross_charge":17186.84,"discounted_cash":12890.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321760 = Hospital System Supply Identifier | 534974 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT MGII SZA","code_information":[{"code":"Sx00-5112-027","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321762","type":"LOCAL"},{"code":"534976","type":"LOCAL"}],"standard_charges":[{"gross_charge":12262.09,"discounted_cash":9196.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321762 = Hospital System Supply Identifier | 534976 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT MGII SZB","code_information":[{"code":"Sx00-5112-027","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321763","type":"LOCAL"},{"code":"534977","type":"LOCAL"}],"standard_charges":[{"gross_charge":12262.09,"discounted_cash":9196.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321763 = Hospital System Supply Identifier | 534977 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT MGII SZD","code_information":[{"code":"Sx00-5112-035","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321764","type":"LOCAL"},{"code":"534978","type":"LOCAL"}],"standard_charges":[{"gross_charge":10495.98,"discounted_cash":7871.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321764 = Hospital System Supply Identifier | 534978 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT MGII SZC","code_information":[{"code":"Sx00-5112-037","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321765","type":"LOCAL"},{"code":"534979","type":"LOCAL"}],"standard_charges":[{"gross_charge":12262.09,"discounted_cash":9196.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321765 = Hospital System Supply Identifier | 534979 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT MGII SZD","code_information":[{"code":"Sx00-5112-037","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321766","type":"LOCAL"},{"code":"534980","type":"LOCAL"}],"standard_charges":[{"gross_charge":12262.09,"discounted_cash":9196.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321766 = Hospital System Supply Identifier | 534980 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT MGII SZE","code_information":[{"code":"Sx00-5112-047","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321767","type":"LOCAL"},{"code":"534981","type":"LOCAL"}],"standard_charges":[{"gross_charge":12262.09,"discounted_cash":9196.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321767 = Hospital System Supply Identifier | 534981 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT MGII SZF","code_information":[{"code":"Sx00-5112-047","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321768","type":"LOCAL"},{"code":"534982","type":"LOCAL"}],"standard_charges":[{"gross_charge":12262.09,"discounted_cash":9196.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321768 = Hospital System Supply Identifier | 534982 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT MGII SZK","code_information":[{"code":"Sx00-5112-055","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321769","type":"LOCAL"},{"code":"534983","type":"LOCAL"}],"standard_charges":[{"gross_charge":10495.98,"discounted_cash":7871.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321769 = Hospital System Supply Identifier | 534983 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT MGII SZK","code_information":[{"code":"Sx00-5112-057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321773","type":"LOCAL"},{"code":"534987","type":"LOCAL"}],"standard_charges":[{"gross_charge":12262.09,"discounted_cash":9196.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321773 = Hospital System Supply Identifier | 534987 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT MGII SZJ","code_information":[{"code":"Sx00-5112-057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321772","type":"LOCAL"},{"code":"534986","type":"LOCAL"}],"standard_charges":[{"gross_charge":12262.09,"discounted_cash":9196.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321772 = Hospital System Supply Identifier | 534986 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT MGII SZG","code_information":[{"code":"Sx00-5112-057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321770","type":"LOCAL"},{"code":"534984","type":"LOCAL"}],"standard_charges":[{"gross_charge":12262.09,"discounted_cash":9196.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321770 = Hospital System Supply Identifier | 534984 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT MGII SZH","code_information":[{"code":"Sx00-5112-057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321771","type":"LOCAL"},{"code":"534985","type":"LOCAL"}],"standard_charges":[{"gross_charge":12262.09,"discounted_cash":9196.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321771 = Hospital System Supply Identifier | 534985 = Lawson ID"}]},{"description":"IMP KNEE TIB BEAR POST FIX","code_information":[{"code":"Sx00-5114-044","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329936","type":"LOCAL"},{"code":"401983","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329936 = Hospital System Supply Identifier | 401983 = Lawson ID"}]},{"description":"BIT DRILL PTELA/FEM","code_information":[{"code":"Sx00-5120-052","type":"CDM"},{"code":"272","type":"RC"},{"code":"158236","type":"LOCAL"},{"code":"313633","type":"LOCAL"}],"standard_charges":[{"gross_charge":225.61,"discounted_cash":169.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 158236 = Hospital System Supply Identifier | 313633 = Lawson ID"}]},{"description":"BIT DRILL 12.7MM NSTRL PEG SS TIBIA MG II","code_information":[{"code":"Sx00-5120-067","type":"CDM"},{"code":"272","type":"RC"},{"code":"1090157","type":"LOCAL"},{"code":"S516400","type":"LOCAL"}],"standard_charges":[{"gross_charge":307.65,"discounted_cash":230.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1090157 = Hospital System Supply Identifier | S516400 = Lawson ID"}]},{"description":"BIT DRILL W/CONNECT 3.2MM","code_information":[{"code":"Sx00-5120-085","type":"CDM"},{"code":"272","type":"RC"},{"code":"149984","type":"LOCAL"},{"code":"237602","type":"LOCAL"}],"standard_charges":[{"gross_charge":225.61,"discounted_cash":169.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 149984 = Hospital System Supply Identifier | 237602 = Lawson ID"}]},{"description":"SCRDRVR HEX MGII 3.5MM","code_information":[{"code":"Sx00-5120-087","type":"CDM"},{"code":"272","type":"RC"},{"code":"202340","type":"LOCAL"},{"code":"452439","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.9,"discounted_cash":285.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 202340 = Hospital System Supply Identifier | 452439 = Lawson ID"}]},{"description":"PLATE TIBIAL 0D NSTRL BOOM SS KNEE MG II","code_information":[{"code":"Sx00-5125-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1100365","type":"LOCAL"},{"code":"S119123","type":"LOCAL"}],"standard_charges":[{"gross_charge":1603.1,"discounted_cash":1202.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1100365 = Hospital System Supply Identifier | S119123 = Lawson ID"}]},{"description":"CLMP INDEPEND LOK 2D LG XTRFX","code_information":[{"code":"Sx00-5200-090","type":"CDM"},{"code":"272","type":"RC"},{"code":"411459","type":"LOCAL"},{"code":"623375","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 411459 = Hospital System Supply Identifier | 623375 = Lawson ID"}]},{"description":"IMP ORTH BAR XTRAFIX 11X100MM","code_information":[{"code":"Sx00-5202-011","type":"CDM"},{"code":"272","type":"RC"},{"code":"410495","type":"LOCAL"},{"code":"421381","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.9,"discounted_cash":285.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410495 = Hospital System Supply Identifier | 421381 = Lawson ID"}]},{"description":"POST FIX EXT STR 11MM","code_information":[{"code":"Sx00-5202-090","type":"CDM"},{"code":"272","type":"RC"},{"code":"409363","type":"LOCAL"},{"code":"395473","type":"LOCAL"}],"standard_charges":[{"gross_charge":257.84,"discounted_cash":193.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 409363 = Hospital System Supply Identifier | 395473 = Lawson ID"}]},{"description":"POST FIX EXT STR 11MM 30DEGREE","code_information":[{"code":"Sx00-5202-090","type":"CDM"},{"code":"272","type":"RC"},{"code":"411430","type":"LOCAL"},{"code":"595879","type":"LOCAL"}],"standard_charges":[{"gross_charge":257.84,"discounted_cash":193.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 411430 = Hospital System Supply Identifier | 595879 = Lawson ID"}]},{"description":"BAR CARBON XTRAFIX 11X150MM","code_information":[{"code":"Sx00-5203-011","type":"CDM"},{"code":"272","type":"RC"},{"code":"410517","type":"LOCAL"},{"code":"425145","type":"LOCAL"}],"standard_charges":[{"gross_charge":504.37,"discounted_cash":378.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410517 = Hospital System Supply Identifier | 425145 = Lawson ID"}]},{"description":"BAR CARBON XTRAFIX 11X200MM","code_information":[{"code":"Sx00-5203-011","type":"CDM"},{"code":"272","type":"RC"},{"code":"410518","type":"LOCAL"},{"code":"425146","type":"LOCAL"}],"standard_charges":[{"gross_charge":542.78,"discounted_cash":407.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410518 = Hospital System Supply Identifier | 425146 = Lawson ID"}]},{"description":"BAR CARBON XTRAFIX 11X350MM","code_information":[{"code":"Sx00-5203-011","type":"CDM"},{"code":"272","type":"RC"},{"code":"410519","type":"LOCAL"},{"code":"425147","type":"LOCAL"}],"standard_charges":[{"gross_charge":633.94,"discounted_cash":475.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410519 = Hospital System Supply Identifier | 425147 = Lawson ID"}]},{"description":"BAR CARBON XTRAFX 11X500MM","code_information":[{"code":"Sx00-5203-011","type":"CDM"},{"code":"272","type":"RC"},{"code":"411458","type":"LOCAL"},{"code":"623374","type":"LOCAL"}],"standard_charges":[{"gross_charge":725.89,"discounted_cash":544.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 411458 = Hospital System Supply Identifier | 623374 = Lawson ID"}]},{"description":"IMP FIX PIN HALF 4X100X35MM","code_information":[{"code":"Sx00-5204-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410497","type":"LOCAL"},{"code":"421384","type":"LOCAL"}],"standard_charges":[{"gross_charge":207.79,"discounted_cash":155.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410497 = Hospital System Supply Identifier | 421384 = Lawson ID"}]},{"description":"PIN FIX EXT HALF 5X200X65MM","code_information":[{"code":"Sx00-5204-050","type":"CDM"},{"code":"272","type":"RC"},{"code":"411190","type":"LOCAL"},{"code":"438994","type":"LOCAL"}],"standard_charges":[{"gross_charge":207.79,"discounted_cash":155.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 411190 = Hospital System Supply Identifier | 438994 = Lawson ID"}]},{"description":"PIN FIX EXT HALF 5X200X45MM","code_information":[{"code":"Sx00-5204-050","type":"CDM"},{"code":"272","type":"RC"},{"code":"410532","type":"LOCAL"},{"code":"428125","type":"LOCAL"}],"standard_charges":[{"gross_charge":207.79,"discounted_cash":155.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410532 = Hospital System Supply Identifier | 428125 = Lawson ID"}]},{"description":"PIN FIX EXT HALF 5X160X35MM","code_information":[{"code":"Sx00-5204-050","type":"CDM"},{"code":"272","type":"RC"},{"code":"409364","type":"LOCAL"},{"code":"395474","type":"LOCAL"}],"standard_charges":[{"gross_charge":207.79,"discounted_cash":155.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 409364 = Hospital System Supply Identifier | 395474 = Lawson ID"}]},{"description":"PIN FIX EXT 5X160X55MM","code_information":[{"code":"Sx00-5204-050","type":"CDM"},{"code":"272","type":"RC"},{"code":"409365","type":"LOCAL"},{"code":"395475","type":"LOCAL"}],"standard_charges":[{"gross_charge":207.79,"discounted_cash":155.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 409365 = Hospital System Supply Identifier | 395475 = Lawson ID"}]},{"description":"PIN FIX EXT 6X200X55MM","code_information":[{"code":"Sx00-5204-060","type":"CDM"},{"code":"272","type":"RC"},{"code":"356301","type":"LOCAL"},{"code":"395476","type":"LOCAL"}],"standard_charges":[{"gross_charge":207.79,"discounted_cash":155.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 356301 = Hospital System Supply Identifier | 395476 = Lawson ID"}]},{"description":"PIN FIX EXT TRNSFIXNG BLK 6MM","code_information":[{"code":"Sx00-5204-090","type":"CDM"},{"code":"272","type":"RC"},{"code":"409366","type":"LOCAL"},{"code":"395477","type":"LOCAL"}],"standard_charges":[{"gross_charge":207.79,"discounted_cash":155.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 409366 = Hospital System Supply Identifier | 395477 = Lawson ID"}]},{"description":"PIN 1/2 BLUNT 5X160X55MM","code_information":[{"code":"Sx00-5205-050","type":"CDM"},{"code":"272","type":"RC"},{"code":"410520","type":"LOCAL"},{"code":"425148","type":"LOCAL"}],"standard_charges":[{"gross_charge":207.79,"discounted_cash":155.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 410520 = Hospital System Supply Identifier | 425148 = Lawson ID"}]},{"description":"DRILL MED 4.0MM","code_information":[{"code":"Sx00-5207-040","type":"CDM"},{"code":"272","type":"RC"},{"code":"409367","type":"LOCAL"},{"code":"395478","type":"LOCAL"}],"standard_charges":[{"gross_charge":346.32,"discounted_cash":259.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 409367 = Hospital System Supply Identifier | 395478 = Lawson ID"}]},{"description":"BIT DRILL LNG 4.0MM","code_information":[{"code":"Sx00-5207-040","type":"CDM"},{"code":"272","type":"RC"},{"code":"411381","type":"LOCAL"},{"code":"463697","type":"LOCAL"}],"standard_charges":[{"gross_charge":346.32,"discounted_cash":259.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 411381 = Hospital System Supply Identifier | 463697 = Lawson ID"}]},{"description":"DRILL 4.5MM","code_information":[{"code":"Sx00-5207-045","type":"CDM"},{"code":"272","type":"RC"},{"code":"409368","type":"LOCAL"},{"code":"395479","type":"LOCAL"}],"standard_charges":[{"gross_charge":346.32,"discounted_cash":259.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 409368 = Hospital System Supply Identifier | 395479 = Lawson ID"}]},{"description":"IMP KNEE FEM POR I/B 54X55","code_information":[{"code":"Sx00-5220-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321774","type":"LOCAL"},{"code":"534988","type":"LOCAL"}],"standard_charges":[{"gross_charge":16526.48,"discounted_cash":12394.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321774 = Hospital System Supply Identifier | 534988 = Lawson ID"}]},{"description":"IMP KNEE FEM POR I/B 59X60","code_information":[{"code":"Sx00-5220-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321775","type":"LOCAL"},{"code":"534989","type":"LOCAL"}],"standard_charges":[{"gross_charge":16526.48,"discounted_cash":12394.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321775 = Hospital System Supply Identifier | 534989 = Lawson ID"}]},{"description":"IMP KNEE PTELA COMP 32MM 7MM","code_information":[{"code":"Sx00-5220-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"327316","type":"LOCAL"},{"code":"418240","type":"LOCAL"}],"standard_charges":[{"gross_charge":5218.12,"discounted_cash":3913.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 327316 = Hospital System Supply Identifier | 418240 = Lawson ID"}]},{"description":"IMP KNEE PTELA DOME 3-PEG 35","code_information":[{"code":"Sx00-5220-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321781","type":"LOCAL"},{"code":"534995","type":"LOCAL"}],"standard_charges":[{"gross_charge":5218.12,"discounted_cash":3913.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321781 = Hospital System Supply Identifier | 534995 = Lawson ID"}]},{"description":"IMP KNEE PTELA DOME 3-PEG 38","code_information":[{"code":"Sx00-5220-019","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321782","type":"LOCAL"},{"code":"534996","type":"LOCAL"}],"standard_charges":[{"gross_charge":5218.12,"discounted_cash":3913.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321782 = Hospital System Supply Identifier | 534996 = Lawson ID"}]},{"description":"IMP KNEE PTELA DOME 3-PEG 41","code_information":[{"code":"Sx00-5220-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321783","type":"LOCAL"},{"code":"534997","type":"LOCAL"}],"standard_charges":[{"gross_charge":5218.12,"discounted_cash":3913.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321783 = Hospital System Supply Identifier | 534997 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT SZ54 44X59","code_information":[{"code":"Sx00-5220-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321784","type":"LOCAL"},{"code":"534998","type":"LOCAL"}],"standard_charges":[{"gross_charge":11152.47,"discounted_cash":8364.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321784 = Hospital System Supply Identifier | 534998 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT STD TIB 59M","code_information":[{"code":"Sx00-5220-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"196058","type":"LOCAL"},{"code":"401984","type":"LOCAL"}],"standard_charges":[{"gross_charge":11152.47,"discounted_cash":8364.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 196058 = Hospital System Supply Identifier | 401984 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT MOD TIB 64M","code_information":[{"code":"Sx00-5220-023","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326821","type":"LOCAL"},{"code":"401985","type":"LOCAL"}],"standard_charges":[{"gross_charge":11152.47,"discounted_cash":8364.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 326821 = Hospital System Supply Identifier | 401985 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT SZ69 56X75","code_information":[{"code":"Sx00-5220-024","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321785","type":"LOCAL"},{"code":"534999","type":"LOCAL"}],"standard_charges":[{"gross_charge":11152.47,"discounted_cash":8364.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321785 = Hospital System Supply Identifier | 534999 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT SZ74 60X81","code_information":[{"code":"Sx00-5220-025","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321786","type":"LOCAL"},{"code":"535000","type":"LOCAL"}],"standard_charges":[{"gross_charge":11152.47,"discounted_cash":8364.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321786 = Hospital System Supply Identifier | 535000 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT SZ54 48X64","code_information":[{"code":"Sx00-5220-026","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321787","type":"LOCAL"},{"code":"535001","type":"LOCAL"}],"standard_charges":[{"gross_charge":11152.47,"discounted_cash":8364.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321787 = Hospital System Supply Identifier | 535001 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT SZ59 52X70","code_information":[{"code":"Sx00-5220-027","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321788","type":"LOCAL"},{"code":"535002","type":"LOCAL"}],"standard_charges":[{"gross_charge":11152.47,"discounted_cash":8364.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321788 = Hospital System Supply Identifier | 535002 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT SZ64 56X75","code_information":[{"code":"Sx00-5220-028","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321789","type":"LOCAL"},{"code":"535003","type":"LOCAL"}],"standard_charges":[{"gross_charge":11152.47,"discounted_cash":8364.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321789 = Hospital System Supply Identifier | 535003 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT SZ69 60X81","code_information":[{"code":"Sx00-5220-029","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321790","type":"LOCAL"},{"code":"535004","type":"LOCAL"}],"standard_charges":[{"gross_charge":11152.47,"discounted_cash":8364.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321790 = Hospital System Supply Identifier | 535004 = Lawson ID"}]},{"description":"IMP KNEE TIB PLY I/B 54X8","code_information":[{"code":"Sx00-5220-031","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321796","type":"LOCAL"},{"code":"535010","type":"LOCAL"}],"standard_charges":[{"gross_charge":8147.07,"discounted_cash":6110.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321796 = Hospital System Supply Identifier | 535010 = Lawson ID"}]},{"description":"IMP KNEE TIB PLY I/B 54X10","code_information":[{"code":"Sx00-5220-031","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321797","type":"LOCAL"},{"code":"535011","type":"LOCAL"}],"standard_charges":[{"gross_charge":8147.07,"discounted_cash":6110.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321797 = Hospital System Supply Identifier | 535011 = Lawson ID"}]},{"description":"IMP KNEE TIB PLY I/B 54X12","code_information":[{"code":"Sx00-5220-031","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321798","type":"LOCAL"},{"code":"535012","type":"LOCAL"}],"standard_charges":[{"gross_charge":8147.07,"discounted_cash":6110.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321798 = Hospital System Supply Identifier | 535012 = Lawson ID"}]},{"description":"IMP KNEE TIB PLY I/B 54X15","code_information":[{"code":"Sx00-5220-031","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321799","type":"LOCAL"},{"code":"535013","type":"LOCAL"}],"standard_charges":[{"gross_charge":8147.07,"discounted_cash":6110.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321799 = Hospital System Supply Identifier | 535013 = Lawson ID"}]},{"description":"IMP KNEE TIB PLY I/B 59X8","code_information":[{"code":"Sx00-5220-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321805","type":"LOCAL"},{"code":"535019","type":"LOCAL"}],"standard_charges":[{"gross_charge":8147.07,"discounted_cash":6110.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321805 = Hospital System Supply Identifier | 535019 = Lawson ID"}]},{"description":"IMP KNEE TIB PLY I/B 59X10","code_information":[{"code":"Sx00-5220-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321806","type":"LOCAL"},{"code":"535020","type":"LOCAL"}],"standard_charges":[{"gross_charge":8147.07,"discounted_cash":6110.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321806 = Hospital System Supply Identifier | 535020 = Lawson ID"}]},{"description":"IMP KNEE TIB PLY I/B 59X12","code_information":[{"code":"Sx00-5220-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321807","type":"LOCAL"},{"code":"535021","type":"LOCAL"}],"standard_charges":[{"gross_charge":8147.07,"discounted_cash":6110.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321807 = Hospital System Supply Identifier | 535021 = Lawson ID"}]},{"description":"IMP KNEE TIB PLY I/B 59X15","code_information":[{"code":"Sx00-5220-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321808","type":"LOCAL"},{"code":"535022","type":"LOCAL"}],"standard_charges":[{"gross_charge":8147.07,"discounted_cash":6110.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321808 = Hospital System Supply Identifier | 535022 = Lawson ID"}]},{"description":"IMP KNEE TIB PLY I/B 64X15","code_information":[{"code":"Sx00-5220-033","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321814","type":"LOCAL"},{"code":"535028","type":"LOCAL"}],"standard_charges":[{"gross_charge":8147.07,"discounted_cash":6110.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321814 = Hospital System Supply Identifier | 535028 = Lawson ID"}]},{"description":"IMP KNEE TIB PLY I/B 64X12","code_information":[{"code":"Sx00-5220-033","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321813","type":"LOCAL"},{"code":"535027","type":"LOCAL"}],"standard_charges":[{"gross_charge":8147.07,"discounted_cash":6110.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321813 = Hospital System Supply Identifier | 535027 = Lawson ID"}]},{"description":"IMP KNEE TIB PLY I/B 64X10","code_information":[{"code":"Sx00-5220-033","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321812","type":"LOCAL"},{"code":"535026","type":"LOCAL"}],"standard_charges":[{"gross_charge":8147.07,"discounted_cash":6110.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321812 = Hospital System Supply Identifier | 535026 = Lawson ID"}]},{"description":"IMP KNEE TIB PLY I/B 64X8","code_information":[{"code":"Sx00-5220-033","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321811","type":"LOCAL"},{"code":"535025","type":"LOCAL"}],"standard_charges":[{"gross_charge":8147.07,"discounted_cash":6110.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321811 = Hospital System Supply Identifier | 535025 = Lawson ID"}]},{"description":"IMP KNEE TIB 18X64MM","code_information":[{"code":"Sx00-5220-033","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"327172","type":"LOCAL"},{"code":"412365","type":"LOCAL"}],"standard_charges":[{"gross_charge":8354.25,"discounted_cash":6265.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 327172 = Hospital System Supply Identifier | 412365 = Lawson ID"}]},{"description":"IMP KNEE TIB PLY I/B 69X10","code_information":[{"code":"Sx00-5220-034","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321822","type":"LOCAL"},{"code":"535036","type":"LOCAL"}],"standard_charges":[{"gross_charge":8147.07,"discounted_cash":6110.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321822 = Hospital System Supply Identifier | 535036 = Lawson ID"}]},{"description":"IMP KNEE TIB PLY I/B 69X12","code_information":[{"code":"Sx00-5220-034","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321823","type":"LOCAL"},{"code":"535037","type":"LOCAL"}],"standard_charges":[{"gross_charge":8147.07,"discounted_cash":6110.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321823 = Hospital System Supply Identifier | 535037 = Lawson ID"}]},{"description":"IMP KNEE TIB PLY I/B 69X15","code_information":[{"code":"Sx00-5220-034","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321824","type":"LOCAL"},{"code":"535038","type":"LOCAL"}],"standard_charges":[{"gross_charge":8147.07,"discounted_cash":6110.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321824 = Hospital System Supply Identifier | 535038 = Lawson ID"}]},{"description":"IMP KNEE TIB PLY I/B 74X10","code_information":[{"code":"Sx00-5220-035","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321832","type":"LOCAL"},{"code":"535046","type":"LOCAL"}],"standard_charges":[{"gross_charge":8147.07,"discounted_cash":6110.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321832 = Hospital System Supply Identifier | 535046 = Lawson ID"}]},{"description":"IMP KNEE TIB PLY I/B 74X12","code_information":[{"code":"Sx00-5220-035","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321833","type":"LOCAL"},{"code":"535047","type":"LOCAL"}],"standard_charges":[{"gross_charge":8147.07,"discounted_cash":6110.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321833 = Hospital System Supply Identifier | 535047 = Lawson ID"}]},{"description":"IMP KNEE TIB PLY I/B 74X15","code_information":[{"code":"Sx00-5220-035","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321834","type":"LOCAL"},{"code":"535048","type":"LOCAL"}],"standard_charges":[{"gross_charge":8147.07,"discounted_cash":6110.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321834 = Hospital System Supply Identifier | 535048 = Lawson ID"}]},{"description":"IMP KNEE PTELA DOME 3-PEG 32","code_information":[{"code":"Sx00-5220-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321835","type":"LOCAL"},{"code":"535049","type":"LOCAL"}],"standard_charges":[{"gross_charge":5218.12,"discounted_cash":3913.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321835 = Hospital System Supply Identifier | 535049 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC 59/54X15","code_information":[{"code":"Sx00-5220-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321839","type":"LOCAL"},{"code":"535053","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.0,"discounted_cash":3312.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321839 = Hospital System Supply Identifier | 535053 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC 59/54X12","code_information":[{"code":"Sx00-5220-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321838","type":"LOCAL"},{"code":"535052","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.0,"discounted_cash":3312.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321838 = Hospital System Supply Identifier | 535052 = Lawson ID"}]},{"description":"IMP KNEE PTELA DOME 3-PEG 35","code_information":[{"code":"Sx00-5220-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321836","type":"LOCAL"},{"code":"535050","type":"LOCAL"}],"standard_charges":[{"gross_charge":5218.12,"discounted_cash":3913.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321836 = Hospital System Supply Identifier | 535050 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC 59/54X10","code_information":[{"code":"Sx00-5220-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321837","type":"LOCAL"},{"code":"535051","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.0,"discounted_cash":3312.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321837 = Hospital System Supply Identifier | 535051 = Lawson ID"}]},{"description":"IMP KNEE PTELA DOM 3-PEG 38","code_information":[{"code":"Sx00-5220-053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321840","type":"LOCAL"},{"code":"535054","type":"LOCAL"}],"standard_charges":[{"gross_charge":5218.12,"discounted_cash":3913.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321840 = Hospital System Supply Identifier | 535054 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC 64/59X10","code_information":[{"code":"Sx00-5220-053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321841","type":"LOCAL"},{"code":"535055","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.0,"discounted_cash":3312.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321841 = Hospital System Supply Identifier | 535055 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC 64/59X12","code_information":[{"code":"Sx00-5220-053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321842","type":"LOCAL"},{"code":"535056","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.0,"discounted_cash":3312.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321842 = Hospital System Supply Identifier | 535056 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC 64/59X15","code_information":[{"code":"Sx00-5220-053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321843","type":"LOCAL"},{"code":"535057","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.0,"discounted_cash":3312.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321843 = Hospital System Supply Identifier | 535057 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC 69/64X12","code_information":[{"code":"Sx00-5220-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321845","type":"LOCAL"},{"code":"535059","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.0,"discounted_cash":3312.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321845 = Hospital System Supply Identifier | 535059 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC 69/64X10","code_information":[{"code":"Sx00-5220-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321844","type":"LOCAL"},{"code":"535058","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.0,"discounted_cash":3312.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321844 = Hospital System Supply Identifier | 535058 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC 69/64X15","code_information":[{"code":"Sx00-5220-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321846","type":"LOCAL"},{"code":"535060","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.0,"discounted_cash":3312.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321846 = Hospital System Supply Identifier | 535060 = Lawson ID"}]},{"description":"IMP TIB WDG HLF SZ74 16D 11.5","code_information":[{"code":"Sx00-5220-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321870","type":"LOCAL"},{"code":"535084","type":"LOCAL"}],"standard_charges":[{"gross_charge":7741.8,"discounted_cash":5806.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321870 = Hospital System Supply Identifier | 535084 = Lawson ID"}]},{"description":"IMP KNEE TIB CUP LOK","code_information":[{"code":"Sx00-5220-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"196545","type":"LOCAL"},{"code":"412507","type":"LOCAL"}],"standard_charges":[{"gross_charge":935.45,"discounted_cash":701.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 196545 = Hospital System Supply Identifier | 412507 = Lawson ID"}]},{"description":"IMP KNEE ROD FLUT I/B 15X25","code_information":[{"code":"Sx00-5220-067","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321872","type":"LOCAL"},{"code":"535086","type":"LOCAL"}],"standard_charges":[{"gross_charge":1960.0,"discounted_cash":1470.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321872 = Hospital System Supply Identifier | 535086 = Lawson ID"}]},{"description":"IMP KNEE ROD FLUT I/B 15X40","code_information":[{"code":"Sx00-5220-068","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321873","type":"LOCAL"},{"code":"535087","type":"LOCAL"}],"standard_charges":[{"gross_charge":1960.0,"discounted_cash":1470.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321873 = Hospital System Supply Identifier | 535087 = Lawson ID"}]},{"description":"IMP KNEE ROD FLUT I/B 10X75","code_information":[{"code":"Sx00-5220-069","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321874","type":"LOCAL"},{"code":"535088","type":"LOCAL"}],"standard_charges":[{"gross_charge":1960.0,"discounted_cash":1470.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321874 = Hospital System Supply Identifier | 535088 = Lawson ID"}]},{"description":"IMP KNEE ROD FLUT I/B 12X75","code_information":[{"code":"Sx00-5220-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321875","type":"LOCAL"},{"code":"535089","type":"LOCAL"}],"standard_charges":[{"gross_charge":1960.0,"discounted_cash":1470.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321875 = Hospital System Supply Identifier | 535089 = Lawson ID"}]},{"description":"IMP STEM FLUTI/B II 13X75MM EX","code_information":[{"code":"Sx00-5220-071","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202346","type":"LOCAL"},{"code":"452445","type":"LOCAL"}],"standard_charges":[{"gross_charge":1960.0,"discounted_cash":1470.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 202346 = Hospital System Supply Identifier | 452445 = Lawson ID"}]},{"description":"IMP KNEE ROD FLUT I/B 14X75","code_information":[{"code":"Sx00-5220-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321876","type":"LOCAL"},{"code":"535090","type":"LOCAL"}],"standard_charges":[{"gross_charge":1960.0,"discounted_cash":1470.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321876 = Hospital System Supply Identifier | 535090 = Lawson ID"}]},{"description":"IMP KNEE ROD FLUT I/B 15X75","code_information":[{"code":"Sx00-5220-073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321877","type":"LOCAL"},{"code":"535091","type":"LOCAL"}],"standard_charges":[{"gross_charge":1960.0,"discounted_cash":1470.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321877 = Hospital System Supply Identifier | 535091 = Lawson ID"}]},{"description":"IMP KNEE ROD FLUT I/B 16X75","code_information":[{"code":"Sx00-5220-074","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321878","type":"LOCAL"},{"code":"535092","type":"LOCAL"}],"standard_charges":[{"gross_charge":1960.0,"discounted_cash":1470.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321878 = Hospital System Supply Identifier | 535092 = Lawson ID"}]},{"description":"IMP KNEE ROD FLUT I/B 17X75","code_information":[{"code":"Sx00-5220-075","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321879","type":"LOCAL"},{"code":"535093","type":"LOCAL"}],"standard_charges":[{"gross_charge":1960.0,"discounted_cash":1470.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321879 = Hospital System Supply Identifier | 535093 = Lawson ID"}]},{"description":"IMP KNEE ROD FLUT I/B 18X75","code_information":[{"code":"Sx00-5220-076","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321880","type":"LOCAL"},{"code":"535094","type":"LOCAL"}],"standard_charges":[{"gross_charge":1960.0,"discounted_cash":1470.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321880 = Hospital System Supply Identifier | 535094 = Lawson ID"}]},{"description":"IMP KNEE ROD FLUT I/B 19X75","code_information":[{"code":"Sx00-5220-077","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321881","type":"LOCAL"},{"code":"535095","type":"LOCAL"}],"standard_charges":[{"gross_charge":1960.0,"discounted_cash":1470.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321881 = Hospital System Supply Identifier | 535095 = Lawson ID"}]},{"description":"IMP KNEE ROD FLUT I/B 20X75","code_information":[{"code":"Sx00-5220-078","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321882","type":"LOCAL"},{"code":"535096","type":"LOCAL"}],"standard_charges":[{"gross_charge":1960.0,"discounted_cash":1470.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321882 = Hospital System Supply Identifier | 535096 = Lawson ID"}]},{"description":"IMP KNEE ROD FLUT I/B 22X75","code_information":[{"code":"Sx00-5220-079","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321883","type":"LOCAL"},{"code":"535097","type":"LOCAL"}],"standard_charges":[{"gross_charge":1960.0,"discounted_cash":1470.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321883 = Hospital System Supply Identifier | 535097 = Lawson ID"}]},{"description":"IMP KNEE ROD FLUT I/B 24X75","code_information":[{"code":"Sx00-5220-080","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321884","type":"LOCAL"},{"code":"535098","type":"LOCAL"}],"standard_charges":[{"gross_charge":1960.0,"discounted_cash":1470.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321884 = Hospital System Supply Identifier | 535098 = Lawson ID"}]},{"description":"SCREW KNEE TIB WDG ATTCH I/B","code_information":[{"code":"Sx00-5220-090","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"321885","type":"LOCAL"},{"code":"535099","type":"LOCAL"}],"standard_charges":[{"gross_charge":535.01,"discounted_cash":401.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321885 = Hospital System Supply Identifier | 535099 = Lawson ID"}]},{"description":"PIN HEADLSS TIB WDG PRVSNL 48","code_information":[{"code":"Sx00-5222-039","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"329152","type":"LOCAL"},{"code":"258701","type":"LOCAL"}],"standard_charges":[{"gross_charge":221.5,"discounted_cash":166.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329152 = Hospital System Supply Identifier | 258701 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC I/B SZ54 25","code_information":[{"code":"Sx00-5224-031","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321890","type":"LOCAL"},{"code":"535104","type":"LOCAL"}],"standard_charges":[{"gross_charge":10549.44,"discounted_cash":7912.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321890 = Hospital System Supply Identifier | 535104 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC I/B SZ54 21","code_information":[{"code":"Sx00-5224-031","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321889","type":"LOCAL"},{"code":"535103","type":"LOCAL"}],"standard_charges":[{"gross_charge":10549.44,"discounted_cash":7912.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321889 = Hospital System Supply Identifier | 535103 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC I/B SZ54 18","code_information":[{"code":"Sx00-5224-031","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321888","type":"LOCAL"},{"code":"535102","type":"LOCAL"}],"standard_charges":[{"gross_charge":10549.44,"discounted_cash":7912.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321888 = Hospital System Supply Identifier | 535102 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC I/B SZ54 12","code_information":[{"code":"Sx00-5224-031","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321886","type":"LOCAL"},{"code":"535100","type":"LOCAL"}],"standard_charges":[{"gross_charge":10549.44,"discounted_cash":7912.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321886 = Hospital System Supply Identifier | 535100 = Lawson ID"}]},{"description":"IMP KNEE TIB 10X54MM","code_information":[{"code":"Sx00-5224-031","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"327174","type":"LOCAL"},{"code":"412368","type":"LOCAL"}],"standard_charges":[{"gross_charge":10549.44,"discounted_cash":7912.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 327174 = Hospital System Supply Identifier | 412368 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC I/B SZ54 15","code_information":[{"code":"Sx00-5224-031","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321887","type":"LOCAL"},{"code":"535101","type":"LOCAL"}],"standard_charges":[{"gross_charge":10549.44,"discounted_cash":7912.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321887 = Hospital System Supply Identifier | 535101 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC I/B SZ59 25","code_information":[{"code":"Sx00-5224-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321895","type":"LOCAL"},{"code":"535109","type":"LOCAL"}],"standard_charges":[{"gross_charge":10911.31,"discounted_cash":8183.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321895 = Hospital System Supply Identifier | 535109 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF I/B CCK 18","code_information":[{"code":"Sx00-5224-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202272","type":"LOCAL"},{"code":"452370","type":"LOCAL"}],"standard_charges":[{"gross_charge":10911.31,"discounted_cash":8183.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 202272 = Hospital System Supply Identifier | 452370 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC I/B SZ59 10","code_information":[{"code":"Sx00-5224-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321891","type":"LOCAL"},{"code":"535105","type":"LOCAL"}],"standard_charges":[{"gross_charge":10911.31,"discounted_cash":8183.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321891 = Hospital System Supply Identifier | 535105 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC I/B SZ59 12","code_information":[{"code":"Sx00-5224-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321892","type":"LOCAL"},{"code":"535106","type":"LOCAL"}],"standard_charges":[{"gross_charge":10911.31,"discounted_cash":8183.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321892 = Hospital System Supply Identifier | 535106 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC I/B SZ59 15","code_information":[{"code":"Sx00-5224-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321893","type":"LOCAL"},{"code":"535107","type":"LOCAL"}],"standard_charges":[{"gross_charge":10911.31,"discounted_cash":8183.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321893 = Hospital System Supply Identifier | 535107 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC I/B SZ59 21","code_information":[{"code":"Sx00-5224-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321894","type":"LOCAL"},{"code":"535108","type":"LOCAL"}],"standard_charges":[{"gross_charge":10911.31,"discounted_cash":8183.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321894 = Hospital System Supply Identifier | 535108 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC I/B SZ64 25","code_information":[{"code":"Sx00-5224-033","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321901","type":"LOCAL"},{"code":"535115","type":"LOCAL"}],"standard_charges":[{"gross_charge":10911.31,"discounted_cash":8183.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321901 = Hospital System Supply Identifier | 535115 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC I/B SZ64 21","code_information":[{"code":"Sx00-5224-033","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321900","type":"LOCAL"},{"code":"535114","type":"LOCAL"}],"standard_charges":[{"gross_charge":10911.31,"discounted_cash":8183.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321900 = Hospital System Supply Identifier | 535114 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC I/B SZ64 18","code_information":[{"code":"Sx00-5224-033","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321899","type":"LOCAL"},{"code":"535113","type":"LOCAL"}],"standard_charges":[{"gross_charge":10911.31,"discounted_cash":8183.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321899 = Hospital System Supply Identifier | 535113 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC I/B SZ64 12","code_information":[{"code":"Sx00-5224-033","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321897","type":"LOCAL"},{"code":"535111","type":"LOCAL"}],"standard_charges":[{"gross_charge":10911.31,"discounted_cash":8183.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321897 = Hospital System Supply Identifier | 535111 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC I/B SZ64 10","code_information":[{"code":"Sx00-5224-033","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321896","type":"LOCAL"},{"code":"535110","type":"LOCAL"}],"standard_charges":[{"gross_charge":10911.31,"discounted_cash":8183.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321896 = Hospital System Supply Identifier | 535110 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC I/B SZ64 15","code_information":[{"code":"Sx00-5224-033","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321898","type":"LOCAL"},{"code":"535112","type":"LOCAL"}],"standard_charges":[{"gross_charge":10911.31,"discounted_cash":8183.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321898 = Hospital System Supply Identifier | 535112 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC I/B SZ69 15","code_information":[{"code":"Sx00-5224-034","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321904","type":"LOCAL"},{"code":"535118","type":"LOCAL"}],"standard_charges":[{"gross_charge":10911.31,"discounted_cash":8183.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321904 = Hospital System Supply Identifier | 535118 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC I/B SZ69 12","code_information":[{"code":"Sx00-5224-034","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321903","type":"LOCAL"},{"code":"535117","type":"LOCAL"}],"standard_charges":[{"gross_charge":10911.31,"discounted_cash":8183.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321903 = Hospital System Supply Identifier | 535117 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC I/B SZ69 21","code_information":[{"code":"Sx00-5224-034","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321905","type":"LOCAL"},{"code":"535119","type":"LOCAL"}],"standard_charges":[{"gross_charge":10911.31,"discounted_cash":8183.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321905 = Hospital System Supply Identifier | 535119 = Lawson ID"}]},{"description":"IMP KNEE IB2 CCK TIB ARTICULAT","code_information":[{"code":"Sx00-5224-034","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"317026","type":"LOCAL"},{"code":"421540","type":"LOCAL"}],"standard_charges":[{"gross_charge":10911.31,"discounted_cash":8183.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 317026 = Hospital System Supply Identifier | 421540 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC I/B SZ69 10","code_information":[{"code":"Sx00-5224-034","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321902","type":"LOCAL"},{"code":"535116","type":"LOCAL"}],"standard_charges":[{"gross_charge":10911.31,"discounted_cash":8183.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321902 = Hospital System Supply Identifier | 535116 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC I/B SZ69 25","code_information":[{"code":"Sx00-5224-034","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321906","type":"LOCAL"},{"code":"535120","type":"LOCAL"}],"standard_charges":[{"gross_charge":10911.31,"discounted_cash":8183.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321906 = Hospital System Supply Identifier | 535120 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC I/B SZ74 21","code_information":[{"code":"Sx00-5224-035","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321911","type":"LOCAL"},{"code":"535125","type":"LOCAL"}],"standard_charges":[{"gross_charge":10549.44,"discounted_cash":7912.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321911 = Hospital System Supply Identifier | 535125 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC I/B SZ74 18","code_information":[{"code":"Sx00-5224-035","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321910","type":"LOCAL"},{"code":"535124","type":"LOCAL"}],"standard_charges":[{"gross_charge":10549.44,"discounted_cash":7912.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321910 = Hospital System Supply Identifier | 535124 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC I/B SZ74 25","code_information":[{"code":"Sx00-5224-035","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321912","type":"LOCAL"},{"code":"535126","type":"LOCAL"}],"standard_charges":[{"gross_charge":10549.44,"discounted_cash":7912.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321912 = Hospital System Supply Identifier | 535126 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC I/B SZ74 12","code_information":[{"code":"Sx00-5224-035","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321908","type":"LOCAL"},{"code":"535122","type":"LOCAL"}],"standard_charges":[{"gross_charge":10549.44,"discounted_cash":7912.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321908 = Hospital System Supply Identifier | 535122 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC I/B SZ74 15","code_information":[{"code":"Sx00-5224-035","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321909","type":"LOCAL"},{"code":"535123","type":"LOCAL"}],"standard_charges":[{"gross_charge":10549.44,"discounted_cash":7912.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321909 = Hospital System Supply Identifier | 535123 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC I/B SZ74 10","code_information":[{"code":"Sx00-5224-035","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321907","type":"LOCAL"},{"code":"535121","type":"LOCAL"}],"standard_charges":[{"gross_charge":10549.44,"discounted_cash":7912.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321907 = Hospital System Supply Identifier | 535121 = Lawson ID"}]},{"description":"IMP KNEE FEM STD 5X5X54MM","code_information":[{"code":"Sx00-5224-061","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"327191","type":"LOCAL"},{"code":"412508","type":"LOCAL"}],"standard_charges":[{"gross_charge":6569.06,"discounted_cash":4926.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 327191 = Hospital System Supply Identifier | 412508 = Lawson ID"}]},{"description":"IMP KNEE AUG DST/POST 54X5X5","code_information":[{"code":"Sx00-5224-061","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321913","type":"LOCAL"},{"code":"535127","type":"LOCAL"}],"standard_charges":[{"gross_charge":6569.06,"discounted_cash":4926.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321913 = Hospital System Supply Identifier | 535127 = Lawson ID"}]},{"description":"IMP KNEE FEM AUG DST 54X10","code_information":[{"code":"Sx00-5224-061","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321914","type":"LOCAL"},{"code":"535128","type":"LOCAL"}],"standard_charges":[{"gross_charge":6569.06,"discounted_cash":4926.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321914 = Hospital System Supply Identifier | 535128 = Lawson ID"}]},{"description":"IMP KNEE AUG DST/POST 54X10X5","code_information":[{"code":"Sx00-5224-061","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321915","type":"LOCAL"},{"code":"535129","type":"LOCAL"}],"standard_charges":[{"gross_charge":6569.06,"discounted_cash":4926.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321915 = Hospital System Supply Identifier | 535129 = Lawson ID"}]},{"description":"IMP KNEE FEM AUG DST 59X10","code_information":[{"code":"Sx00-5224-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321918","type":"LOCAL"},{"code":"535132","type":"LOCAL"}],"standard_charges":[{"gross_charge":6569.06,"discounted_cash":4926.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321918 = Hospital System Supply Identifier | 535132 = Lawson ID"}]},{"description":"IMP KNEE AUG DST/POST 59X10X5","code_information":[{"code":"Sx00-5224-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321919","type":"LOCAL"},{"code":"535133","type":"LOCAL"}],"standard_charges":[{"gross_charge":6569.06,"discounted_cash":4926.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321919 = Hospital System Supply Identifier | 535133 = Lawson ID"}]},{"description":"IMP KNEE FEM AUG DST 59X5","code_information":[{"code":"Sx00-5224-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321916","type":"LOCAL"},{"code":"535130","type":"LOCAL"}],"standard_charges":[{"gross_charge":6569.06,"discounted_cash":4926.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321916 = Hospital System Supply Identifier | 535130 = Lawson ID"}]},{"description":"IMP KNEE AUG DST/POST 59X5X5","code_information":[{"code":"Sx00-5224-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321917","type":"LOCAL"},{"code":"535131","type":"LOCAL"}],"standard_charges":[{"gross_charge":6569.06,"discounted_cash":4926.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321917 = Hospital System Supply Identifier | 535131 = Lawson ID"}]},{"description":"IMP KNEE FEM AUG DST 64X5","code_information":[{"code":"Sx00-5224-063","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321920","type":"LOCAL"},{"code":"535134","type":"LOCAL"}],"standard_charges":[{"gross_charge":6569.06,"discounted_cash":4926.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321920 = Hospital System Supply Identifier | 535134 = Lawson ID"}]},{"description":"IMP KNEE AUG DST/POST 64X5X5","code_information":[{"code":"Sx00-5224-063","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321921","type":"LOCAL"},{"code":"535135","type":"LOCAL"}],"standard_charges":[{"gross_charge":6569.06,"discounted_cash":4926.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321921 = Hospital System Supply Identifier | 535135 = Lawson ID"}]},{"description":"IMP KNEE FEM AUG DST 64X10","code_information":[{"code":"Sx00-5224-063","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321922","type":"LOCAL"},{"code":"535136","type":"LOCAL"}],"standard_charges":[{"gross_charge":6569.06,"discounted_cash":4926.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321922 = Hospital System Supply Identifier | 535136 = Lawson ID"}]},{"description":"IMP KNEE AUG DST/POST 64X10X5","code_information":[{"code":"Sx00-5224-063","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321923","type":"LOCAL"},{"code":"535137","type":"LOCAL"}],"standard_charges":[{"gross_charge":6569.06,"discounted_cash":4926.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321923 = Hospital System Supply Identifier | 535137 = Lawson ID"}]},{"description":"IMP KNEE AUG DST/POST 69X10X5","code_information":[{"code":"Sx00-5224-064","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321927","type":"LOCAL"},{"code":"535141","type":"LOCAL"}],"standard_charges":[{"gross_charge":6569.06,"discounted_cash":4926.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321927 = Hospital System Supply Identifier | 535141 = Lawson ID"}]},{"description":"IMP KNEE FEM AUG DST 69X5","code_information":[{"code":"Sx00-5224-064","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321924","type":"LOCAL"},{"code":"535138","type":"LOCAL"}],"standard_charges":[{"gross_charge":6569.06,"discounted_cash":4926.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321924 = Hospital System Supply Identifier | 535138 = Lawson ID"}]},{"description":"IMP KNEE AUG DST/POST 69X5X5","code_information":[{"code":"Sx00-5224-064","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321925","type":"LOCAL"},{"code":"535139","type":"LOCAL"}],"standard_charges":[{"gross_charge":6569.06,"discounted_cash":4926.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321925 = Hospital System Supply Identifier | 535139 = Lawson ID"}]},{"description":"IMP KNEE FEM AUG DST 69X10","code_information":[{"code":"Sx00-5224-064","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321926","type":"LOCAL"},{"code":"535140","type":"LOCAL"}],"standard_charges":[{"gross_charge":6569.06,"discounted_cash":4926.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321926 = Hospital System Supply Identifier | 535140 = Lawson ID"}]},{"description":"IMP KNEE FEM AUG DST 74X10","code_information":[{"code":"Sx00-5224-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321930","type":"LOCAL"},{"code":"535144","type":"LOCAL"}],"standard_charges":[{"gross_charge":6569.06,"discounted_cash":4926.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321930 = Hospital System Supply Identifier | 535144 = Lawson ID"}]},{"description":"IMP KNEE AUG DST/POST 74X10X5","code_information":[{"code":"Sx00-5224-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321931","type":"LOCAL"},{"code":"535145","type":"LOCAL"}],"standard_charges":[{"gross_charge":6569.06,"discounted_cash":4926.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321931 = Hospital System Supply Identifier | 535145 = Lawson ID"}]},{"description":"IMP KNEE FEM AUG DST 74X5","code_information":[{"code":"Sx00-5224-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321928","type":"LOCAL"},{"code":"535142","type":"LOCAL"}],"standard_charges":[{"gross_charge":6569.06,"discounted_cash":4926.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321928 = Hospital System Supply Identifier | 535142 = Lawson ID"}]},{"description":"IMP KNEE AUG DST/POST 74X5X5","code_information":[{"code":"Sx00-5224-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321929","type":"LOCAL"},{"code":"535143","type":"LOCAL"}],"standard_charges":[{"gross_charge":6569.06,"discounted_cash":4926.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321929 = Hospital System Supply Identifier | 535143 = Lawson ID"}]},{"description":"SCREW AUG BLCK DST I/B 5","code_information":[{"code":"Sx00-5224-090","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"321932","type":"LOCAL"},{"code":"535146","type":"LOCAL"}],"standard_charges":[{"gross_charge":460.88,"discounted_cash":345.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321932 = Hospital System Supply Identifier | 535146 = Lawson ID"}]},{"description":"SCREW AUG BLCK DST I/B 10","code_information":[{"code":"Sx00-5224-091","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"321933","type":"LOCAL"},{"code":"535147","type":"LOCAL"}],"standard_charges":[{"gross_charge":460.88,"discounted_cash":345.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321933 = Hospital System Supply Identifier | 535147 = Lawson ID"}]},{"description":"IMP FEM COMP GSM FLX SZ1 RT","code_information":[{"code":"Sx00-5410-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"166068","type":"LOCAL"},{"code":"388017","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 166068 = Hospital System Supply Identifier | 388017 = Lawson ID"}]},{"description":"IMP KNEE GSM NP FLEX FEM SIZE","code_information":[{"code":"Sx00-5410-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"439272","type":"LOCAL"},{"code":"446467","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 439272 = Hospital System Supply Identifier | 446467 = Lawson ID"}]},{"description":"COMPONENT FEMORAL SZ 2 RT","code_information":[{"code":"Sx00-5410-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"163708","type":"LOCAL"},{"code":"366329","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 163708 = Hospital System Supply Identifier | 366329 = Lawson ID"}]},{"description":"IMP KNEE FEM GSM NP FLX SZ2 LT","code_information":[{"code":"Sx00-5410-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"328260","type":"LOCAL"},{"code":"441601","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 328260 = Hospital System Supply Identifier | 441601 = Lawson ID"}]},{"description":"COMPONENT FEMORAL SZ 3 RT","code_information":[{"code":"Sx00-5410-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325891","type":"LOCAL"},{"code":"366326","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 325891 = Hospital System Supply Identifier | 366326 = Lawson ID"}]},{"description":"IMP KNEE FEM GSM NP FLX SZ3 LT","code_information":[{"code":"Sx00-5410-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"179011","type":"LOCAL"},{"code":"441602","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 179011 = Hospital System Supply Identifier | 441602 = Lawson ID"}]},{"description":"IMP KNEE FEM GSM NP FLX SZ4 RT","code_information":[{"code":"Sx00-5410-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"179012","type":"LOCAL"},{"code":"441604","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 179012 = Hospital System Supply Identifier | 441604 = Lawson ID"}]},{"description":"IMP KNEE FEM GSM NP FLX SZ4 LT","code_information":[{"code":"Sx00-5410-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"328261","type":"LOCAL"},{"code":"441603","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 328261 = Hospital System Supply Identifier | 441603 = Lawson ID"}]},{"description":"FEMUR GSM FLEX SZ 5 RT","code_information":[{"code":"Sx00-5410-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"166017","type":"LOCAL"},{"code":"386217","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 166017 = Hospital System Supply Identifier | 386217 = Lawson ID"}]},{"description":"IMP KNEE GSM NP FLEX FEM SIZE","code_information":[{"code":"Sx00-5410-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"179059","type":"LOCAL"},{"code":"446468","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 179059 = Hospital System Supply Identifier | 446468 = Lawson ID"}]},{"description":"IMP KNEE FEM GSM POR FLX 1-LT","code_information":[{"code":"Sx00-5412-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303238","type":"LOCAL"},{"code":"522195","type":"LOCAL"}],"standard_charges":[{"gross_charge":3808.75,"discounted_cash":2856.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303238 = Hospital System Supply Identifier | 522195 = Lawson ID"}]},{"description":"IMP KNEE FEM GSM POR FLX 1-RT","code_information":[{"code":"Sx00-5412-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303239","type":"LOCAL"},{"code":"522196","type":"LOCAL"}],"standard_charges":[{"gross_charge":3808.75,"discounted_cash":2856.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303239 = Hospital System Supply Identifier | 522196 = Lawson ID"}]},{"description":"IMP KNEE FEM GSM POR FLX 2-LT","code_information":[{"code":"Sx00-5412-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303240","type":"LOCAL"},{"code":"522197","type":"LOCAL"}],"standard_charges":[{"gross_charge":3808.75,"discounted_cash":2856.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303240 = Hospital System Supply Identifier | 522197 = Lawson ID"}]},{"description":"IMP KNEE FEM GSM POR FLX 2-RT","code_information":[{"code":"Sx00-5412-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303241","type":"LOCAL"},{"code":"522198","type":"LOCAL"}],"standard_charges":[{"gross_charge":3808.75,"discounted_cash":2856.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303241 = Hospital System Supply Identifier | 522198 = Lawson ID"}]},{"description":"IMP KNEE GSM POR FLEX FEM SIZE","code_information":[{"code":"Sx00-5412-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"662230","type":"LOCAL"},{"code":"446469","type":"LOCAL"}],"standard_charges":[{"gross_charge":3808.75,"discounted_cash":2856.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 662230 = Hospital System Supply Identifier | 446469 = Lawson ID"}]},{"description":"IMP KNEE FEM GSM POR FLX 3-RT","code_information":[{"code":"Sx00-5412-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303242","type":"LOCAL"},{"code":"522199","type":"LOCAL"}],"standard_charges":[{"gross_charge":3808.75,"discounted_cash":2856.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303242 = Hospital System Supply Identifier | 522199 = Lawson ID"}]},{"description":"IMP KNEE FEM GSM POR FLX 4-RT","code_information":[{"code":"Sx00-5412-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303243","type":"LOCAL"},{"code":"522200","type":"LOCAL"}],"standard_charges":[{"gross_charge":3808.75,"discounted_cash":2856.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303243 = Hospital System Supply Identifier | 522200 = Lawson ID"}]},{"description":"IMP KNEE GSM POR FLEX FEM SIZE","code_information":[{"code":"Sx00-5412-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"662231","type":"LOCAL"},{"code":"446470","type":"LOCAL"}],"standard_charges":[{"gross_charge":3808.75,"discounted_cash":2856.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 662231 = Hospital System Supply Identifier | 446470 = Lawson ID"}]},{"description":"IMP KNEE FEM GSM POR FLX 5-RT","code_information":[{"code":"Sx00-5412-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303245","type":"LOCAL"},{"code":"522202","type":"LOCAL"}],"standard_charges":[{"gross_charge":3808.75,"discounted_cash":2856.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303245 = Hospital System Supply Identifier | 522202 = Lawson ID"}]},{"description":"IMP KNEE FEM GSM POR FLX 5-LT","code_information":[{"code":"Sx00-5412-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303244","type":"LOCAL"},{"code":"522201","type":"LOCAL"}],"standard_charges":[{"gross_charge":3808.75,"discounted_cash":2856.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303244 = Hospital System Supply Identifier | 522201 = Lawson ID"}]},{"description":"FEMUR GFS FLEX SZ 0 LT","code_information":[{"code":"Sx00-5414-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"164491","type":"LOCAL"},{"code":"370023","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 164491 = Hospital System Supply Identifier | 370023 = Lawson ID"}]},{"description":"IMP KNEE FEM 0 RT","code_information":[{"code":"Sx00-5414-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"181656","type":"LOCAL"},{"code":"453455","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 181656 = Hospital System Supply Identifier | 453455 = Lawson ID"}]},{"description":"FEMORAL COMP GSF FLEX SZ 1 LT","code_information":[{"code":"Sx00-5414-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"164240","type":"LOCAL"},{"code":"369325","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 164240 = Hospital System Supply Identifier | 369325 = Lawson ID"}]},{"description":"FEMORAL COMP GSF FLEX SZ 1 RT","code_information":[{"code":"Sx00-5414-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"164483","type":"LOCAL"},{"code":"370011","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 164483 = Hospital System Supply Identifier | 370011 = Lawson ID"}]},{"description":"FEMUR GFS SZ 2 RT","code_information":[{"code":"Sx00-5414-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"165253","type":"LOCAL"},{"code":"374466","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 165253 = Hospital System Supply Identifier | 374466 = Lawson ID"}]},{"description":"IMP KNEE FEM GSF NP FLX SZ2 LT","code_information":[{"code":"Sx00-5414-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"328262","type":"LOCAL"},{"code":"441605","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 328262 = Hospital System Supply Identifier | 441605 = Lawson ID"}]},{"description":"COMPONENT GSF FEMORAL SZ 3","code_information":[{"code":"Sx00-5414-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"169985","type":"LOCAL"},{"code":"366331","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 169985 = Hospital System Supply Identifier | 366331 = Lawson ID"}]},{"description":"IMP GSF NP FLEX FEM SIZE 3 LEF","code_information":[{"code":"Sx00-5414-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"445181","type":"LOCAL"},{"code":"446473","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 445181 = Hospital System Supply Identifier | 446473 = Lawson ID"}]},{"description":"IMP KNEE GSF NP FLEX FEM SIZE","code_information":[{"code":"Sx00-5414-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"445182","type":"LOCAL"},{"code":"446474","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 445182 = Hospital System Supply Identifier | 446474 = Lawson ID"}]},{"description":"IMP KNEE FEM GSF NP FLX 4-LT","code_information":[{"code":"Sx00-5414-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303246","type":"LOCAL"},{"code":"522203","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303246 = Hospital System Supply Identifier | 522203 = Lawson ID"}]},{"description":"IMP KNEE FEM GSF POR FLX 0 RT","code_information":[{"code":"Sx00-5416-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"306351","type":"LOCAL"},{"code":"526193","type":"LOCAL"}],"standard_charges":[{"gross_charge":3808.75,"discounted_cash":2856.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 306351 = Hospital System Supply Identifier | 526193 = Lawson ID"}]},{"description":"IMP KNEE FEM GSF POR FLX 0 LT","code_information":[{"code":"Sx00-5416-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"306350","type":"LOCAL"},{"code":"526192","type":"LOCAL"}],"standard_charges":[{"gross_charge":3808.75,"discounted_cash":2856.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 306350 = Hospital System Supply Identifier | 526192 = Lawson ID"}]},{"description":"IMP KNEE FEM GSF POR FLX 1 LT","code_information":[{"code":"Sx00-5416-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"306352","type":"LOCAL"},{"code":"526194","type":"LOCAL"}],"standard_charges":[{"gross_charge":3808.75,"discounted_cash":2856.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 306352 = Hospital System Supply Identifier | 526194 = Lawson ID"}]},{"description":"IMP KNEE FEM GSF POR FLX 1 RT","code_information":[{"code":"Sx00-5416-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"306353","type":"LOCAL"},{"code":"526195","type":"LOCAL"}],"standard_charges":[{"gross_charge":3808.75,"discounted_cash":2856.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 306353 = Hospital System Supply Identifier | 526195 = Lawson ID"}]},{"description":"IMP KNEE GSF POR FLEX FEM SIZE","code_information":[{"code":"Sx00-5416-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"662233","type":"LOCAL"},{"code":"446475","type":"LOCAL"}],"standard_charges":[{"gross_charge":3808.75,"discounted_cash":2856.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 662233 = Hospital System Supply Identifier | 446475 = Lawson ID"}]},{"description":"IMP KNEE FEM GSF POR FLX 2 LT","code_information":[{"code":"Sx00-5416-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"306354","type":"LOCAL"},{"code":"526196","type":"LOCAL"}],"standard_charges":[{"gross_charge":3808.75,"discounted_cash":2856.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 306354 = Hospital System Supply Identifier | 526196 = Lawson ID"}]},{"description":"IMP KNEE FEM GSF POR FLX 2 RT","code_information":[{"code":"Sx00-5416-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"306355","type":"LOCAL"},{"code":"526197","type":"LOCAL"}],"standard_charges":[{"gross_charge":3808.75,"discounted_cash":2856.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 306355 = Hospital System Supply Identifier | 526197 = Lawson ID"}]},{"description":"IMP KNEE FEM GSF POR FLX 3 LT","code_information":[{"code":"Sx00-5416-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"306356","type":"LOCAL"},{"code":"526198","type":"LOCAL"}],"standard_charges":[{"gross_charge":3808.75,"discounted_cash":2856.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 306356 = Hospital System Supply Identifier | 526198 = Lawson ID"}]},{"description":"IMP KNEE FEM GSF POR FLX 3 RT","code_information":[{"code":"Sx00-5416-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"306357","type":"LOCAL"},{"code":"526199","type":"LOCAL"}],"standard_charges":[{"gross_charge":3808.75,"discounted_cash":2856.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 306357 = Hospital System Supply Identifier | 526199 = Lawson ID"}]},{"description":"IMP KNEE FEM GSF POR FLX 4 LT","code_information":[{"code":"Sx00-5416-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"306358","type":"LOCAL"},{"code":"526200","type":"LOCAL"}],"standard_charges":[{"gross_charge":3808.75,"discounted_cash":2856.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 306358 = Hospital System Supply Identifier | 526200 = Lawson ID"}]},{"description":"IMP KNEE PTELA FLX PLY SZ3 8","code_information":[{"code":"Sx00-5418-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303249","type":"LOCAL"},{"code":"522206","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303249 = Hospital System Supply Identifier | 522206 = Lawson ID"}]},{"description":"IMP KNEE PTELA FLX PLY SZ1 8","code_information":[{"code":"Sx00-5418-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303248","type":"LOCAL"},{"code":"522205","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303248 = Hospital System Supply Identifier | 522205 = Lawson ID"}]},{"description":"IMP KNEE PTLA FLX PLY SZ 2 8MM","code_information":[{"code":"Sx00-5418-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"179013","type":"LOCAL"},{"code":"441606","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 179013 = Hospital System Supply Identifier | 441606 = Lawson ID"}]},{"description":"IMP KNEE PTELA FLX PLY SZ0 8","code_information":[{"code":"Sx00-5418-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303247","type":"LOCAL"},{"code":"522204","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303247 = Hospital System Supply Identifier | 522204 = Lawson ID"}]},{"description":"IMP KNEE PTELA FLX PLY SZ0 10","code_information":[{"code":"Sx00-5418-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303250","type":"LOCAL"},{"code":"522207","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303250 = Hospital System Supply Identifier | 522207 = Lawson ID"}]},{"description":"IMP KNEE PTELA FLX PLY SZ1 10","code_information":[{"code":"Sx00-5418-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303251","type":"LOCAL"},{"code":"522208","type":"LOCAL"}],"standard_charges":[{"gross_charge":987.0,"discounted_cash":740.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303251 = Hospital System Supply Identifier | 522208 = Lawson ID"}]},{"description":"IMP KNEE PTELA FLX PLY SZ2 10","code_information":[{"code":"Sx00-5418-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303252","type":"LOCAL"},{"code":"522209","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303252 = Hospital System Supply Identifier | 522209 = Lawson ID"}]},{"description":"IMP KNEE PTELA FLX PLY SZ3 10","code_information":[{"code":"Sx00-5418-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303253","type":"LOCAL"},{"code":"522210","type":"LOCAL"}],"standard_charges":[{"gross_charge":987.0,"discounted_cash":740.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303253 = Hospital System Supply Identifier | 522210 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC SZ00/0LT 11","code_information":[{"code":"Sx00-5423-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303255","type":"LOCAL"},{"code":"522212","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303255 = Hospital System Supply Identifier | 522212 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC SZ00/0LT 13","code_information":[{"code":"Sx00-5424-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303257","type":"LOCAL"},{"code":"522214","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303257 = Hospital System Supply Identifier | 522214 = Lawson ID"}]},{"description":"IMP FLX PROLONG ART SURF SIZE","code_information":[{"code":"Sx00-5424-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"179060","type":"LOCAL"},{"code":"446479","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 179060 = Hospital System Supply Identifier | 446479 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC SZ00/0LT 11","code_information":[{"code":"Sx00-5424-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303256","type":"LOCAL"},{"code":"522213","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303256 = Hospital System Supply Identifier | 522213 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC SZ00/0LT 16","code_information":[{"code":"Sx00-5424-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303258","type":"LOCAL"},{"code":"522215","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303258 = Hospital System Supply Identifier | 522215 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC SZ00/0LT 19","code_information":[{"code":"Sx00-5424-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303259","type":"LOCAL"},{"code":"522216","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303259 = Hospital System Supply Identifier | 522216 = Lawson ID"}]},{"description":"IMP KNEE ARTC FLX PRO .5 LT 9","code_information":[{"code":"Sx00-5424-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"179014","type":"LOCAL"},{"code":"441610","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 179014 = Hospital System Supply Identifier | 441610 = Lawson ID"}]},{"description":"IMP KNEE ARTC FLX PRO .5 LT 11","code_information":[{"code":"Sx00-5424-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"328266","type":"LOCAL"},{"code":"441611","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 328266 = Hospital System Supply Identifier | 441611 = Lawson ID"}]},{"description":"IMP FLX PROLONG ART SURF SIZE","code_information":[{"code":"Sx00-5424-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"199186","type":"LOCAL"},{"code":"446480","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 199186 = Hospital System Supply Identifier | 446480 = Lawson ID"}]},{"description":"IMP FLX PROLONG ART SURF SIZE","code_information":[{"code":"Sx00-5424-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"439273","type":"LOCAL"},{"code":"446481","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 439273 = Hospital System Supply Identifier | 446481 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC SZ1/2LT 19","code_information":[{"code":"Sx00-5424-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303260","type":"LOCAL"},{"code":"522217","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303260 = Hospital System Supply Identifier | 522217 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC S3/4/5LT 19","code_information":[{"code":"Sx00-5424-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303261","type":"LOCAL"},{"code":"522218","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303261 = Hospital System Supply Identifier | 522218 = Lawson ID"}]},{"description":"IMP FLX PRLONG ART SURFACE SIZ","code_information":[{"code":"Sx00-5424-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"662234","type":"LOCAL"},{"code":"446484","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 662234 = Hospital System Supply Identifier | 446484 = Lawson ID"}]},{"description":"IMP FLX PRLONG ART SURFACE SZE","code_information":[{"code":"Sx00-5424-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"179061","type":"LOCAL"},{"code":"446482","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 179061 = Hospital System Supply Identifier | 446482 = Lawson ID"}]},{"description":"IMP KNEE ARTC FLX PRO 345 LT13","code_information":[{"code":"Sx00-5424-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"328267","type":"LOCAL"},{"code":"441612","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 328267 = Hospital System Supply Identifier | 441612 = Lawson ID"}]},{"description":"IMP FLX PRLONG ART SURF SIZE 3","code_information":[{"code":"Sx00-5424-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"179062","type":"LOCAL"},{"code":"446483","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 179062 = Hospital System Supply Identifier | 446483 = Lawson ID"}]},{"description":"IMP FLX PRLONG CONG ART SURF S","code_information":[{"code":"Sx00-5424-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"662235","type":"LOCAL"},{"code":"446485","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 662235 = Hospital System Supply Identifier | 446485 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC SZ00/0-RT9","code_information":[{"code":"Sx00-5424-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303262","type":"LOCAL"},{"code":"522219","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303262 = Hospital System Supply Identifier | 522219 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC SZ00/0-RT13","code_information":[{"code":"Sx00-5424-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303263","type":"LOCAL"},{"code":"522220","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303263 = Hospital System Supply Identifier | 522220 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC SZ00/0-RT16","code_information":[{"code":"Sx00-5424-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303264","type":"LOCAL"},{"code":"522221","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303264 = Hospital System Supply Identifier | 522221 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC SZ00/0-RT19","code_information":[{"code":"Sx00-5424-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303265","type":"LOCAL"},{"code":"522222","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303265 = Hospital System Supply Identifier | 522222 = Lawson ID"}]},{"description":"IMP FLX PRLONG CONG ART SURF S","code_information":[{"code":"Sx00-5424-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"179063","type":"LOCAL"},{"code":"446487","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 179063 = Hospital System Supply Identifier | 446487 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC SZ1/2-RT19","code_information":[{"code":"Sx00-5424-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303266","type":"LOCAL"},{"code":"522223","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303266 = Hospital System Supply Identifier | 522223 = Lawson ID"}]},{"description":"IMP FLX PRLONG CONG ART SURF S","code_information":[{"code":"Sx00-5424-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"406895","type":"LOCAL"},{"code":"446486","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 406895 = Hospital System Supply Identifier | 446486 = Lawson ID"}]},{"description":"SURFACE ARTICULAR SZ 1.2 9MM","code_information":[{"code":"Sx00-5424-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"178547","type":"LOCAL"},{"code":"366333","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 178547 = Hospital System Supply Identifier | 366333 = Lawson ID"}]},{"description":"SURFACE ARTICULAR SZ 1.2 RT","code_information":[{"code":"Sx00-5424-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"178546","type":"LOCAL"},{"code":"366330","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 178546 = Hospital System Supply Identifier | 366330 = Lawson ID"}]},{"description":"IMP KNEE ARTC FLX PL 345 RT 9","code_information":[{"code":"Sx00-5424-023","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"179015","type":"LOCAL"},{"code":"441613","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 179015 = Hospital System Supply Identifier | 441613 = Lawson ID"}]},{"description":"IMP FLX PRLONG CONG ART SURF S","code_information":[{"code":"Sx00-5424-023","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"363159","type":"LOCAL"},{"code":"446488","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 363159 = Hospital System Supply Identifier | 446488 = Lawson ID"}]},{"description":"IMP FLX PRLONG CONG ART SURF S","code_information":[{"code":"Sx00-5424-023","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"179064","type":"LOCAL"},{"code":"446489","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 179064 = Hospital System Supply Identifier | 446489 = Lawson ID"}]},{"description":"IMP FLX PRLONG CONG ART SURF S","code_information":[{"code":"Sx00-5424-023","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"476864","type":"LOCAL"},{"code":"446490","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 476864 = Hospital System Supply Identifier | 446490 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTCSZ3/4/5-RT19","code_information":[{"code":"Sx00-5424-023","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303267","type":"LOCAL"},{"code":"522224","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303267 = Hospital System Supply Identifier | 522224 = Lawson ID"}]},{"description":"INSERT ARTICULAR 1-2 9MM CONGRUENT UHMWPE KNEE TIBIA RIGHT NATURAL-KNEE II","code_information":[{"code":"Sx00-5425-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1097416","type":"LOCAL"},{"code":"S652293","type":"LOCAL"}],"standard_charges":[{"gross_charge":584.53,"discounted_cash":438.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1097416 = Hospital System Supply Identifier | S652293 = Lawson ID"}]},{"description":"INSERT ARTICULAR 1-2 11MM CONGRUENT UHMWPE KNEE TIBIA RIGHT NATURAL-KNEE II","code_information":[{"code":"Sx00-5425-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1097415","type":"LOCAL"},{"code":"S652294","type":"LOCAL"}],"standard_charges":[{"gross_charge":584.53,"discounted_cash":438.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1097415 = Hospital System Supply Identifier | S652294 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC SZ00/0-LT11","code_information":[{"code":"Sx00-5428-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303268","type":"LOCAL"},{"code":"522225","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303268 = Hospital System Supply Identifier | 522225 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC SZ00/0-LT19","code_information":[{"code":"Sx00-5428-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303271","type":"LOCAL"},{"code":"522228","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303271 = Hospital System Supply Identifier | 522228 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC SZ00/0-LT16","code_information":[{"code":"Sx00-5428-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303270","type":"LOCAL"},{"code":"522227","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303270 = Hospital System Supply Identifier | 522227 = Lawson ID"}]},{"description":"INSERT PROLONG ULTRA 9MM","code_information":[{"code":"Sx00-5428-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"164493","type":"LOCAL"},{"code":"370025","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 164493 = Hospital System Supply Identifier | 370025 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC SZ00/0-LT13","code_information":[{"code":"Sx00-5428-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303269","type":"LOCAL"},{"code":"522226","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303269 = Hospital System Supply Identifier | 522226 = Lawson ID"}]},{"description":"INSERT TIB FLEX SZ1-2 9MM LT","code_information":[{"code":"Sx00-5428-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"164241","type":"LOCAL"},{"code":"369326","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 164241 = Hospital System Supply Identifier | 369326 = Lawson ID"}]},{"description":"IMP KNEE ARTC FLX PL 12 LT 11","code_information":[{"code":"Sx00-5428-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"328268","type":"LOCAL"},{"code":"441614","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 328268 = Hospital System Supply Identifier | 441614 = Lawson ID"}]},{"description":"IMP KNEE GSF NP FLEX FEM SIZE","code_information":[{"code":"Sx00-5428-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"445183","type":"LOCAL"},{"code":"446493","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 445183 = Hospital System Supply Identifier | 446493 = Lawson ID"}]},{"description":"IMP KNEE FLX PROLONG UL CONG A","code_information":[{"code":"Sx00-5428-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"662236","type":"LOCAL"},{"code":"446494","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 662236 = Hospital System Supply Identifier | 446494 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC SZ1/2-LT16","code_information":[{"code":"Sx00-5428-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303272","type":"LOCAL"},{"code":"522229","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303272 = Hospital System Supply Identifier | 522229 = Lawson ID"}]},{"description":"IMP KNEE ARTC FLX PL 345 LT 9","code_information":[{"code":"Sx00-5428-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"179016","type":"LOCAL"},{"code":"441615","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 179016 = Hospital System Supply Identifier | 441615 = Lawson ID"}]},{"description":"IMP KNEE PRLONG UL CONG ART SU","code_information":[{"code":"Sx00-5428-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"662237","type":"LOCAL"},{"code":"446495","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 662237 = Hospital System Supply Identifier | 446495 = Lawson ID"}]},{"description":"IMP KNEE PRLONG UL CONG ART SU","code_information":[{"code":"Sx00-5428-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"662238","type":"LOCAL"},{"code":"446496","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 662238 = Hospital System Supply Identifier | 446496 = Lawson ID"}]},{"description":"IMP FLX PRLONG UL CONG ART SUR","code_information":[{"code":"Sx00-5428-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"662239","type":"LOCAL"},{"code":"446497","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 662239 = Hospital System Supply Identifier | 446497 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTCSZ3/4/5-LT16","code_information":[{"code":"Sx00-5428-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303273","type":"LOCAL"},{"code":"522230","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303273 = Hospital System Supply Identifier | 522230 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC SZ00/0-RT16","code_information":[{"code":"Sx00-5428-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303276","type":"LOCAL"},{"code":"522233","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303276 = Hospital System Supply Identifier | 522233 = Lawson ID"}]},{"description":"INSERT PROLONG ULTRA 11MM","code_information":[{"code":"Sx00-5428-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"164484","type":"LOCAL"},{"code":"370012","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 164484 = Hospital System Supply Identifier | 370012 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC SZ00/0-RT9","code_information":[{"code":"Sx00-5428-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303274","type":"LOCAL"},{"code":"522231","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303274 = Hospital System Supply Identifier | 522231 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC SZ00/0-RT13","code_information":[{"code":"Sx00-5428-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303275","type":"LOCAL"},{"code":"522232","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303275 = Hospital System Supply Identifier | 522232 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC SZ00/0-RT19","code_information":[{"code":"Sx00-5428-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303277","type":"LOCAL"},{"code":"522234","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303277 = Hospital System Supply Identifier | 522234 = Lawson ID"}]},{"description":"IMPFLX PRLONG UL CONG ART SURF","code_information":[{"code":"Sx00-5428-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"662240","type":"LOCAL"},{"code":"446498","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 662240 = Hospital System Supply Identifier | 446498 = Lawson ID"}]},{"description":"IMP FLX PRLONG UL CONG ART SUR","code_information":[{"code":"Sx00-5428-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"662242","type":"LOCAL"},{"code":"446501","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 662242 = Hospital System Supply Identifier | 446501 = Lawson ID"}]},{"description":"IMP FLX PRLONG UL CONG ART SUR","code_information":[{"code":"Sx00-5428-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"662241","type":"LOCAL"},{"code":"446500","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 662241 = Hospital System Supply Identifier | 446500 = Lawson ID"}]},{"description":"IMP KNEE ARTC FLX PL 12 RT 9MM","code_information":[{"code":"Sx00-5428-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"328269","type":"LOCAL"},{"code":"441616","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 328269 = Hospital System Supply Identifier | 441616 = Lawson ID"}]},{"description":"IMP FLX PRLONG UL CONG ART SUR","code_information":[{"code":"Sx00-5428-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"179065","type":"LOCAL"},{"code":"446499","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 179065 = Hospital System Supply Identifier | 446499 = Lawson ID"}]},{"description":"SURFACE ARTICULAR SZ 3/4/5","code_information":[{"code":"Sx00-5428-023","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"169984","type":"LOCAL"},{"code":"366327","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 169984 = Hospital System Supply Identifier | 366327 = Lawson ID"}]},{"description":"SURFACE ARTICULAR SZ 3/4/5 RT","code_information":[{"code":"Sx00-5428-023","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325892","type":"LOCAL"},{"code":"366368","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 325892 = Hospital System Supply Identifier | 366368 = Lawson ID"}]},{"description":"IMP FLX PRLONG UL CONG ART SUR","code_information":[{"code":"Sx00-5428-023","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"662243","type":"LOCAL"},{"code":"446503","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 662243 = Hospital System Supply Identifier | 446503 = Lawson ID"}]},{"description":"IMP FLX PRLNG UL CONG ART SURF","code_information":[{"code":"Sx00-5428-023","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"662244","type":"LOCAL"},{"code":"446504","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 662244 = Hospital System Supply Identifier | 446504 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTCSZ3/4/5-RT19","code_information":[{"code":"Sx00-5428-023","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303278","type":"LOCAL"},{"code":"522235","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303278 = Hospital System Supply Identifier | 522235 = Lawson ID"}]},{"description":"IMP KNEE FEM CONE TRAB LT 40MM","code_information":[{"code":"Sx00-5450-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202225","type":"LOCAL"},{"code":"452323","type":"LOCAL"}],"standard_charges":[{"gross_charge":11197.12,"discounted_cash":8397.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 202225 = Hospital System Supply Identifier | 452323 = Lawson ID"}]},{"description":"IMP FEM CONE AUG SM LT 30","code_information":[{"code":"Sx00-5450-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322570","type":"LOCAL"},{"code":"535784","type":"LOCAL"}],"standard_charges":[{"gross_charge":11197.12,"discounted_cash":8397.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322570 = Hospital System Supply Identifier | 535784 = Lawson ID"}]},{"description":"IMP FEM CONE AUG SM RT 30","code_information":[{"code":"Sx00-5450-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322571","type":"LOCAL"},{"code":"535785","type":"LOCAL"}],"standard_charges":[{"gross_charge":11197.12,"discounted_cash":8397.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322571 = Hospital System Supply Identifier | 535785 = Lawson ID"}]},{"description":"IMP FEM CONE AUG SM RT 40","code_information":[{"code":"Sx00-5450-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322572","type":"LOCAL"},{"code":"535786","type":"LOCAL"}],"standard_charges":[{"gross_charge":11197.12,"discounted_cash":8397.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322572 = Hospital System Supply Identifier | 535786 = Lawson ID"}]},{"description":"IMP KNEE TIB CONE LG 55X36 RT","code_information":[{"code":"Sx00-5450-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322575","type":"LOCAL"},{"code":"535789","type":"LOCAL"}],"standard_charges":[{"gross_charge":8130.0,"discounted_cash":6097.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322575 = Hospital System Supply Identifier | 535789 = Lawson ID"}]},{"description":"IMP KNEE TIB CONE LG 67X38 RT","code_information":[{"code":"Sx00-5450-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322579","type":"LOCAL"},{"code":"535793","type":"LOCAL"}],"standard_charges":[{"gross_charge":8130.0,"discounted_cash":6097.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322579 = Hospital System Supply Identifier | 535793 = Lawson ID"}]},{"description":"IMP KNEE TIB CONE LG 67X38 LT","code_information":[{"code":"Sx00-5450-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322578","type":"LOCAL"},{"code":"535792","type":"LOCAL"}],"standard_charges":[{"gross_charge":8130.0,"discounted_cash":6097.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322578 = Hospital System Supply Identifier | 535792 = Lawson ID"}]},{"description":"IMP KNEE TIB CONE LG 60X36 RT","code_information":[{"code":"Sx00-5450-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322577","type":"LOCAL"},{"code":"535791","type":"LOCAL"}],"standard_charges":[{"gross_charge":8130.0,"discounted_cash":6097.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322577 = Hospital System Supply Identifier | 535791 = Lawson ID"}]},{"description":"IMP KNEE TIB CONE LG 60X36 LT","code_information":[{"code":"Sx00-5450-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322576","type":"LOCAL"},{"code":"535790","type":"LOCAL"}],"standard_charges":[{"gross_charge":8130.0,"discounted_cash":6097.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322576 = Hospital System Supply Identifier | 535790 = Lawson ID"}]},{"description":"IMP TIB CONE LG TM LT 55X36MM","code_information":[{"code":"Sx00-5450-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202226","type":"LOCAL"},{"code":"452324","type":"LOCAL"}],"standard_charges":[{"gross_charge":8130.0,"discounted_cash":6097.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 202226 = Hospital System Supply Identifier | 452324 = Lawson ID"}]},{"description":"IMP KNEE TIB CONE TM MED 41X34","code_information":[{"code":"Sx00-5450-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"327808","type":"LOCAL"},{"code":"427247","type":"LOCAL"}],"standard_charges":[{"gross_charge":8130.0,"discounted_cash":6097.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 327808 = Hospital System Supply Identifier | 427247 = Lawson ID"}]},{"description":"IMP KNEE CONE LG RT 51X34X25MM","code_information":[{"code":"Sx00-5450-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"327791","type":"LOCAL"},{"code":"425965","type":"LOCAL"}],"standard_charges":[{"gross_charge":8130.0,"discounted_cash":6097.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 327791 = Hospital System Supply Identifier | 425965 = Lawson ID"}]},{"description":"KNEE CONE TIBIAL LARGE LEFT 51","code_information":[{"code":"Sx00-5450-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"196905","type":"LOCAL"},{"code":"425149","type":"LOCAL"}],"standard_charges":[{"gross_charge":8130.0,"discounted_cash":6097.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 196905 = Hospital System Supply Identifier | 425149 = Lawson ID"}]},{"description":"IMP KNEE TIB MED 35X31MM","code_information":[{"code":"Sx00-5450-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"330203","type":"LOCAL"},{"code":"421386","type":"LOCAL"}],"standard_charges":[{"gross_charge":8130.0,"discounted_cash":6097.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 330203 = Hospital System Supply Identifier | 421386 = Lawson ID"}]},{"description":"IMP KNEE TIB CONE TM MED 31X31","code_information":[{"code":"Sx00-5450-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326294","type":"LOCAL"},{"code":"395480","type":"LOCAL"}],"standard_charges":[{"gross_charge":8130.0,"discounted_cash":6097.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 326294 = Hospital System Supply Identifier | 395480 = Lawson ID"}]},{"description":"IMP TIB CONE MED TM 46X34MM","code_information":[{"code":"Sx00-5450-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"199311","type":"LOCAL"},{"code":"446832","type":"LOCAL"}],"standard_charges":[{"gross_charge":8130.0,"discounted_cash":6097.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 199311 = Hospital System Supply Identifier | 446832 = Lawson ID"}]},{"description":"IMP FEM CONE AUG MED LT 40","code_information":[{"code":"Sx00-5450-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322582","type":"LOCAL"},{"code":"535796","type":"LOCAL"}],"standard_charges":[{"gross_charge":11197.12,"discounted_cash":8397.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322582 = Hospital System Supply Identifier | 535796 = Lawson ID"}]},{"description":"IMP FEM CONE AUG MED LT 30","code_information":[{"code":"Sx00-5450-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322580","type":"LOCAL"},{"code":"535794","type":"LOCAL"}],"standard_charges":[{"gross_charge":11197.12,"discounted_cash":8397.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322580 = Hospital System Supply Identifier | 535794 = Lawson ID"}]},{"description":"IMP FEM CONE AUG MED RT 30","code_information":[{"code":"Sx00-5450-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322581","type":"LOCAL"},{"code":"535795","type":"LOCAL"}],"standard_charges":[{"gross_charge":11197.12,"discounted_cash":8397.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322581 = Hospital System Supply Identifier | 535795 = Lawson ID"}]},{"description":"IMP FEM CONE AUG MED RT 40","code_information":[{"code":"Sx00-5450-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322583","type":"LOCAL"},{"code":"535797","type":"LOCAL"}],"standard_charges":[{"gross_charge":11197.12,"discounted_cash":8397.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322583 = Hospital System Supply Identifier | 535797 = Lawson ID"}]},{"description":"IMP FEM CONE AUG LARGE LT 30","code_information":[{"code":"Sx00-5450-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322586","type":"LOCAL"},{"code":"535800","type":"LOCAL"}],"standard_charges":[{"gross_charge":11197.12,"discounted_cash":8397.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322586 = Hospital System Supply Identifier | 535800 = Lawson ID"}]},{"description":"IMP FEM CONE AUG LARGE RT 30","code_information":[{"code":"Sx00-5450-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322587","type":"LOCAL"},{"code":"535801","type":"LOCAL"}],"standard_charges":[{"gross_charge":11197.12,"discounted_cash":8397.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322587 = Hospital System Supply Identifier | 535801 = Lawson ID"}]},{"description":"IMP FEM CONE AUG LARGE LT 40","code_information":[{"code":"Sx00-5450-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322588","type":"LOCAL"},{"code":"535802","type":"LOCAL"}],"standard_charges":[{"gross_charge":11197.12,"discounted_cash":8397.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322588 = Hospital System Supply Identifier | 535802 = Lawson ID"}]},{"description":"IMP FEM CONE AUG LARGE RT 40","code_information":[{"code":"Sx00-5450-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322589","type":"LOCAL"},{"code":"535803","type":"LOCAL"}],"standard_charges":[{"gross_charge":11197.12,"discounted_cash":8397.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322589 = Hospital System Supply Identifier | 535803 = Lawson ID"}]},{"description":"TM FEM DIAPHYSEAL CONE 30 SMAL","code_information":[{"code":"Sx00-5450-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"662245","type":"LOCAL"},{"code":"446507","type":"LOCAL"}],"standard_charges":[{"gross_charge":8130.0,"discounted_cash":6097.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 662245 = Hospital System Supply Identifier | 446507 = Lawson ID"}]},{"description":"TM FEM DPHSEAL CONE 30MM SM","code_information":[{"code":"Sx00-5450-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"662246","type":"LOCAL"},{"code":"446508","type":"LOCAL"}],"standard_charges":[{"gross_charge":8130.0,"discounted_cash":6097.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 662246 = Hospital System Supply Identifier | 446508 = Lawson ID"}]},{"description":"IMP FEM CONE DPHSEAL MED LT 30","code_information":[{"code":"Sx00-5450-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322592","type":"LOCAL"},{"code":"535806","type":"LOCAL"}],"standard_charges":[{"gross_charge":8130.0,"discounted_cash":6097.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322592 = Hospital System Supply Identifier | 535806 = Lawson ID"}]},{"description":"IMP FEM CONE DPHSEAL MED RT 30","code_information":[{"code":"Sx00-5450-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322593","type":"LOCAL"},{"code":"535807","type":"LOCAL"}],"standard_charges":[{"gross_charge":8130.0,"discounted_cash":6097.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322593 = Hospital System Supply Identifier | 535807 = Lawson ID"}]},{"description":"IMP FEM CONE LG TM LT 30MM","code_information":[{"code":"Sx00-5450-019","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202222","type":"LOCAL"},{"code":"452320","type":"LOCAL"}],"standard_charges":[{"gross_charge":8130.0,"discounted_cash":6097.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 202222 = Hospital System Supply Identifier | 452320 = Lawson ID"}]},{"description":"IMP FEM CONE DPHSEAL LG RT 30","code_information":[{"code":"Sx00-5450-019","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322594","type":"LOCAL"},{"code":"535808","type":"LOCAL"}],"standard_charges":[{"gross_charge":8130.0,"discounted_cash":6097.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322594 = Hospital System Supply Identifier | 535808 = Lawson ID"}]},{"description":"IMP FEM CONE MTPHSEAL SM RT 35","code_information":[{"code":"Sx00-5450-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322596","type":"LOCAL"},{"code":"535810","type":"LOCAL"}],"standard_charges":[{"gross_charge":8130.0,"discounted_cash":6097.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322596 = Hospital System Supply Identifier | 535810 = Lawson ID"}]},{"description":"IMP FEM CONE MTPHSEAL SM LT 35","code_information":[{"code":"Sx00-5450-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322595","type":"LOCAL"},{"code":"535809","type":"LOCAL"}],"standard_charges":[{"gross_charge":8130.0,"discounted_cash":6097.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322595 = Hospital System Supply Identifier | 535809 = Lawson ID"}]},{"description":"IMP FEM CONE MTPHSEAL MD RT 35","code_information":[{"code":"Sx00-5450-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322598","type":"LOCAL"},{"code":"535812","type":"LOCAL"}],"standard_charges":[{"gross_charge":8130.0,"discounted_cash":6097.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322598 = Hospital System Supply Identifier | 535812 = Lawson ID"}]},{"description":"IMP FEM CONE MTPHSEAL MD LT 35","code_information":[{"code":"Sx00-5450-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322597","type":"LOCAL"},{"code":"535811","type":"LOCAL"}],"standard_charges":[{"gross_charge":8130.0,"discounted_cash":6097.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322597 = Hospital System Supply Identifier | 535811 = Lawson ID"}]},{"description":"IMP FEM CONE LG TM LT 35MM","code_information":[{"code":"Sx00-5450-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202223","type":"LOCAL"},{"code":"452321","type":"LOCAL"}],"standard_charges":[{"gross_charge":8130.0,"discounted_cash":6097.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 202223 = Hospital System Supply Identifier | 452321 = Lawson ID"}]},{"description":"IMP FEM CONE LG TM RT 35MM","code_information":[{"code":"Sx00-5450-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202224","type":"LOCAL"},{"code":"452322","type":"LOCAL"}],"standard_charges":[{"gross_charge":8130.0,"discounted_cash":6097.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 202224 = Hospital System Supply Identifier | 452322 = Lawson ID"}]},{"description":"IMP TIB CONE FULL XSM SZ48-15","code_information":[{"code":"Sx00-5450-048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322599","type":"LOCAL"},{"code":"535813","type":"LOCAL"}],"standard_charges":[{"gross_charge":8130.0,"discounted_cash":6097.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322599 = Hospital System Supply Identifier | 535813 = Lawson ID"}]},{"description":"IMP TIB CONE FULL SM SZ52-15","code_information":[{"code":"Sx00-5450-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322600","type":"LOCAL"},{"code":"535814","type":"LOCAL"}],"standard_charges":[{"gross_charge":8130.0,"discounted_cash":6097.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322600 = Hospital System Supply Identifier | 535814 = Lawson ID"}]},{"description":"IMP TIB CONE STD SZ59 30MM MED","code_information":[{"code":"Sx00-5450-059","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329610","type":"LOCAL"},{"code":"353708","type":"LOCAL"}],"standard_charges":[{"gross_charge":8130.0,"discounted_cash":6097.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329610 = Hospital System Supply Identifier | 353708 = Lawson ID"}]},{"description":"IMP TIB CONE FULL MED SZ59-30","code_information":[{"code":"Sx00-5450-059","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322601","type":"LOCAL"},{"code":"535815","type":"LOCAL"}],"standard_charges":[{"gross_charge":10072.35,"discounted_cash":7554.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322601 = Hospital System Supply Identifier | 535815 = Lawson ID"}]},{"description":"IMP TIB CONE SZ59 STP 30/15 LT","code_information":[{"code":"Sx00-5450-059","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322602","type":"LOCAL"},{"code":"535816","type":"LOCAL"}],"standard_charges":[{"gross_charge":8130.0,"discounted_cash":6097.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322602 = Hospital System Supply Identifier | 535816 = Lawson ID"}]},{"description":"IMP TIB CONE SZ59 STP 15/30 RT","code_information":[{"code":"Sx00-5450-059","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322603","type":"LOCAL"},{"code":"535817","type":"LOCAL"}],"standard_charges":[{"gross_charge":8130.0,"discounted_cash":6097.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322603 = Hospital System Supply Identifier | 535817 = Lawson ID"}]},{"description":"IMP TIB CONE SZ67 STP 15/30 LT","code_information":[{"code":"Sx00-5450-067","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322606","type":"LOCAL"},{"code":"535820","type":"LOCAL"}],"standard_charges":[{"gross_charge":8130.0,"discounted_cash":6097.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322606 = Hospital System Supply Identifier | 535820 = Lawson ID"}]},{"description":"IMP TIB CONE SZ67 STP 30/15 LT","code_information":[{"code":"Sx00-5450-067","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322605","type":"LOCAL"},{"code":"535819","type":"LOCAL"}],"standard_charges":[{"gross_charge":8130.0,"discounted_cash":6097.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322605 = Hospital System Supply Identifier | 535819 = Lawson ID"}]},{"description":"IMP KNEE TIB CONE TRAB SZ67 15","code_information":[{"code":"Sx00-5450-067","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202227","type":"LOCAL"},{"code":"452325","type":"LOCAL"}],"standard_charges":[{"gross_charge":8130.0,"discounted_cash":6097.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 202227 = Hospital System Supply Identifier | 452325 = Lawson ID"}]},{"description":"IMP TIB CONE FULL LG SZ67-30","code_information":[{"code":"Sx00-5450-067","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322604","type":"LOCAL"},{"code":"535818","type":"LOCAL"}],"standard_charges":[{"gross_charge":10072.35,"discounted_cash":7554.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322604 = Hospital System Supply Identifier | 535818 = Lawson ID"}]},{"description":"BUR TIB CONE LG","code_information":[{"code":"Sx00-5452-013","type":"CDM"},{"code":"272","type":"RC"},{"code":"199607","type":"LOCAL"},{"code":"447589","type":"LOCAL"}],"standard_charges":[{"gross_charge":832.02,"discounted_cash":624.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 199607 = Hospital System Supply Identifier | 447589 = Lawson ID"}]},{"description":"PLATE EXTERNAL FIXATION BURR TEMPLATE","code_information":[{"code":"Sx00-5452-013","type":"CDM"},{"code":"272","type":"RC"},{"code":"1100355","type":"LOCAL"},{"code":"S657300","type":"LOCAL"}],"standard_charges":[{"gross_charge":2870.35,"discounted_cash":2152.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1100355 = Hospital System Supply Identifier | S657300 = Lawson ID"}]},{"description":"ALGRFT CARTLG NAT TISS DENOVO","code_information":[{"code":"Sx00-5606-000","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1762","type":"HCPCS"},{"code":"455483","type":"LOCAL"},{"code":"453691","type":"LOCAL"}],"standard_charges":[{"gross_charge":12562.3,"discounted_cash":9421.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 455483 = Hospital System Supply Identifier | 453691 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZC","code_information":[{"code":"Sx00-5750-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325561","type":"LOCAL"},{"code":"354410","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 325561 = Hospital System Supply Identifier | 354410 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZC","code_information":[{"code":"Sx00-5750-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325562","type":"LOCAL"},{"code":"354411","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 325562 = Hospital System Supply Identifier | 354411 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZC","code_information":[{"code":"Sx00-5750-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325564","type":"LOCAL"},{"code":"354414","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 325564 = Hospital System Supply Identifier | 354414 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZC","code_information":[{"code":"Sx00-5750-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325565","type":"LOCAL"},{"code":"354416","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 325565 = Hospital System Supply Identifier | 354416 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZD","code_information":[{"code":"Sx00-5750-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325465","type":"LOCAL"},{"code":"348627","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 325465 = Hospital System Supply Identifier | 348627 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZD","code_information":[{"code":"Sx00-5750-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"178437","type":"LOCAL"},{"code":"343824","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 178437 = Hospital System Supply Identifier | 343824 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZD","code_information":[{"code":"Sx00-5750-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"324891","type":"LOCAL"},{"code":"330181","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 324891 = Hospital System Supply Identifier | 330181 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZD","code_information":[{"code":"Sx00-5750-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"178395","type":"LOCAL"},{"code":"333588","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 178395 = Hospital System Supply Identifier | 333588 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZE","code_information":[{"code":"Sx00-5750-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"179185","type":"LOCAL"},{"code":"333589","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 179185 = Hospital System Supply Identifier | 333589 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZE","code_information":[{"code":"Sx00-5750-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"178445","type":"LOCAL"},{"code":"345973","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 178445 = Hospital System Supply Identifier | 345973 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZE","code_information":[{"code":"Sx00-5750-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"178484","type":"LOCAL"},{"code":"354412","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 178484 = Hospital System Supply Identifier | 354412 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZE","code_information":[{"code":"Sx00-5750-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"178485","type":"LOCAL"},{"code":"354417","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 178485 = Hospital System Supply Identifier | 354417 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZF","code_information":[{"code":"Sx00-5750-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325563","type":"LOCAL"},{"code":"354413","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 325563 = Hospital System Supply Identifier | 354413 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZF","code_information":[{"code":"Sx00-5750-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"178440","type":"LOCAL"},{"code":"345393","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 178440 = Hospital System Supply Identifier | 345393 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZF","code_information":[{"code":"Sx00-5750-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325466","type":"LOCAL"},{"code":"348628","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 325466 = Hospital System Supply Identifier | 348628 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZF","code_information":[{"code":"Sx00-5750-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325549","type":"LOCAL"},{"code":"354395","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 325549 = Hospital System Supply Identifier | 354395 = Lawson ID"}]},{"description":"IMP KNEE-C FEM NXGN SZG LT","code_information":[{"code":"Sx00-5750-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329889","type":"LOCAL"},{"code":"395481","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329889 = Hospital System Supply Identifier | 395481 = Lawson ID"}]},{"description":"IMP KNEE-C FEM NXGN MNS SZG LT","code_information":[{"code":"Sx00-5750-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329890","type":"LOCAL"},{"code":"395482","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329890 = Hospital System Supply Identifier | 395482 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZG","code_information":[{"code":"Sx00-5750-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"327192","type":"LOCAL"},{"code":"412509","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 327192 = Hospital System Supply Identifier | 412509 = Lawson ID"}]},{"description":"IMP KNEE-C FEM NXGN MNS SZG RT","code_information":[{"code":"Sx00-5750-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303279","type":"LOCAL"},{"code":"522236","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303279 = Hospital System Supply Identifier | 522236 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZC","code_information":[{"code":"Sx00-5764-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"194941","type":"LOCAL"},{"code":"360589","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 194941 = Hospital System Supply Identifier | 360589 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZC","code_information":[{"code":"Sx00-5764-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"171770","type":"LOCAL"},{"code":"412510","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 171770 = Hospital System Supply Identifier | 412510 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZD","code_information":[{"code":"Sx00-5764-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"158789","type":"LOCAL"},{"code":"317223","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 158789 = Hospital System Supply Identifier | 317223 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZD","code_information":[{"code":"Sx00-5764-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"169921","type":"LOCAL"},{"code":"351669","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 169921 = Hospital System Supply Identifier | 351669 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZE","code_information":[{"code":"Sx00-5764-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"159842","type":"LOCAL"},{"code":"344612","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 159842 = Hospital System Supply Identifier | 344612 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZE","code_information":[{"code":"Sx00-5764-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"169893","type":"LOCAL"},{"code":"344611","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 169893 = Hospital System Supply Identifier | 344611 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZF","code_information":[{"code":"Sx00-5764-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"160639","type":"LOCAL"},{"code":"351666","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 160639 = Hospital System Supply Identifier | 351666 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZF","code_information":[{"code":"Sx00-5764-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"160640","type":"LOCAL"},{"code":"351668","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 160640 = Hospital System Supply Identifier | 351668 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZG","code_information":[{"code":"Sx00-5764-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"160606","type":"LOCAL"},{"code":"351578","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 160606 = Hospital System Supply Identifier | 351578 = Lawson ID"}]},{"description":"IMP KNEE-C FEM COMP NXGN RTSZG","code_information":[{"code":"Sx00-5764-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"170233","type":"LOCAL"},{"code":"395483","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 170233 = Hospital System Supply Identifier | 395483 = Lawson ID"}]},{"description":"CLAMP EXTERNAL FIXATION NSTRL REPLACEMENT O RING SS KNEE PATELLA AOR MG II","code_information":[{"code":"Sx00-5781-045","type":"CDM"},{"code":"272","type":"RC"},{"code":"1092613","type":"LOCAL"},{"code":"S371986","type":"LOCAL"}],"standard_charges":[{"gross_charge":174.33,"discounted_cash":130.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1092613 = Hospital System Supply Identifier | S371986 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC SM 21","code_information":[{"code":"Sx00-5782-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321938","type":"LOCAL"},{"code":"535152","type":"LOCAL"}],"standard_charges":[{"gross_charge":6172.66,"discounted_cash":4629.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321938 = Hospital System Supply Identifier | 535152 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC SM 16","code_information":[{"code":"Sx00-5782-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321936","type":"LOCAL"},{"code":"535150","type":"LOCAL"}],"standard_charges":[{"gross_charge":6172.66,"discounted_cash":4629.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321936 = Hospital System Supply Identifier | 535150 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC SM 18.5","code_information":[{"code":"Sx00-5782-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321937","type":"LOCAL"},{"code":"535151","type":"LOCAL"}],"standard_charges":[{"gross_charge":6172.66,"discounted_cash":4629.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321937 = Hospital System Supply Identifier | 535151 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC SM 8.5","code_information":[{"code":"Sx00-5782-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321934","type":"LOCAL"},{"code":"535148","type":"LOCAL"}],"standard_charges":[{"gross_charge":6172.66,"discounted_cash":4629.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321934 = Hospital System Supply Identifier | 535148 = Lawson ID"}]},{"description":"IMP KNEE TIB SURF ARTC","code_information":[{"code":"Sx00-5782-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"330183","type":"LOCAL"},{"code":"419992","type":"LOCAL"}],"standard_charges":[{"gross_charge":6172.66,"discounted_cash":4629.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 330183 = Hospital System Supply Identifier | 419992 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC SM 13.5","code_information":[{"code":"Sx00-5782-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321935","type":"LOCAL"},{"code":"535149","type":"LOCAL"}],"standard_charges":[{"gross_charge":6172.66,"discounted_cash":4629.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321935 = Hospital System Supply Identifier | 535149 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC REG 8.5","code_information":[{"code":"Sx00-5782-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321939","type":"LOCAL"},{"code":"535153","type":"LOCAL"}],"standard_charges":[{"gross_charge":6172.66,"discounted_cash":4629.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321939 = Hospital System Supply Identifier | 535153 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC REG 11","code_information":[{"code":"Sx00-5782-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321940","type":"LOCAL"},{"code":"535154","type":"LOCAL"}],"standard_charges":[{"gross_charge":6172.66,"discounted_cash":4629.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321940 = Hospital System Supply Identifier | 535154 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC REG 13.5","code_information":[{"code":"Sx00-5782-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321941","type":"LOCAL"},{"code":"535155","type":"LOCAL"}],"standard_charges":[{"gross_charge":6172.66,"discounted_cash":4629.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321941 = Hospital System Supply Identifier | 535155 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC REG 16","code_information":[{"code":"Sx00-5782-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321942","type":"LOCAL"},{"code":"535156","type":"LOCAL"}],"standard_charges":[{"gross_charge":6172.66,"discounted_cash":4629.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321942 = Hospital System Supply Identifier | 535156 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC REG 18.5","code_information":[{"code":"Sx00-5782-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321943","type":"LOCAL"},{"code":"535157","type":"LOCAL"}],"standard_charges":[{"gross_charge":6172.66,"discounted_cash":4629.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321943 = Hospital System Supply Identifier | 535157 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC REG 21","code_information":[{"code":"Sx00-5782-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321944","type":"LOCAL"},{"code":"535158","type":"LOCAL"}],"standard_charges":[{"gross_charge":6172.66,"discounted_cash":4629.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321944 = Hospital System Supply Identifier | 535158 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC LG 18.5","code_information":[{"code":"Sx00-5782-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321948","type":"LOCAL"},{"code":"535162","type":"LOCAL"}],"standard_charges":[{"gross_charge":6172.66,"discounted_cash":4629.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321948 = Hospital System Supply Identifier | 535162 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC LG 21","code_information":[{"code":"Sx00-5782-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321949","type":"LOCAL"},{"code":"535163","type":"LOCAL"}],"standard_charges":[{"gross_charge":6172.66,"discounted_cash":4629.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321949 = Hospital System Supply Identifier | 535163 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC LG 11","code_information":[{"code":"Sx00-5782-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321946","type":"LOCAL"},{"code":"535160","type":"LOCAL"}],"standard_charges":[{"gross_charge":6172.66,"discounted_cash":4629.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321946 = Hospital System Supply Identifier | 535160 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC LG 8.5","code_information":[{"code":"Sx00-5782-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321945","type":"LOCAL"},{"code":"535159","type":"LOCAL"}],"standard_charges":[{"gross_charge":6172.66,"discounted_cash":4629.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321945 = Hospital System Supply Identifier | 535159 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF MG LG 13.5","code_information":[{"code":"Sx00-5782-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202083","type":"LOCAL"},{"code":"452179","type":"LOCAL"}],"standard_charges":[{"gross_charge":6172.66,"discounted_cash":4629.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 202083 = Hospital System Supply Identifier | 452179 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC LG 16","code_information":[{"code":"Sx00-5782-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321947","type":"LOCAL"},{"code":"535161","type":"LOCAL"}],"standard_charges":[{"gross_charge":6172.66,"discounted_cash":4629.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321947 = Hospital System Supply Identifier | 535161 = Lawson ID"}]},{"description":"IMP KNEE EXT M/G 23","code_information":[{"code":"Sx00-5782-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321950","type":"LOCAL"},{"code":"535164","type":"LOCAL"}],"standard_charges":[{"gross_charge":5479.78,"discounted_cash":4109.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321950 = Hospital System Supply Identifier | 535164 = Lawson ID"}]},{"description":"IMP KNEE EXT M/G 43","code_information":[{"code":"Sx00-5782-076","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321951","type":"LOCAL"},{"code":"535165","type":"LOCAL"}],"standard_charges":[{"gross_charge":5479.78,"discounted_cash":4109.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321951 = Hospital System Supply Identifier | 535165 = Lawson ID"}]},{"description":"IMP KNEE EXT M/G 67","code_information":[{"code":"Sx00-5782-086","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321952","type":"LOCAL"},{"code":"535166","type":"LOCAL"}],"standard_charges":[{"gross_charge":5479.78,"discounted_cash":4109.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321952 = Hospital System Supply Identifier | 535166 = Lawson ID"}]},{"description":"IMP KNEE FEM M/G RT 59X66","code_information":[{"code":"Sx00-5784-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321953","type":"LOCAL"},{"code":"535167","type":"LOCAL"}],"standard_charges":[{"gross_charge":14297.8,"discounted_cash":10723.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321953 = Hospital System Supply Identifier | 535167 = Lawson ID"}]},{"description":"INST ROD ALIGN TIB","code_information":[{"code":"Sx00-5785-079","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"449583","type":"LOCAL"},{"code":"314217","type":"LOCAL"}],"standard_charges":[{"gross_charge":153.82,"discounted_cash":115.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 449583 = Hospital System Supply Identifier | 314217 = Lawson ID"}]},{"description":"ROD EXTERNAL FIXATION NSTRL ALIGNMENT COUPLER SS MG II","code_information":[{"code":"Sx00-5785-080","type":"CDM"},{"code":"272","type":"RC"},{"code":"1102289","type":"LOCAL"},{"code":"S76061","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.37,"discounted_cash":192.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1102289 = Hospital System Supply Identifier | S76061 = Lawson ID"}]},{"description":"IMP KNEE FEM LT SM 14 55X57","code_information":[{"code":"Sx00-5786-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321954","type":"LOCAL"},{"code":"535168","type":"LOCAL"}],"standard_charges":[{"gross_charge":13989.73,"discounted_cash":10492.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321954 = Hospital System Supply Identifier | 535168 = Lawson ID"}]},{"description":"IMP KNEE FEM LT SM 18 55X57","code_information":[{"code":"Sx00-5786-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321955","type":"LOCAL"},{"code":"535169","type":"LOCAL"}],"standard_charges":[{"gross_charge":13989.73,"discounted_cash":10492.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321955 = Hospital System Supply Identifier | 535169 = Lawson ID"}]},{"description":"IMP KNEE FEM RT SM 14 55X57","code_information":[{"code":"Sx00-5786-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321956","type":"LOCAL"},{"code":"535170","type":"LOCAL"}],"standard_charges":[{"gross_charge":13989.73,"discounted_cash":10492.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321956 = Hospital System Supply Identifier | 535170 = Lawson ID"}]},{"description":"IMP KNEE FEM RT SM 18 55X57","code_information":[{"code":"Sx00-5786-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321957","type":"LOCAL"},{"code":"535171","type":"LOCAL"}],"standard_charges":[{"gross_charge":13989.73,"discounted_cash":10492.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321957 = Hospital System Supply Identifier | 535171 = Lawson ID"}]},{"description":"IMP KNEE FEM LT REG 14 63X68","code_information":[{"code":"Sx00-5786-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321958","type":"LOCAL"},{"code":"535172","type":"LOCAL"}],"standard_charges":[{"gross_charge":13989.73,"discounted_cash":10492.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321958 = Hospital System Supply Identifier | 535172 = Lawson ID"}]},{"description":"IMP KNEE FEM LT REG 18 63X68","code_information":[{"code":"Sx00-5786-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321959","type":"LOCAL"},{"code":"535173","type":"LOCAL"}],"standard_charges":[{"gross_charge":13989.73,"discounted_cash":10492.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321959 = Hospital System Supply Identifier | 535173 = Lawson ID"}]},{"description":"IMP KNEE FEM LT LG 14 72X76","code_information":[{"code":"Sx00-5786-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321960","type":"LOCAL"},{"code":"535174","type":"LOCAL"}],"standard_charges":[{"gross_charge":13989.73,"discounted_cash":10492.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321960 = Hospital System Supply Identifier | 535174 = Lawson ID"}]},{"description":"IMP KNEE FEM LT LG 18 72X76","code_information":[{"code":"Sx00-5786-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321961","type":"LOCAL"},{"code":"535175","type":"LOCAL"}],"standard_charges":[{"gross_charge":13989.73,"discounted_cash":10492.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321961 = Hospital System Supply Identifier | 535175 = Lawson ID"}]},{"description":"IMP KNEE FEM RT LG 14 72X76","code_information":[{"code":"Sx00-5786-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321962","type":"LOCAL"},{"code":"535176","type":"LOCAL"}],"standard_charges":[{"gross_charge":13989.73,"discounted_cash":10492.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321962 = Hospital System Supply Identifier | 535176 = Lawson ID"}]},{"description":"IMP KNEE FEM RT LG 14 72X76","code_information":[{"code":"Sx00-5786-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321963","type":"LOCAL"},{"code":"535177","type":"LOCAL"}],"standard_charges":[{"gross_charge":13989.73,"discounted_cash":10492.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321963 = Hospital System Supply Identifier | 535177 = Lawson ID"}]},{"description":"COMPONENT ARTICULAR SURFACE 1 25 X 40 MM X 10 MM TIBIAL KNEE UHMWPE UNICOMPARTMENTAL STRL MILLER GALANTE","code_information":[{"code":"Sx00-5788-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"449611","type":"LOCAL"},{"code":"340078","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 449611 = Hospital System Supply Identifier | 340078 = Lawson ID"}]},{"description":"IMP KNEE TIB ARTC MG SER1 8MM","code_information":[{"code":"Sx00-5788-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"581884","type":"LOCAL"},{"code":"675996","type":"LOCAL"}],"standard_charges":[{"gross_charge":1615.75,"discounted_cash":1211.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 581884 = Hospital System Supply Identifier | 675996 = Lawson ID"}]},{"description":"COMPONENT ARTICULAR SURFACE 8 MM KNEE TIBIAL UHMWPE SERIES 2 UNICOMPARTMENTAL MILLER/GALANTE","code_information":[{"code":"Sx00-5788-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"449572","type":"LOCAL"},{"code":"247359","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 449572 = Hospital System Supply Identifier | 247359 = Lawson ID"}]},{"description":"COMPONENT ARTICULAR SURFACE 48 X 30 MM X 12 MM TIBIAL KNEE UHMWPE SERIES 3 UNICOMPARTMENTAL STRL MILLER GALANTE","code_information":[{"code":"Sx00-5788-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"449601","type":"LOCAL"},{"code":"324115","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 449601 = Hospital System Supply Identifier | 324115 = Lawson ID"}]},{"description":"BIT DRILL M/G UNI KNEE 9MM","code_information":[{"code":"Sx00-5789-049","type":"CDM"},{"code":"272","type":"RC"},{"code":"449582","type":"LOCAL"},{"code":"313632","type":"LOCAL"}],"standard_charges":[{"gross_charge":276.88,"discounted_cash":207.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 449582 = Hospital System Supply Identifier | 313632 = Lawson ID"}]},{"description":"GAUGE M/G TENSION","code_information":[{"code":"Sx00-5789-071","type":"CDM"},{"code":"272","type":"RC"},{"code":"202234","type":"LOCAL"},{"code":"452332","type":"LOCAL"}],"standard_charges":[{"gross_charge":379.43,"discounted_cash":284.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 202234 = Hospital System Supply Identifier | 452332 = Lawson ID"}]},{"description":"NO USAGE - COMPONENT FEM SM PLUS 44 X 21 MM LFT MEDIAL RT LATERAL KNEE ZIMALOY PRECOAT UNICOMPARTMENTAL STRL MILLER/GALANTE","code_information":[{"code":"Sx00-5790-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"449574","type":"LOCAL"},{"code":"248011","type":"LOCAL"}],"standard_charges":[{"gross_charge":5225.0,"discounted_cash":3918.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 449574 = Hospital System Supply Identifier | 248011 = Lawson ID"}]},{"description":"NO USAGE - COMPONENT FEM SM PLUS 21 X 44 MM MEDIAL RT LATERAL LFT KNEE ZIMALOY PRECOAT UNICOMPARTMENTAL STRL MILLER/GALANTE","code_information":[{"code":"Sx00-5790-023","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"449602","type":"LOCAL"},{"code":"324116","type":"LOCAL"}],"standard_charges":[{"gross_charge":5225.0,"discounted_cash":3918.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 449602 = Hospital System Supply Identifier | 324116 = Lawson ID"}]},{"description":"NO USAGE - COMPONENT FEM REG 47 X 24 MM RT MEDIAL LFT LATERAL KNEE ZIMALOY PRECOAT UNICOMPARTMENTAL STRL MILLER/GALANTE","code_information":[{"code":"Sx00-5790-025","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"449612","type":"LOCAL"},{"code":"340079","type":"LOCAL"}],"standard_charges":[{"gross_charge":5225.0,"discounted_cash":3918.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 449612 = Hospital System Supply Identifier | 340079 = Lawson ID"}]},{"description":"NO USAGE - COMPONENT FEM REG PLUS 25 X 50 MM MEDIAL LFT LATERAL RT KNEE ZIMALOY PRECOAT UNICOMPARTMENTAL STRL MILLER/GALANTE","code_information":[{"code":"Sx00-5790-026","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"449570","type":"LOCAL"},{"code":"246163","type":"LOCAL"}],"standard_charges":[{"gross_charge":5225.0,"discounted_cash":3918.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 449570 = Hospital System Supply Identifier | 246163 = Lawson ID"}]},{"description":"NO USAGE - COMPONENT FEM REG PLUS 50 X 25 MM RT MEDIAL LFT LATERAL KNEE ZIMALOY PRECOAT UNICOMPARTMENTAL STRL MILLER/GALANTE","code_information":[{"code":"Sx00-5790-027","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"449569","type":"LOCAL"},{"code":"246162","type":"LOCAL"}],"standard_charges":[{"gross_charge":5225.0,"discounted_cash":3918.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 449569 = Hospital System Supply Identifier | 246162 = Lawson ID"}]},{"description":"NO USAGE - COMPONENT FEM 52 MM LFT KNEE MEDIAL/RT LATERAL ANTERIOR/POSTERIOR PRECOAT MG UNI","code_information":[{"code":"Sx00-5790-028","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"449603","type":"LOCAL"},{"code":"324117","type":"LOCAL"}],"standard_charges":[{"gross_charge":5225.0,"discounted_cash":3918.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 449603 = Hospital System Supply Identifier | 324117 = Lawson ID"}]},{"description":"NO USAGE - COMPONENT FEM LG 28 X 52 MM LFT/RT ZIMALOY COBALT CHROMIUM MOLYBDENUM PMMA UNICOMPARTMENTAL PRECOAT STRL M/G","code_information":[{"code":"Sx00-5790-029","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"449613","type":"LOCAL"},{"code":"340080","type":"LOCAL"}],"standard_charges":[{"gross_charge":5225.0,"discounted_cash":3918.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 449613 = Hospital System Supply Identifier | 340080 = Lawson ID"}]},{"description":"NO USAGE - PLATE BONE 40 MM LFT MEDIAL/RT LATERAL TIBIAL TIVANIUM UNICOMPARTMENTAL STRL M/G","code_information":[{"code":"Sx00-5790-045","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"449614","type":"LOCAL"},{"code":"340081","type":"LOCAL"}],"standard_charges":[{"gross_charge":3197.0,"discounted_cash":2397.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 449614 = Hospital System Supply Identifier | 340081 = Lawson ID"}]},{"description":"IMP KNEE TIB M/G SER 2 44X27","code_information":[{"code":"Sx00-5790-055","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"449571","type":"LOCAL"},{"code":"247358","type":"LOCAL"}],"standard_charges":[{"gross_charge":3197.0,"discounted_cash":2397.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 449571 = Hospital System Supply Identifier | 247358 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT UNI TIB SZ2","code_information":[{"code":"Sx00-5790-055","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"449573","type":"LOCAL"},{"code":"247360","type":"LOCAL"}],"standard_charges":[{"gross_charge":3197.0,"discounted_cash":2397.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 449573 = Hospital System Supply Identifier | 247360 = Lawson ID"}]},{"description":"PLATE TIB UNI MED-LT LAT-RT 3S","code_information":[{"code":"Sx00-5790-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"449605","type":"LOCAL"},{"code":"324120","type":"LOCAL"}],"standard_charges":[{"gross_charge":3197.0,"discounted_cash":2397.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 449605 = Hospital System Supply Identifier | 324120 = Lawson ID"}]},{"description":"NO USAGE - COMPONENT TIBIAL PLATE 30 X 48 MM RT MEDIAL LFT LATERAL TIVANIUM SERIES 3 PRECOAT UNICOMPARTMENTAL STRL MILLER/GALANTE","code_information":[{"code":"Sx00-5790-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"449604","type":"LOCAL"},{"code":"324119","type":"LOCAL"}],"standard_charges":[{"gross_charge":3197.0,"discounted_cash":2397.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 449604 = Hospital System Supply Identifier | 324119 = Lawson ID"}]},{"description":"SCREW HEADED 48MM","code_information":[{"code":"Sx00-5791-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"564883","type":"LOCAL"},{"code":"673550","type":"LOCAL"}],"standard_charges":[{"gross_charge":94.5,"discounted_cash":70.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 564883 = Hospital System Supply Identifier | 673550 = Lawson ID"}]},{"description":"SCREW HD SS 27MM","code_information":[{"code":"Sx00-5791-043","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"193183","type":"LOCAL"},{"code":"253689","type":"LOCAL"}],"standard_charges":[{"gross_charge":235.86,"discounted_cash":176.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 193183 = Hospital System Supply Identifier | 253689 = Lawson ID"}]},{"description":"SCREW HEADED 27MM","code_information":[{"code":"Sx00-5791-043","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"564884","type":"LOCAL"},{"code":"673551","type":"LOCAL"}],"standard_charges":[{"gross_charge":94.5,"discounted_cash":70.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 564884 = Hospital System Supply Identifier | 673551 = Lawson ID"}]},{"description":"SCREW HEADED 33MM","code_information":[{"code":"Sx00-5791-044","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"564885","type":"LOCAL"},{"code":"673552","type":"LOCAL"}],"standard_charges":[{"gross_charge":94.5,"discounted_cash":70.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 564885 = Hospital System Supply Identifier | 673552 = Lawson ID"}]},{"description":"SCREW HD SS 33MM","code_information":[{"code":"Sx00-5791-044","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"178423","type":"LOCAL"},{"code":"340083","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.37,"discounted_cash":192.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 178423 = Hospital System Supply Identifier | 340083 = Lawson ID"}]},{"description":"PIN SLOT HLDNG","code_information":[{"code":"Sx00-5791-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"178275","type":"LOCAL"},{"code":"253688","type":"LOCAL"}],"standard_charges":[{"gross_charge":336.95,"discounted_cash":252.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 178275 = Hospital System Supply Identifier | 253688 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC PROV SZ2 8","code_information":[{"code":"Sx00-5841-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303299","type":"LOCAL"},{"code":"522256","type":"LOCAL"}],"standard_charges":[{"gross_charge":439.5,"discounted_cash":329.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303299 = Hospital System Supply Identifier | 522256 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC PROV SZ2 9","code_information":[{"code":"Sx00-5841-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303300","type":"LOCAL"},{"code":"522257","type":"LOCAL"}],"standard_charges":[{"gross_charge":439.5,"discounted_cash":329.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303300 = Hospital System Supply Identifier | 522257 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC PROV SZ2 10","code_information":[{"code":"Sx00-5841-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303301","type":"LOCAL"},{"code":"522258","type":"LOCAL"}],"standard_charges":[{"gross_charge":439.5,"discounted_cash":329.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303301 = Hospital System Supply Identifier | 522258 = Lawson ID"}]},{"description":"WASHER KT PROX TIB SEG","code_information":[{"code":"Sx00-5850-000","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"322826","type":"LOCAL"},{"code":"536041","type":"LOCAL"}],"standard_charges":[{"gross_charge":6182.08,"discounted_cash":4636.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322826 = Hospital System Supply Identifier | 536041 = Lawson ID"}]},{"description":"IMP KNEE PROX TIB SEG SZ1","code_information":[{"code":"Sx00-5850-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322827","type":"LOCAL"},{"code":"536042","type":"LOCAL"}],"standard_charges":[{"gross_charge":25941.72,"discounted_cash":19456.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322827 = Hospital System Supply Identifier | 536042 = Lawson ID"}]},{"description":"IMP KNEE PROX TIB SEG SZ2","code_information":[{"code":"Sx00-5850-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322828","type":"LOCAL"},{"code":"536043","type":"LOCAL"}],"standard_charges":[{"gross_charge":25941.72,"discounted_cash":19456.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322828 = Hospital System Supply Identifier | 536043 = Lawson ID"}]},{"description":"IMP KNEE PROX TIB SEG SZ3","code_information":[{"code":"Sx00-5850-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322829","type":"LOCAL"},{"code":"536044","type":"LOCAL"}],"standard_charges":[{"gross_charge":25941.72,"discounted_cash":19456.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322829 = Hospital System Supply Identifier | 536044 = Lawson ID"}]},{"description":"IMP KNEE SEG FEM POLY BOX","code_information":[{"code":"Sx00-5850-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"667568","type":"LOCAL"},{"code":"661679","type":"LOCAL"}],"standard_charges":[{"gross_charge":1065.96,"discounted_cash":799.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 667568 = Hospital System Supply Identifier | 661679 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP RT SZB","code_information":[{"code":"Sx00-5850-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322830","type":"LOCAL"},{"code":"536045","type":"LOCAL"}],"standard_charges":[{"gross_charge":22219.74,"discounted_cash":16664.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322830 = Hospital System Supply Identifier | 536045 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP LT SZB","code_information":[{"code":"Sx00-5850-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325122","type":"LOCAL"},{"code":"337480","type":"LOCAL"}],"standard_charges":[{"gross_charge":22219.74,"discounted_cash":16664.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 325122 = Hospital System Supply Identifier | 337480 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP SZB","code_information":[{"code":"Sx00-5850-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"327988","type":"LOCAL"},{"code":"433871","type":"LOCAL"}],"standard_charges":[{"gross_charge":935.59,"discounted_cash":701.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 327988 = Hospital System Supply Identifier | 433871 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP DST SZC","code_information":[{"code":"Sx00-5850-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325622","type":"LOCAL"},{"code":"355935","type":"LOCAL"}],"standard_charges":[{"gross_charge":22219.74,"discounted_cash":16664.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 325622 = Hospital System Supply Identifier | 355935 = Lawson ID"}]},{"description":"IMP TIB INS FEMUR SZC","code_information":[{"code":"Sx00-5850-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329671","type":"LOCAL"},{"code":"355936","type":"LOCAL"}],"standard_charges":[{"gross_charge":980.59,"discounted_cash":735.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329671 = Hospital System Supply Identifier | 355936 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP DST SZC RT","code_information":[{"code":"Sx00-5850-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325921","type":"LOCAL"},{"code":"370199","type":"LOCAL"}],"standard_charges":[{"gross_charge":22219.74,"discounted_cash":16664.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 325921 = Hospital System Supply Identifier | 370199 = Lawson ID"}]},{"description":"SEG DIST FEM POLY BOX SZ C","code_information":[{"code":"Sx00-5850-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1019417","type":"LOCAL"},{"code":"869365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1065.96,"discounted_cash":799.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1019417 = Hospital System Supply Identifier | 869365 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF SEG SZ B 23","code_information":[{"code":"Sx00-5850-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322833","type":"LOCAL"},{"code":"536048","type":"LOCAL"}],"standard_charges":[{"gross_charge":6060.88,"discounted_cash":4545.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322833 = Hospital System Supply Identifier | 536048 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF SEG SZ B 17","code_information":[{"code":"Sx00-5850-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322832","type":"LOCAL"},{"code":"536047","type":"LOCAL"}],"standard_charges":[{"gross_charge":6060.88,"discounted_cash":4545.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322832 = Hospital System Supply Identifier | 536047 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF SEG SZ B 26","code_information":[{"code":"Sx00-5850-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322834","type":"LOCAL"},{"code":"536049","type":"LOCAL"}],"standard_charges":[{"gross_charge":6060.88,"discounted_cash":4545.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322834 = Hospital System Supply Identifier | 536049 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC SZB 20MM","code_information":[{"code":"Sx00-5850-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325124","type":"LOCAL"},{"code":"337482","type":"LOCAL"}],"standard_charges":[{"gross_charge":6060.88,"discounted_cash":4545.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 325124 = Hospital System Supply Identifier | 337482 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF SEG SZ B 14","code_information":[{"code":"Sx00-5850-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322831","type":"LOCAL"},{"code":"536046","type":"LOCAL"}],"standard_charges":[{"gross_charge":6060.88,"discounted_cash":4545.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322831 = Hospital System Supply Identifier | 536046 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT SZB 12MM","code_information":[{"code":"Sx00-5850-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325123","type":"LOCAL"},{"code":"337481","type":"LOCAL"}],"standard_charges":[{"gross_charge":6060.88,"discounted_cash":4545.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 325123 = Hospital System Supply Identifier | 337481 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP SZC 17MM","code_information":[{"code":"Sx00-5850-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325536","type":"LOCAL"},{"code":"353710","type":"LOCAL"}],"standard_charges":[{"gross_charge":6060.88,"discounted_cash":4545.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 325536 = Hospital System Supply Identifier | 353710 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP SZC 23MM","code_information":[{"code":"Sx00-5850-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325922","type":"LOCAL"},{"code":"370200","type":"LOCAL"}],"standard_charges":[{"gross_charge":6060.88,"discounted_cash":4545.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 325922 = Hospital System Supply Identifier | 370200 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP SZC 14MM","code_information":[{"code":"Sx00-5850-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326081","type":"LOCAL"},{"code":"380807","type":"LOCAL"}],"standard_charges":[{"gross_charge":6060.88,"discounted_cash":4545.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 326081 = Hospital System Supply Identifier | 380807 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF SEG SZ C 12","code_information":[{"code":"Sx00-5850-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322835","type":"LOCAL"},{"code":"536050","type":"LOCAL"}],"standard_charges":[{"gross_charge":6060.88,"discounted_cash":4545.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322835 = Hospital System Supply Identifier | 536050 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF SEG SZ C 20","code_information":[{"code":"Sx00-5850-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322836","type":"LOCAL"},{"code":"536051","type":"LOCAL"}],"standard_charges":[{"gross_charge":6060.88,"discounted_cash":4545.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322836 = Hospital System Supply Identifier | 536051 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF SEG SZ C 26","code_information":[{"code":"Sx00-5850-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322837","type":"LOCAL"},{"code":"536052","type":"LOCAL"}],"standard_charges":[{"gross_charge":6060.88,"discounted_cash":4545.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322837 = Hospital System Supply Identifier | 536052 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP SZC 38MM","code_information":[{"code":"Sx00-5850-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322838","type":"LOCAL"},{"code":"536053","type":"LOCAL"}],"standard_charges":[{"gross_charge":14041.86,"discounted_cash":10531.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322838 = Hospital System Supply Identifier | 536053 = Lawson ID"}]},{"description":"WASHER FLAT SEG TM HIP 7","code_information":[{"code":"Sx00-5850-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"322840","type":"LOCAL"},{"code":"536055","type":"LOCAL"}],"standard_charges":[{"gross_charge":4062.2,"discounted_cash":3046.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322840 = Hospital System Supply Identifier | 536055 = Lawson ID"}]},{"description":"IMP KNEE FEM BDY PROX SEG 46","code_information":[{"code":"Sx00-5850-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322843","type":"LOCAL"},{"code":"536058","type":"LOCAL"}],"standard_charges":[{"gross_charge":20203.89,"discounted_cash":15152.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322843 = Hospital System Supply Identifier | 536058 = Lawson ID"}]},{"description":"IMP KNEE FEM BDY PROX SEG 38","code_information":[{"code":"Sx00-5850-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322842","type":"LOCAL"},{"code":"536057","type":"LOCAL"}],"standard_charges":[{"gross_charge":20203.89,"discounted_cash":15152.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322842 = Hospital System Supply Identifier | 536057 = Lawson ID"}]},{"description":"WASHER FLAT SEG TM HIP 4","code_information":[{"code":"Sx00-5850-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"322839","type":"LOCAL"},{"code":"536054","type":"LOCAL"}],"standard_charges":[{"gross_charge":4062.2,"discounted_cash":3046.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322839 = Hospital System Supply Identifier | 536054 = Lawson ID"}]},{"description":"WASHER CRV SEG TM HIP 4","code_information":[{"code":"Sx00-5850-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"322841","type":"LOCAL"},{"code":"536056","type":"LOCAL"}],"standard_charges":[{"gross_charge":4062.2,"discounted_cash":3046.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322841 = Hospital System Supply Identifier | 536056 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF SEG SZ D 26","code_information":[{"code":"Sx00-5850-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322849","type":"LOCAL"},{"code":"536064","type":"LOCAL"}],"standard_charges":[{"gross_charge":6060.88,"discounted_cash":4545.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322849 = Hospital System Supply Identifier | 536064 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF SEG SZ D 12","code_information":[{"code":"Sx00-5850-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322844","type":"LOCAL"},{"code":"536059","type":"LOCAL"}],"standard_charges":[{"gross_charge":6060.88,"discounted_cash":4545.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322844 = Hospital System Supply Identifier | 536059 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF SEG SZ D 14","code_information":[{"code":"Sx00-5850-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322845","type":"LOCAL"},{"code":"536060","type":"LOCAL"}],"standard_charges":[{"gross_charge":6060.88,"discounted_cash":4545.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322845 = Hospital System Supply Identifier | 536060 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF SEG SZ D 17","code_information":[{"code":"Sx00-5850-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322846","type":"LOCAL"},{"code":"536061","type":"LOCAL"}],"standard_charges":[{"gross_charge":6060.88,"discounted_cash":4545.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322846 = Hospital System Supply Identifier | 536061 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF SEG SZ D 20","code_information":[{"code":"Sx00-5850-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322847","type":"LOCAL"},{"code":"536062","type":"LOCAL"}],"standard_charges":[{"gross_charge":6060.88,"discounted_cash":4545.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322847 = Hospital System Supply Identifier | 536062 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF SEG SZ D 23","code_information":[{"code":"Sx00-5850-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322848","type":"LOCAL"},{"code":"536063","type":"LOCAL"}],"standard_charges":[{"gross_charge":6060.88,"discounted_cash":4545.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322848 = Hospital System Supply Identifier | 536063 = Lawson ID"}]},{"description":"IMP KNEE DST FEM SEG SZB LT","code_information":[{"code":"Sx00-5850-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"582447","type":"LOCAL"},{"code":"676559","type":"LOCAL"}],"standard_charges":[{"gross_charge":24231.58,"discounted_cash":18173.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 582447 = Hospital System Supply Identifier | 676559 = Lawson ID"}]},{"description":"IMP KNEE SEGDIST FEM SZ B RT","code_information":[{"code":"Sx00-5850-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"667569","type":"LOCAL"},{"code":"661681","type":"LOCAL"}],"standard_charges":[{"gross_charge":24231.58,"discounted_cash":18173.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 667569 = Hospital System Supply Identifier | 661681 = Lawson ID"}]},{"description":"IMP KNEE DST FEM SEG SZC RT","code_information":[{"code":"Sx00-5850-043","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"582445","type":"LOCAL"},{"code":"676557","type":"LOCAL"}],"standard_charges":[{"gross_charge":24231.58,"discounted_cash":18173.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 582445 = Hospital System Supply Identifier | 676557 = Lawson ID"}]},{"description":"IMP KNEE DST FEM SEG SZC LT","code_information":[{"code":"Sx00-5850-043","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"582446","type":"LOCAL"},{"code":"676558","type":"LOCAL"}],"standard_charges":[{"gross_charge":24231.58,"discounted_cash":18173.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 582446 = Hospital System Supply Identifier | 676558 = Lawson ID"}]},{"description":"IMP KNEE SEG INTCAL 45","code_information":[{"code":"Sx00-5850-044","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322850","type":"LOCAL"},{"code":"536065","type":"LOCAL"}],"standard_charges":[{"gross_charge":10262.7,"discounted_cash":7697.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322850 = Hospital System Supply Identifier | 536065 = Lawson ID"}]},{"description":"IMP KNEE SEG INTCAL 55","code_information":[{"code":"Sx00-5850-044","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322851","type":"LOCAL"},{"code":"536066","type":"LOCAL"}],"standard_charges":[{"gross_charge":10262.7,"discounted_cash":7697.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322851 = Hospital System Supply Identifier | 536066 = Lawson ID"}]},{"description":"IMP KNEE SEG INTCAL 65","code_information":[{"code":"Sx00-5850-044","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322852","type":"LOCAL"},{"code":"536067","type":"LOCAL"}],"standard_charges":[{"gross_charge":10262.7,"discounted_cash":7697.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322852 = Hospital System Supply Identifier | 536067 = Lawson ID"}]},{"description":"IMP KNEE SEG FEM/TIB M-F 45","code_information":[{"code":"Sx00-5850-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322865","type":"LOCAL"},{"code":"536080","type":"LOCAL"}],"standard_charges":[{"gross_charge":10631.25,"discounted_cash":7973.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322865 = Hospital System Supply Identifier | 536080 = Lawson ID"}]},{"description":"IMP KNEE SEG FEM/TIB M-F 35","code_information":[{"code":"Sx00-5850-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322864","type":"LOCAL"},{"code":"536079","type":"LOCAL"}],"standard_charges":[{"gross_charge":10631.25,"discounted_cash":7973.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322864 = Hospital System Supply Identifier | 536079 = Lawson ID"}]},{"description":"IMP KNEE SEG FEM/TIB M-F 220","code_information":[{"code":"Sx00-5850-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322863","type":"LOCAL"},{"code":"536078","type":"LOCAL"}],"standard_charges":[{"gross_charge":10631.25,"discounted_cash":7973.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322863 = Hospital System Supply Identifier | 536078 = Lawson ID"}]},{"description":"IMP KNEE SEG FEM/TIB M-F 200","code_information":[{"code":"Sx00-5850-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322862","type":"LOCAL"},{"code":"536077","type":"LOCAL"}],"standard_charges":[{"gross_charge":10744.65,"discounted_cash":8058.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322862 = Hospital System Supply Identifier | 536077 = Lawson ID"}]},{"description":"IMP KNEE SEG FEM/TIB M-F 180","code_information":[{"code":"Sx00-5850-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322861","type":"LOCAL"},{"code":"536076","type":"LOCAL"}],"standard_charges":[{"gross_charge":10744.65,"discounted_cash":8058.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322861 = Hospital System Supply Identifier | 536076 = Lawson ID"}]},{"description":"IMP KNEE SEG FEM/TIB M-F 160","code_information":[{"code":"Sx00-5850-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322860","type":"LOCAL"},{"code":"536075","type":"LOCAL"}],"standard_charges":[{"gross_charge":10744.65,"discounted_cash":8058.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322860 = Hospital System Supply Identifier | 536075 = Lawson ID"}]},{"description":"IMP KNEE SEG FEM/TIB M-F 140","code_information":[{"code":"Sx00-5850-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322859","type":"LOCAL"},{"code":"536074","type":"LOCAL"}],"standard_charges":[{"gross_charge":10631.25,"discounted_cash":7973.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322859 = Hospital System Supply Identifier | 536074 = Lawson ID"}]},{"description":"IMP KNEE SEG FEM/TIB M-F 100","code_information":[{"code":"Sx00-5850-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322857","type":"LOCAL"},{"code":"536072","type":"LOCAL"}],"standard_charges":[{"gross_charge":10631.25,"discounted_cash":7973.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322857 = Hospital System Supply Identifier | 536072 = Lawson ID"}]},{"description":"IMP KNEE SEG FEM/TIB M-F 55","code_information":[{"code":"Sx00-5850-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322866","type":"LOCAL"},{"code":"536081","type":"LOCAL"}],"standard_charges":[{"gross_charge":10631.25,"discounted_cash":7973.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322866 = Hospital System Supply Identifier | 536081 = Lawson ID"}]},{"description":"IMP KNEE SEG FEM/TIB M-F 80","code_information":[{"code":"Sx00-5850-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322856","type":"LOCAL"},{"code":"536071","type":"LOCAL"}],"standard_charges":[{"gross_charge":10631.25,"discounted_cash":7973.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322856 = Hospital System Supply Identifier | 536071 = Lawson ID"}]},{"description":"IMP KNEE SEG FEM/TIB M-F 60","code_information":[{"code":"Sx00-5850-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322855","type":"LOCAL"},{"code":"536070","type":"LOCAL"}],"standard_charges":[{"gross_charge":10631.25,"discounted_cash":7973.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322855 = Hospital System Supply Identifier | 536070 = Lawson ID"}]},{"description":"IMP KNEE SEG FEM/TIB M-F 50","code_information":[{"code":"Sx00-5850-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322854","type":"LOCAL"},{"code":"536069","type":"LOCAL"}],"standard_charges":[{"gross_charge":10631.25,"discounted_cash":7973.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322854 = Hospital System Supply Identifier | 536069 = Lawson ID"}]},{"description":"IMP KNEE SEG FEM/TIB M-F 40","code_information":[{"code":"Sx00-5850-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322853","type":"LOCAL"},{"code":"536068","type":"LOCAL"}],"standard_charges":[{"gross_charge":10631.25,"discounted_cash":7973.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322853 = Hospital System Supply Identifier | 536068 = Lawson ID"}]},{"description":"IMP KNEE SEG TIB/FIB M/F 30MM","code_information":[{"code":"Sx00-5850-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325537","type":"LOCAL"},{"code":"353711","type":"LOCAL"}],"standard_charges":[{"gross_charge":10631.25,"discounted_cash":7973.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 325537 = Hospital System Supply Identifier | 353711 = Lawson ID"}]},{"description":"IMP KNEE SEG FEM/TIB M-F 120","code_information":[{"code":"Sx00-5850-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322858","type":"LOCAL"},{"code":"536073","type":"LOCAL"}],"standard_charges":[{"gross_charge":10631.25,"discounted_cash":7973.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322858 = Hospital System Supply Identifier | 536073 = Lawson ID"}]},{"description":"IMP KNEE SEG FEM/TIB M-M 200","code_information":[{"code":"Sx00-5850-048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322869","type":"LOCAL"},{"code":"536084","type":"LOCAL"}],"standard_charges":[{"gross_charge":10262.7,"discounted_cash":7697.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322869 = Hospital System Supply Identifier | 536084 = Lawson ID"}]},{"description":"IMP KNEE SEG FEM/TIB M-M 80","code_information":[{"code":"Sx00-5850-048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322867","type":"LOCAL"},{"code":"536082","type":"LOCAL"}],"standard_charges":[{"gross_charge":10262.7,"discounted_cash":7697.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322867 = Hospital System Supply Identifier | 536082 = Lawson ID"}]},{"description":"IMP KNEE SEG FEM/TIB M-M 90","code_information":[{"code":"Sx00-5850-048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322868","type":"LOCAL"},{"code":"536083","type":"LOCAL"}],"standard_charges":[{"gross_charge":10262.7,"discounted_cash":7697.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322868 = Hospital System Supply Identifier | 536083 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF SEG SZ E 12","code_information":[{"code":"Sx00-5850-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322870","type":"LOCAL"},{"code":"536085","type":"LOCAL"}],"standard_charges":[{"gross_charge":6060.88,"discounted_cash":4545.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322870 = Hospital System Supply Identifier | 536085 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF SEG SZ E 14","code_information":[{"code":"Sx00-5850-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322871","type":"LOCAL"},{"code":"536086","type":"LOCAL"}],"standard_charges":[{"gross_charge":6060.88,"discounted_cash":4545.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322871 = Hospital System Supply Identifier | 536086 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF SEG SZ E 17","code_information":[{"code":"Sx00-5850-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322872","type":"LOCAL"},{"code":"536087","type":"LOCAL"}],"standard_charges":[{"gross_charge":6060.88,"discounted_cash":4545.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322872 = Hospital System Supply Identifier | 536087 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF SEG SZ E 20","code_information":[{"code":"Sx00-5850-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322873","type":"LOCAL"},{"code":"536088","type":"LOCAL"}],"standard_charges":[{"gross_charge":6060.88,"discounted_cash":4545.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322873 = Hospital System Supply Identifier | 536088 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF SEG SZ E 23","code_information":[{"code":"Sx00-5850-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322874","type":"LOCAL"},{"code":"536089","type":"LOCAL"}],"standard_charges":[{"gross_charge":6060.88,"discounted_cash":4545.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322874 = Hospital System Supply Identifier | 536089 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF SEG SZ E 26","code_information":[{"code":"Sx00-5850-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322875","type":"LOCAL"},{"code":"536090","type":"LOCAL"}],"standard_charges":[{"gross_charge":6060.88,"discounted_cash":4545.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322875 = Hospital System Supply Identifier | 536090 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF SEG SZ F 26","code_information":[{"code":"Sx00-5850-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322881","type":"LOCAL"},{"code":"536096","type":"LOCAL"}],"standard_charges":[{"gross_charge":5888.26,"discounted_cash":4416.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322881 = Hospital System Supply Identifier | 536096 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF SEG SZ F 23","code_information":[{"code":"Sx00-5850-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322880","type":"LOCAL"},{"code":"536095","type":"LOCAL"}],"standard_charges":[{"gross_charge":6060.88,"discounted_cash":4545.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322880 = Hospital System Supply Identifier | 536095 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF SEG SZ F 20","code_information":[{"code":"Sx00-5850-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322879","type":"LOCAL"},{"code":"536094","type":"LOCAL"}],"standard_charges":[{"gross_charge":6060.88,"discounted_cash":4545.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322879 = Hospital System Supply Identifier | 536094 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF SEG SZ F 17","code_information":[{"code":"Sx00-5850-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322878","type":"LOCAL"},{"code":"536093","type":"LOCAL"}],"standard_charges":[{"gross_charge":6060.88,"discounted_cash":4545.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322878 = Hospital System Supply Identifier | 536093 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF SEG SZ F 14","code_information":[{"code":"Sx00-5850-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322877","type":"LOCAL"},{"code":"536092","type":"LOCAL"}],"standard_charges":[{"gross_charge":6060.88,"discounted_cash":4545.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322877 = Hospital System Supply Identifier | 536092 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF SEG SZ F 12","code_information":[{"code":"Sx00-5850-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322876","type":"LOCAL"},{"code":"536091","type":"LOCAL"}],"standard_charges":[{"gross_charge":6060.88,"discounted_cash":4545.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322876 = Hospital System Supply Identifier | 536091 = Lawson ID"}]},{"description":"KIT IMP INS FEM HNG SVC SZB","code_information":[{"code":"Sx00-5850-070","type":"CDM"},{"code":"272","type":"RC"},{"code":"322882","type":"LOCAL"},{"code":"536097","type":"LOCAL"}],"standard_charges":[{"gross_charge":6612.06,"discounted_cash":4959.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322882 = Hospital System Supply Identifier | 536097 = Lawson ID"}]},{"description":"KIT IMP INS FEM HNG SVC SZ C","code_information":[{"code":"Sx00-5850-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"329859","type":"LOCAL"},{"code":"389850","type":"LOCAL"}],"standard_charges":[{"gross_charge":6612.06,"discounted_cash":4959.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329859 = Hospital System Supply Identifier | 389850 = Lawson ID"}]},{"description":"KIT TKR B STRL LF HINGE SERVIC","code_information":[{"code":"Sx00-5850-071","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"945505","type":"LOCAL"},{"code":"830110","type":"LOCAL"}],"standard_charges":[{"gross_charge":6612.06,"discounted_cash":4959.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 945505 = Hospital System Supply Identifier | 830110 = Lawson ID"}]},{"description":"SEG DIST FEM HINGE SZ C","code_information":[{"code":"Sx00-5850-071","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1019418","type":"LOCAL"},{"code":"869366","type":"LOCAL"}],"standard_charges":[{"gross_charge":6612.06,"discounted_cash":4959.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1019418 = Hospital System Supply Identifier | 869366 = Lawson ID"}]},{"description":"KIT SEG SHIELD HNG SVC SZF","code_information":[{"code":"Sx00-5850-075","type":"CDM"},{"code":"272","type":"RC"},{"code":"322887","type":"LOCAL"},{"code":"536102","type":"LOCAL"}],"standard_charges":[{"gross_charge":5581.38,"discounted_cash":4186.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322887 = Hospital System Supply Identifier | 536102 = Lawson ID"}]},{"description":"KIT SEG SHIELD HNG SVC SZE","code_information":[{"code":"Sx00-5850-075","type":"CDM"},{"code":"272","type":"RC"},{"code":"322886","type":"LOCAL"},{"code":"536101","type":"LOCAL"}],"standard_charges":[{"gross_charge":5581.38,"discounted_cash":4186.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322886 = Hospital System Supply Identifier | 536101 = Lawson ID"}]},{"description":"KIT SEG SHIELD HNG SVC SZC","code_information":[{"code":"Sx00-5850-075","type":"CDM"},{"code":"272","type":"RC"},{"code":"322884","type":"LOCAL"},{"code":"536099","type":"LOCAL"}],"standard_charges":[{"gross_charge":5581.38,"discounted_cash":4186.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322884 = Hospital System Supply Identifier | 536099 = Lawson ID"}]},{"description":"KIT SEG SHIELD HNG SVC SZB","code_information":[{"code":"Sx00-5850-075","type":"CDM"},{"code":"272","type":"RC"},{"code":"322883","type":"LOCAL"},{"code":"536098","type":"LOCAL"}],"standard_charges":[{"gross_charge":5581.38,"discounted_cash":4186.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322883 = Hospital System Supply Identifier | 536098 = Lawson ID"}]},{"description":"KIT SEG SHIELD HNG SVC SZD","code_information":[{"code":"Sx00-5850-075","type":"CDM"},{"code":"272","type":"RC"},{"code":"322885","type":"LOCAL"},{"code":"536100","type":"LOCAL"}],"standard_charges":[{"gross_charge":5581.38,"discounted_cash":4186.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322885 = Hospital System Supply Identifier | 536100 = Lawson ID"}]},{"description":"WASHER ORTHOPEDIC FLAT 4MM TRABECULAR METAL HIP PROXIMAL","code_information":[{"code":"Sx00-5851-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1113647","type":"LOCAL"},{"code":"S651506","type":"LOCAL"}],"standard_charges":[{"gross_charge":960.78,"discounted_cash":720.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1113647 = Hospital System Supply Identifier | S651506 = Lawson ID"}]},{"description":"WASHER ORTHOPEDIC FLAT 7MM TRABECULAR METAL HIP PROXIMAL","code_information":[{"code":"Sx00-5851-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1113648","type":"LOCAL"},{"code":"S651507","type":"LOCAL"}],"standard_charges":[{"gross_charge":693.35,"discounted_cash":520.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1113648 = Hospital System Supply Identifier | S651507 = Lawson ID"}]},{"description":"WASHER ORTHOPEDIC CURVE 4MM TRABECULAR METAL HIP","code_information":[{"code":"Sx00-5851-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1113646","type":"LOCAL"},{"code":"S651508","type":"LOCAL"}],"standard_charges":[{"gross_charge":1671.95,"discounted_cash":1253.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1113646 = Hospital System Supply Identifier | S651508 = Lawson ID"}]},{"description":"BRACE ANKLE EXCELERATOR 9.5IN","code_information":[{"code":"Sx00-5852-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325125","type":"LOCAL"},{"code":"337483","type":"LOCAL"}],"standard_charges":[{"gross_charge":7244.72,"discounted_cash":5433.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 325125 = Hospital System Supply Identifier | 337483 = Lawson ID"}]},{"description":"IMP KNEE TOT STEM COLLAR 35MM","code_information":[{"code":"Sx00-5852-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329611","type":"LOCAL"},{"code":"353712","type":"LOCAL"}],"standard_charges":[{"gross_charge":7244.72,"discounted_cash":5433.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329611 = Hospital System Supply Identifier | 353712 = Lawson ID"}]},{"description":"IMP KNEE STEM COLLAR 25MM","code_information":[{"code":"Sx00-5852-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"317312","type":"LOCAL"},{"code":"530452","type":"LOCAL"}],"standard_charges":[{"gross_charge":7244.72,"discounted_cash":5433.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 317312 = Hospital System Supply Identifier | 530452 = Lawson ID"}]},{"description":"IMP KNEE TOT STEM COLLAR 30MM","code_information":[{"code":"Sx00-5852-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"317085","type":"LOCAL"},{"code":"511241","type":"LOCAL"}],"standard_charges":[{"gross_charge":7244.72,"discounted_cash":5433.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 317085 = Hospital System Supply Identifier | 511241 = Lawson ID"}]},{"description":"IMP KNEE COLR TRAB 17-19","code_information":[{"code":"Sx00-5852-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322888","type":"LOCAL"},{"code":"536104","type":"LOCAL"}],"standard_charges":[{"gross_charge":7244.72,"discounted_cash":5433.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322888 = Hospital System Supply Identifier | 536104 = Lawson ID"}]},{"description":"IMP KNEE COLR SMTH 9-16","code_information":[{"code":"Sx00-5852-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322889","type":"LOCAL"},{"code":"536105","type":"LOCAL"}],"standard_charges":[{"gross_charge":7244.72,"discounted_cash":5433.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322889 = Hospital System Supply Identifier | 536105 = Lawson ID"}]},{"description":"IMP KNEE COLR SMTH 17-19","code_information":[{"code":"Sx00-5852-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322890","type":"LOCAL"},{"code":"536106","type":"LOCAL"}],"standard_charges":[{"gross_charge":7244.72,"discounted_cash":5433.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322890 = Hospital System Supply Identifier | 536106 = Lawson ID"}]},{"description":"IMP KNEE STEM FLUT STR 16X130","code_information":[{"code":"Sx00-5852-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322896","type":"LOCAL"},{"code":"536112","type":"LOCAL"}],"standard_charges":[{"gross_charge":11768.75,"discounted_cash":8826.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322896 = Hospital System Supply Identifier | 536112 = Lawson ID"}]},{"description":"IMP KNEE STEM FLUT STR 15X130","code_information":[{"code":"Sx00-5852-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322895","type":"LOCAL"},{"code":"536111","type":"LOCAL"}],"standard_charges":[{"gross_charge":11768.75,"discounted_cash":8826.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322895 = Hospital System Supply Identifier | 536111 = Lawson ID"}]},{"description":"IMP KNEE STEM FLUT STR 19X130","code_information":[{"code":"Sx00-5852-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322898","type":"LOCAL"},{"code":"536114","type":"LOCAL"}],"standard_charges":[{"gross_charge":11768.75,"discounted_cash":8826.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322898 = Hospital System Supply Identifier | 536114 = Lawson ID"}]},{"description":"IMP KNEE STEM FLUT STR 18X130","code_information":[{"code":"Sx00-5852-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322897","type":"LOCAL"},{"code":"536113","type":"LOCAL"}],"standard_charges":[{"gross_charge":11768.75,"discounted_cash":8826.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322897 = Hospital System Supply Identifier | 536113 = Lawson ID"}]},{"description":"IMP KNEE STEM FLUT STR 13X130","code_information":[{"code":"Sx00-5852-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322893","type":"LOCAL"},{"code":"536109","type":"LOCAL"}],"standard_charges":[{"gross_charge":11768.75,"discounted_cash":8826.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322893 = Hospital System Supply Identifier | 536109 = Lawson ID"}]},{"description":"IMP KNEE STEM FLUT STR 11X130","code_information":[{"code":"Sx00-5852-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322892","type":"LOCAL"},{"code":"536108","type":"LOCAL"}],"standard_charges":[{"gross_charge":11768.75,"discounted_cash":8826.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322892 = Hospital System Supply Identifier | 536108 = Lawson ID"}]},{"description":"IMP KNEE STEM FLUT STR 14X130","code_information":[{"code":"Sx00-5852-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322894","type":"LOCAL"},{"code":"536110","type":"LOCAL"}],"standard_charges":[{"gross_charge":11768.75,"discounted_cash":8826.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322894 = Hospital System Supply Identifier | 536110 = Lawson ID"}]},{"description":"IMP KNEE STEM FLUT STR 10X130","code_information":[{"code":"Sx00-5852-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322891","type":"LOCAL"},{"code":"536107","type":"LOCAL"}],"standard_charges":[{"gross_charge":11768.75,"discounted_cash":8826.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322891 = Hospital System Supply Identifier | 536107 = Lawson ID"}]},{"description":"IMP KNEE FEM STEM 17X130MM","code_information":[{"code":"Sx00-5852-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"317086","type":"LOCAL"},{"code":"511242","type":"LOCAL"}],"standard_charges":[{"gross_charge":11768.75,"discounted_cash":8826.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 317086 = Hospital System Supply Identifier | 511242 = Lawson ID"}]},{"description":"IMP KNEE FEM STEM 9X130MM","code_information":[{"code":"Sx00-5852-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"316921","type":"LOCAL"},{"code":"378334","type":"LOCAL"}],"standard_charges":[{"gross_charge":11768.75,"discounted_cash":8826.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 316921 = Hospital System Supply Identifier | 378334 = Lawson ID"}]},{"description":"IMP KNEE FEM STEM 12X130MM","code_information":[{"code":"Sx00-5852-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325538","type":"LOCAL"},{"code":"353713","type":"LOCAL"}],"standard_charges":[{"gross_charge":11768.75,"discounted_cash":8826.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 325538 = Hospital System Supply Identifier | 353713 = Lawson ID"}]},{"description":"IMP KNEE STEM FLUT STR 19X190","code_information":[{"code":"Sx00-5852-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322908","type":"LOCAL"},{"code":"536124","type":"LOCAL"}],"standard_charges":[{"gross_charge":11768.75,"discounted_cash":8826.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322908 = Hospital System Supply Identifier | 536124 = Lawson ID"}]},{"description":"IMP KNEE STEM FLUT STR 18X190","code_information":[{"code":"Sx00-5852-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322907","type":"LOCAL"},{"code":"536123","type":"LOCAL"}],"standard_charges":[{"gross_charge":11768.75,"discounted_cash":8826.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322907 = Hospital System Supply Identifier | 536123 = Lawson ID"}]},{"description":"IMP KNEE STEM FLUT STR 17X190","code_information":[{"code":"Sx00-5852-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322906","type":"LOCAL"},{"code":"536122","type":"LOCAL"}],"standard_charges":[{"gross_charge":11439.22,"discounted_cash":8579.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322906 = Hospital System Supply Identifier | 536122 = Lawson ID"}]},{"description":"IMP KNEE STEM FLUT STR 16X190","code_information":[{"code":"Sx00-5852-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322905","type":"LOCAL"},{"code":"536121","type":"LOCAL"}],"standard_charges":[{"gross_charge":11768.75,"discounted_cash":8826.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322905 = Hospital System Supply Identifier | 536121 = Lawson ID"}]},{"description":"IMP KNEE STEM FLUT STR 15X190","code_information":[{"code":"Sx00-5852-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322904","type":"LOCAL"},{"code":"536120","type":"LOCAL"}],"standard_charges":[{"gross_charge":11768.75,"discounted_cash":8826.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322904 = Hospital System Supply Identifier | 536120 = Lawson ID"}]},{"description":"IMP KNEE STEM FLUT STR 13X190","code_information":[{"code":"Sx00-5852-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322902","type":"LOCAL"},{"code":"536118","type":"LOCAL"}],"standard_charges":[{"gross_charge":11768.75,"discounted_cash":8826.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322902 = Hospital System Supply Identifier | 536118 = Lawson ID"}]},{"description":"IMP KNEE STEM FLUT STR 11X190","code_information":[{"code":"Sx00-5852-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322901","type":"LOCAL"},{"code":"536117","type":"LOCAL"}],"standard_charges":[{"gross_charge":11768.75,"discounted_cash":8826.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322901 = Hospital System Supply Identifier | 536117 = Lawson ID"}]},{"description":"IMP KNEE STEM FLUT STR 10X190","code_information":[{"code":"Sx00-5852-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322900","type":"LOCAL"},{"code":"536116","type":"LOCAL"}],"standard_charges":[{"gross_charge":11768.75,"discounted_cash":8826.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322900 = Hospital System Supply Identifier | 536116 = Lawson ID"}]},{"description":"IMP KNEE STEM FLUT STR 9X190","code_information":[{"code":"Sx00-5852-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322899","type":"LOCAL"},{"code":"536115","type":"LOCAL"}],"standard_charges":[{"gross_charge":11768.75,"discounted_cash":8826.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322899 = Hospital System Supply Identifier | 536115 = Lawson ID"}]},{"description":"IMP KNEE STEM EXT 12X190MM","code_information":[{"code":"Sx00-5852-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325126","type":"LOCAL"},{"code":"337484","type":"LOCAL"}],"standard_charges":[{"gross_charge":11768.75,"discounted_cash":8826.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 325126 = Hospital System Supply Identifier | 337484 = Lawson ID"}]},{"description":"IMP KNEE STEM FLUT STR 14X190","code_information":[{"code":"Sx00-5852-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322903","type":"LOCAL"},{"code":"536119","type":"LOCAL"}],"standard_charges":[{"gross_charge":11768.75,"discounted_cash":8826.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322903 = Hospital System Supply Identifier | 536119 = Lawson ID"}]},{"description":"IMP KNEE STEM FLUT BOW 17X250","code_information":[{"code":"Sx00-5852-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322914","type":"LOCAL"},{"code":"536130","type":"LOCAL"}],"standard_charges":[{"gross_charge":11335.66,"discounted_cash":8501.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322914 = Hospital System Supply Identifier | 536130 = Lawson ID"}]},{"description":"IMP KNEE STEM FLUT BOW 19X250","code_information":[{"code":"Sx00-5852-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322916","type":"LOCAL"},{"code":"536132","type":"LOCAL"}],"standard_charges":[{"gross_charge":11015.55,"discounted_cash":8261.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322916 = Hospital System Supply Identifier | 536132 = Lawson ID"}]},{"description":"IMP KNEE STEM FLUT BOW 18X250","code_information":[{"code":"Sx00-5852-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322915","type":"LOCAL"},{"code":"536131","type":"LOCAL"}],"standard_charges":[{"gross_charge":11015.55,"discounted_cash":8261.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322915 = Hospital System Supply Identifier | 536131 = Lawson ID"}]},{"description":"IMP KNEE STEM FLUT BOW 16X250","code_information":[{"code":"Sx00-5852-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322913","type":"LOCAL"},{"code":"536129","type":"LOCAL"}],"standard_charges":[{"gross_charge":11015.55,"discounted_cash":8261.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322913 = Hospital System Supply Identifier | 536129 = Lawson ID"}]},{"description":"IMP KNEE STEM FLUT BOW 13X250","code_information":[{"code":"Sx00-5852-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322910","type":"LOCAL"},{"code":"536126","type":"LOCAL"}],"standard_charges":[{"gross_charge":11335.66,"discounted_cash":8501.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322910 = Hospital System Supply Identifier | 536126 = Lawson ID"}]},{"description":"IMP KNEE STEM FLUT BOW 14X250","code_information":[{"code":"Sx00-5852-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322911","type":"LOCAL"},{"code":"536127","type":"LOCAL"}],"standard_charges":[{"gross_charge":11335.66,"discounted_cash":8501.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322911 = Hospital System Supply Identifier | 536127 = Lawson ID"}]},{"description":"IMP KNEE STEM FLUT BOW 12X250","code_information":[{"code":"Sx00-5852-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322909","type":"LOCAL"},{"code":"536125","type":"LOCAL"}],"standard_charges":[{"gross_charge":11335.66,"discounted_cash":8501.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322909 = Hospital System Supply Identifier | 536125 = Lawson ID"}]},{"description":"IMP KNEE STEM FLUT BOW 15X250","code_information":[{"code":"Sx00-5852-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322912","type":"LOCAL"},{"code":"536128","type":"LOCAL"}],"standard_charges":[{"gross_charge":11335.66,"discounted_cash":8501.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322912 = Hospital System Supply Identifier | 536128 = Lawson ID"}]},{"description":"IMP KNEE FEM STEM STR 19X130","code_information":[{"code":"Sx00-5852-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322926","type":"LOCAL"},{"code":"536143","type":"LOCAL"}],"standard_charges":[{"gross_charge":11439.22,"discounted_cash":8579.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322926 = Hospital System Supply Identifier | 536143 = Lawson ID"}]},{"description":"IMP KNEE EXT FEM STEM R 10X130","code_information":[{"code":"Sx00-5852-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"317311","type":"LOCAL"},{"code":"530451","type":"LOCAL"}],"standard_charges":[{"gross_charge":11768.75,"discounted_cash":8826.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 317311 = Hospital System Supply Identifier | 530451 = Lawson ID"}]},{"description":"IMP KNEE FEM STEM STR 9X130","code_information":[{"code":"Sx00-5852-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322917","type":"LOCAL"},{"code":"536133","type":"LOCAL"}],"standard_charges":[{"gross_charge":11439.22,"discounted_cash":8579.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322917 = Hospital System Supply Identifier | 536133 = Lawson ID"}]},{"description":"IMP KNEE FEM STEM STR 11X130","code_information":[{"code":"Sx00-5852-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322918","type":"LOCAL"},{"code":"536135","type":"LOCAL"}],"standard_charges":[{"gross_charge":11768.75,"discounted_cash":8826.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322918 = Hospital System Supply Identifier | 536135 = Lawson ID"}]},{"description":"IMP KNEE FEM STEM STR 12X130","code_information":[{"code":"Sx00-5852-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322919","type":"LOCAL"},{"code":"536136","type":"LOCAL"}],"standard_charges":[{"gross_charge":11768.75,"discounted_cash":8826.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322919 = Hospital System Supply Identifier | 536136 = Lawson ID"}]},{"description":"IMP KNEE FEM STEM STR 13X130","code_information":[{"code":"Sx00-5852-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322920","type":"LOCAL"},{"code":"536137","type":"LOCAL"}],"standard_charges":[{"gross_charge":11768.75,"discounted_cash":8826.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322920 = Hospital System Supply Identifier | 536137 = Lawson ID"}]},{"description":"IMP KNEE FEM STEM STR 14X130","code_information":[{"code":"Sx00-5852-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322921","type":"LOCAL"},{"code":"536138","type":"LOCAL"}],"standard_charges":[{"gross_charge":11768.75,"discounted_cash":8826.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322921 = Hospital System Supply Identifier | 536138 = Lawson ID"}]},{"description":"IMP KNEE FEM STEM STR 15X130","code_information":[{"code":"Sx00-5852-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322922","type":"LOCAL"},{"code":"536139","type":"LOCAL"}],"standard_charges":[{"gross_charge":11768.75,"discounted_cash":8826.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322922 = Hospital System Supply Identifier | 536139 = Lawson ID"}]},{"description":"IMP KNEE FEM STEM STR 16X130","code_information":[{"code":"Sx00-5852-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322923","type":"LOCAL"},{"code":"536140","type":"LOCAL"}],"standard_charges":[{"gross_charge":11768.75,"discounted_cash":8826.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322923 = Hospital System Supply Identifier | 536140 = Lawson ID"}]},{"description":"IMP KNEE FEM STEM STR 17X130","code_information":[{"code":"Sx00-5852-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322924","type":"LOCAL"},{"code":"536141","type":"LOCAL"}],"standard_charges":[{"gross_charge":11439.22,"discounted_cash":8579.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322924 = Hospital System Supply Identifier | 536141 = Lawson ID"}]},{"description":"IMP KNEE FEM STEM STR 18X130","code_information":[{"code":"Sx00-5852-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322925","type":"LOCAL"},{"code":"536142","type":"LOCAL"}],"standard_charges":[{"gross_charge":11768.75,"discounted_cash":8826.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322925 = Hospital System Supply Identifier | 536142 = Lawson ID"}]},{"description":"IMP KNEE FEM STEM BOW 16X190","code_information":[{"code":"Sx00-5852-074","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322934","type":"LOCAL"},{"code":"536151","type":"LOCAL"}],"standard_charges":[{"gross_charge":13432.16,"discounted_cash":10074.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322934 = Hospital System Supply Identifier | 536151 = Lawson ID"}]},{"description":"IMP KNEE FEM STEM BOW 18X190","code_information":[{"code":"Sx00-5852-074","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322936","type":"LOCAL"},{"code":"536153","type":"LOCAL"}],"standard_charges":[{"gross_charge":13096.26,"discounted_cash":9822.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322936 = Hospital System Supply Identifier | 536153 = Lawson ID"}]},{"description":"IMP KNEE FEM STEM BOW 15X190","code_information":[{"code":"Sx00-5852-074","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322933","type":"LOCAL"},{"code":"536150","type":"LOCAL"}],"standard_charges":[{"gross_charge":13432.16,"discounted_cash":10074.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322933 = Hospital System Supply Identifier | 536150 = Lawson ID"}]},{"description":"IMP KNEE FEM STEM BOW 19X190","code_information":[{"code":"Sx00-5852-074","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322937","type":"LOCAL"},{"code":"536154","type":"LOCAL"}],"standard_charges":[{"gross_charge":13096.26,"discounted_cash":9822.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322937 = Hospital System Supply Identifier | 536154 = Lawson ID"}]},{"description":"IMP KNEE FEM STEM BOW 14X190","code_information":[{"code":"Sx00-5852-074","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322932","type":"LOCAL"},{"code":"536149","type":"LOCAL"}],"standard_charges":[{"gross_charge":13432.16,"discounted_cash":10074.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322932 = Hospital System Supply Identifier | 536149 = Lawson ID"}]},{"description":"IMP KNEE FEM STEM BOW 17X190","code_information":[{"code":"Sx00-5852-074","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322935","type":"LOCAL"},{"code":"536152","type":"LOCAL"}],"standard_charges":[{"gross_charge":13432.16,"discounted_cash":10074.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322935 = Hospital System Supply Identifier | 536152 = Lawson ID"}]},{"description":"IMP KNEE FEM STEM BOW 12X190","code_information":[{"code":"Sx00-5852-074","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322930","type":"LOCAL"},{"code":"536147","type":"LOCAL"}],"standard_charges":[{"gross_charge":13432.16,"discounted_cash":10074.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322930 = Hospital System Supply Identifier | 536147 = Lawson ID"}]},{"description":"IMP KNEE FEM STEM BOW 9X190","code_information":[{"code":"Sx00-5852-074","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322927","type":"LOCAL"},{"code":"536144","type":"LOCAL"}],"standard_charges":[{"gross_charge":13096.26,"discounted_cash":9822.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322927 = Hospital System Supply Identifier | 536144 = Lawson ID"}]},{"description":"IMP KNEE FEM STEM BOW 10X190","code_information":[{"code":"Sx00-5852-074","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322928","type":"LOCAL"},{"code":"536145","type":"LOCAL"}],"standard_charges":[{"gross_charge":13096.26,"discounted_cash":9822.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322928 = Hospital System Supply Identifier | 536145 = Lawson ID"}]},{"description":"IMP KNEE FEM STEM BOW 13X190","code_information":[{"code":"Sx00-5852-074","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322931","type":"LOCAL"},{"code":"536148","type":"LOCAL"}],"standard_charges":[{"gross_charge":13096.26,"discounted_cash":9822.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322931 = Hospital System Supply Identifier | 536148 = Lawson ID"}]},{"description":"IMP KNEE FEM STEM BOW 11X190","code_information":[{"code":"Sx00-5852-074","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322929","type":"LOCAL"},{"code":"536146","type":"LOCAL"}],"standard_charges":[{"gross_charge":13432.16,"discounted_cash":10074.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322929 = Hospital System Supply Identifier | 536146 = Lawson ID"}]},{"description":"IMP KNEE PTELA AUG NXGN 19.5MM","code_information":[{"code":"Sx00-5876-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325145","type":"LOCAL"},{"code":"340098","type":"LOCAL"}],"standard_charges":[{"gross_charge":6153.42,"discounted_cash":4615.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 325145 = Hospital System Supply Identifier | 340098 = Lawson ID"}]},{"description":"IMP KNEE PTELA AUG NXGN 22.5MM","code_information":[{"code":"Sx00-5876-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325146","type":"LOCAL"},{"code":"340099","type":"LOCAL"}],"standard_charges":[{"gross_charge":6153.42,"discounted_cash":4615.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 325146 = Hospital System Supply Identifier | 340099 = Lawson ID"}]},{"description":"IMP KNEE PTELA AUG NXGN 20.0MM","code_information":[{"code":"Sx00-5876-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"327306","type":"LOCAL"},{"code":"416875","type":"LOCAL"}],"standard_charges":[{"gross_charge":6153.42,"discounted_cash":4615.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 327306 = Hospital System Supply Identifier | 416875 = Lawson ID"}]},{"description":"IMP KNEE PTELA AUG NXGN 23.0","code_information":[{"code":"Sx00-5876-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322620","type":"LOCAL"},{"code":"535834","type":"LOCAL"}],"standard_charges":[{"gross_charge":6153.42,"discounted_cash":4615.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322620 = Hospital System Supply Identifier | 535834 = Lawson ID"}]},{"description":"IMP KNEE PTELA INS NXGN 2MM","code_information":[{"code":"Sx00-5878-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"149991","type":"LOCAL"},{"code":"237609","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 149991 = Hospital System Supply Identifier | 237609 = Lawson ID"}]},{"description":"IMP KNEE PTELA INS NXGN 35MM","code_information":[{"code":"Sx00-5878-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"158501","type":"LOCAL"},{"code":"314598","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 158501 = Hospital System Supply Identifier | 314598 = Lawson ID"}]},{"description":"IMP COMPONENT PATELLAR KNEE NEXGEN 00587806538 PMMA 10X38MM","code_information":[{"code":"Sx00-5878-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"164498","type":"LOCAL"},{"code":"370030","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 164498 = Hospital System Supply Identifier | 370030 = Lawson ID"}]},{"description":"IMP KNEE PTELA INS NXGN 41MM","code_information":[{"code":"Sx00-5878-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303329","type":"LOCAL"},{"code":"522286","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303329 = Hospital System Supply Identifier | 522286 = Lawson ID"}]},{"description":"IMP KNEE PTELA NXGEN POR 10X29","code_information":[{"code":"Sx00-5878-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"581898","type":"LOCAL"},{"code":"676010","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 581898 = Hospital System Supply Identifier | 676010 = Lawson ID"}]},{"description":"IMP KNEE TIB N-MOD NXGN SZ1","code_information":[{"code":"Sx00-5880-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322733","type":"LOCAL"},{"code":"535948","type":"LOCAL"}],"standard_charges":[{"gross_charge":9903.6,"discounted_cash":7427.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322733 = Hospital System Supply Identifier | 535948 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG FULL 10 SZ1","code_information":[{"code":"Sx00-5880-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322734","type":"LOCAL"},{"code":"535949","type":"LOCAL"}],"standard_charges":[{"gross_charge":3703.49,"discounted_cash":2777.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322734 = Hospital System Supply Identifier | 535949 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT HNG NXGN SZ","code_information":[{"code":"Sx00-5880-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325539","type":"LOCAL"},{"code":"353714","type":"LOCAL"}],"standard_charges":[{"gross_charge":9903.6,"discounted_cash":7427.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 325539 = Hospital System Supply Identifier | 353714 = Lawson ID"}]},{"description":"IMP TIB AUG NXGN SZ2 10MM","code_information":[{"code":"Sx00-5880-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329612","type":"LOCAL"},{"code":"353715","type":"LOCAL"}],"standard_charges":[{"gross_charge":3703.49,"discounted_cash":2777.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329612 = Hospital System Supply Identifier | 353715 = Lawson ID"}]},{"description":"IMP KNEE TIB HNG NXGN SZ2","code_information":[{"code":"Sx00-5880-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325543","type":"LOCAL"},{"code":"354348","type":"LOCAL"}],"standard_charges":[{"gross_charge":9903.6,"discounted_cash":7427.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 325543 = Hospital System Supply Identifier | 354348 = Lawson ID"}]},{"description":"IMP KNEE TIB N-MOD NXGN SZ3","code_information":[{"code":"Sx00-5880-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322735","type":"LOCAL"},{"code":"535950","type":"LOCAL"}],"standard_charges":[{"gross_charge":9903.6,"discounted_cash":7427.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322735 = Hospital System Supply Identifier | 535950 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG FULL 10 SZ3","code_information":[{"code":"Sx00-5880-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322736","type":"LOCAL"},{"code":"535951","type":"LOCAL"}],"standard_charges":[{"gross_charge":3703.49,"discounted_cash":2777.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322736 = Hospital System Supply Identifier | 535951 = Lawson ID"}]},{"description":"IMP PLATE TIB STEM SZ3 46X67MM","code_information":[{"code":"Sx00-5880-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"199189","type":"LOCAL"},{"code":"446528","type":"LOCAL"}],"standard_charges":[{"gross_charge":9903.6,"discounted_cash":7427.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 199189 = Hospital System Supply Identifier | 446528 = Lawson ID"}]},{"description":"IMP KNEE TIB ROT HNG SZ4","code_information":[{"code":"Sx00-5880-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322737","type":"LOCAL"},{"code":"535952","type":"LOCAL"}],"standard_charges":[{"gross_charge":9903.6,"discounted_cash":7427.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322737 = Hospital System Supply Identifier | 535952 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG FULL 10 SZ4","code_information":[{"code":"Sx00-5880-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322738","type":"LOCAL"},{"code":"535953","type":"LOCAL"}],"standard_charges":[{"gross_charge":3703.49,"discounted_cash":2777.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322738 = Hospital System Supply Identifier | 535953 = Lawson ID"}]},{"description":"IMP KNEE TIB ROT HNG SZ5","code_information":[{"code":"Sx00-5880-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322739","type":"LOCAL"},{"code":"535954","type":"LOCAL"}],"standard_charges":[{"gross_charge":9903.6,"discounted_cash":7427.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322739 = Hospital System Supply Identifier | 535954 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG FULL 10 SZ5","code_information":[{"code":"Sx00-5880-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322740","type":"LOCAL"},{"code":"535955","type":"LOCAL"}],"standard_charges":[{"gross_charge":3703.49,"discounted_cash":2777.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322740 = Hospital System Supply Identifier | 535955 = Lawson ID"}]},{"description":"IMP KNEE TIB ROT HNG SZ6","code_information":[{"code":"Sx00-5880-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322741","type":"LOCAL"},{"code":"535956","type":"LOCAL"}],"standard_charges":[{"gross_charge":9903.6,"discounted_cash":7427.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322741 = Hospital System Supply Identifier | 535956 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG FULL 10 SZ6","code_information":[{"code":"Sx00-5880-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322742","type":"LOCAL"},{"code":"535957","type":"LOCAL"}],"standard_charges":[{"gross_charge":3703.49,"discounted_cash":2777.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322742 = Hospital System Supply Identifier | 535957 = Lawson ID"}]},{"description":"IMP KNEE FEM ROT HNG NXGN B-LT","code_information":[{"code":"Sx00-5880-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322743","type":"LOCAL"},{"code":"535958","type":"LOCAL"}],"standard_charges":[{"gross_charge":19763.66,"discounted_cash":14822.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322743 = Hospital System Supply Identifier | 535958 = Lawson ID"}]},{"description":"IMP KNEE FEM ROT HNG NXGN B-RT","code_information":[{"code":"Sx00-5880-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322744","type":"LOCAL"},{"code":"535959","type":"LOCAL"}],"standard_charges":[{"gross_charge":19763.66,"discounted_cash":14822.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322744 = Hospital System Supply Identifier | 535959 = Lawson ID"}]},{"description":"IMP KNEE FEM ROT HNG NXGN C-RT","code_information":[{"code":"Sx00-5880-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322746","type":"LOCAL"},{"code":"535961","type":"LOCAL"}],"standard_charges":[{"gross_charge":19763.66,"discounted_cash":14822.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322746 = Hospital System Supply Identifier | 535961 = Lawson ID"}]},{"description":"IMP KNEE FEM ROT HNG NXGN C-LT","code_information":[{"code":"Sx00-5880-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322745","type":"LOCAL"},{"code":"535960","type":"LOCAL"}],"standard_charges":[{"gross_charge":19763.66,"discounted_cash":14822.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322745 = Hospital System Supply Identifier | 535960 = Lawson ID"}]},{"description":"IMP ROTATING HINGE FEM","code_information":[{"code":"Sx00-5880-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"317061","type":"LOCAL"},{"code":"446529","type":"LOCAL"}],"standard_charges":[{"gross_charge":19763.66,"discounted_cash":14822.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 317061 = Hospital System Supply Identifier | 446529 = Lawson ID"}]},{"description":"IMP HINGE FEM ROTG SZ-D LT","code_information":[{"code":"Sx00-5880-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"199312","type":"LOCAL"},{"code":"446834","type":"LOCAL"}],"standard_charges":[{"gross_charge":19763.66,"discounted_cash":14822.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 199312 = Hospital System Supply Identifier | 446834 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP HNG NXGN SZE","code_information":[{"code":"Sx00-5880-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325544","type":"LOCAL"},{"code":"354349","type":"LOCAL"}],"standard_charges":[{"gross_charge":19763.66,"discounted_cash":14822.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 325544 = Hospital System Supply Identifier | 354349 = Lawson ID"}]},{"description":"IMP KNEE FEM ROT HNG NXGN E-LT","code_information":[{"code":"Sx00-5880-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322747","type":"LOCAL"},{"code":"535962","type":"LOCAL"}],"standard_charges":[{"gross_charge":19763.66,"discounted_cash":14822.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322747 = Hospital System Supply Identifier | 535962 = Lawson ID"}]},{"description":"IMP KNEE FEM ROT HNG NXGN F-LT","code_information":[{"code":"Sx00-5880-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322748","type":"LOCAL"},{"code":"535963","type":"LOCAL"}],"standard_charges":[{"gross_charge":19763.66,"discounted_cash":14822.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322748 = Hospital System Supply Identifier | 535963 = Lawson ID"}]},{"description":"IMP KNEE FEM ROT HNG NXGN F-RT","code_information":[{"code":"Sx00-5880-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322749","type":"LOCAL"},{"code":"535964","type":"LOCAL"}],"standard_charges":[{"gross_charge":19763.66,"discounted_cash":14822.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322749 = Hospital System Supply Identifier | 535964 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF ROT HNG B23","code_information":[{"code":"Sx00-5880-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322754","type":"LOCAL"},{"code":"535969","type":"LOCAL"}],"standard_charges":[{"gross_charge":4501.56,"discounted_cash":3376.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322754 = Hospital System Supply Identifier | 535969 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF ROT HNG B26","code_information":[{"code":"Sx00-5880-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322755","type":"LOCAL"},{"code":"535970","type":"LOCAL"}],"standard_charges":[{"gross_charge":4501.56,"discounted_cash":3376.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322755 = Hospital System Supply Identifier | 535970 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF ROT HNG B20","code_information":[{"code":"Sx00-5880-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322753","type":"LOCAL"},{"code":"535968","type":"LOCAL"}],"standard_charges":[{"gross_charge":4501.56,"discounted_cash":3376.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322753 = Hospital System Supply Identifier | 535968 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF ROT HNG B14","code_information":[{"code":"Sx00-5880-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322751","type":"LOCAL"},{"code":"535966","type":"LOCAL"}],"standard_charges":[{"gross_charge":4501.56,"discounted_cash":3376.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322751 = Hospital System Supply Identifier | 535966 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF ROT HNG B12","code_information":[{"code":"Sx00-5880-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322750","type":"LOCAL"},{"code":"535965","type":"LOCAL"}],"standard_charges":[{"gross_charge":4501.56,"discounted_cash":3376.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322750 = Hospital System Supply Identifier | 535965 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF ROT HNG B17","code_information":[{"code":"Sx00-5880-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322752","type":"LOCAL"},{"code":"535967","type":"LOCAL"}],"standard_charges":[{"gross_charge":4501.56,"discounted_cash":3376.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322752 = Hospital System Supply Identifier | 535967 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG FULL NXGN SZ2","code_information":[{"code":"Sx00-5880-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322756","type":"LOCAL"},{"code":"535971","type":"LOCAL"}],"standard_charges":[{"gross_charge":9591.75,"discounted_cash":7193.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322756 = Hospital System Supply Identifier | 535971 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG FULL NXGN SZ3","code_information":[{"code":"Sx00-5880-023","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322757","type":"LOCAL"},{"code":"535972","type":"LOCAL"}],"standard_charges":[{"gross_charge":9591.75,"discounted_cash":7193.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322757 = Hospital System Supply Identifier | 535972 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG FULL NXGN SZ4","code_information":[{"code":"Sx00-5880-024","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322758","type":"LOCAL"},{"code":"535973","type":"LOCAL"}],"standard_charges":[{"gross_charge":9591.75,"discounted_cash":7193.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322758 = Hospital System Supply Identifier | 535973 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG FULL NXGN SZ5","code_information":[{"code":"Sx00-5880-025","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322759","type":"LOCAL"},{"code":"535974","type":"LOCAL"}],"standard_charges":[{"gross_charge":11157.58,"discounted_cash":8368.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322759 = Hospital System Supply Identifier | 535974 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG FULL NXGN SZ6","code_information":[{"code":"Sx00-5880-026","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322760","type":"LOCAL"},{"code":"535975","type":"LOCAL"}],"standard_charges":[{"gross_charge":9591.75,"discounted_cash":7193.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322760 = Hospital System Supply Identifier | 535975 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF ROT HNG C26","code_information":[{"code":"Sx00-5880-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322766","type":"LOCAL"},{"code":"535981","type":"LOCAL"}],"standard_charges":[{"gross_charge":4501.56,"discounted_cash":3376.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322766 = Hospital System Supply Identifier | 535981 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF ROT HNG C23","code_information":[{"code":"Sx00-5880-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322765","type":"LOCAL"},{"code":"535980","type":"LOCAL"}],"standard_charges":[{"gross_charge":4501.56,"discounted_cash":3376.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322765 = Hospital System Supply Identifier | 535980 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF ROT HNG C20","code_information":[{"code":"Sx00-5880-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322764","type":"LOCAL"},{"code":"535979","type":"LOCAL"}],"standard_charges":[{"gross_charge":4501.56,"discounted_cash":3376.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322764 = Hospital System Supply Identifier | 535979 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF ROT HNG C14","code_information":[{"code":"Sx00-5880-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322762","type":"LOCAL"},{"code":"535977","type":"LOCAL"}],"standard_charges":[{"gross_charge":4501.56,"discounted_cash":3376.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322762 = Hospital System Supply Identifier | 535977 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF ROT HNG C12","code_information":[{"code":"Sx00-5880-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322761","type":"LOCAL"},{"code":"535976","type":"LOCAL"}],"standard_charges":[{"gross_charge":4501.56,"discounted_cash":3376.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322761 = Hospital System Supply Identifier | 535976 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF ROT HNG C17","code_information":[{"code":"Sx00-5880-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322763","type":"LOCAL"},{"code":"535978","type":"LOCAL"}],"standard_charges":[{"gross_charge":4501.56,"discounted_cash":3376.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322763 = Hospital System Supply Identifier | 535978 = Lawson ID"}]},{"description":"IMP TIB INS NXGN HNG SZ3 12MM","code_information":[{"code":"Sx00-5880-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"194016","type":"LOCAL"},{"code":"324130","type":"LOCAL"}],"standard_charges":[{"gross_charge":4501.56,"discounted_cash":3376.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 194016 = Hospital System Supply Identifier | 324130 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF ROT HNG D14","code_information":[{"code":"Sx00-5880-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322767","type":"LOCAL"},{"code":"535982","type":"LOCAL"}],"standard_charges":[{"gross_charge":4501.56,"discounted_cash":3376.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322767 = Hospital System Supply Identifier | 535982 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF ROT HNG D17","code_information":[{"code":"Sx00-5880-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322768","type":"LOCAL"},{"code":"535983","type":"LOCAL"}],"standard_charges":[{"gross_charge":4501.56,"discounted_cash":3376.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322768 = Hospital System Supply Identifier | 535983 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF ROT HNG D20","code_information":[{"code":"Sx00-5880-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322769","type":"LOCAL"},{"code":"535984","type":"LOCAL"}],"standard_charges":[{"gross_charge":4501.56,"discounted_cash":3376.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322769 = Hospital System Supply Identifier | 535984 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF ROT HNG D23","code_information":[{"code":"Sx00-5880-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322770","type":"LOCAL"},{"code":"535985","type":"LOCAL"}],"standard_charges":[{"gross_charge":4501.56,"discounted_cash":3376.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322770 = Hospital System Supply Identifier | 535985 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF ROT HNG D26","code_information":[{"code":"Sx00-5880-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322771","type":"LOCAL"},{"code":"535986","type":"LOCAL"}],"standard_charges":[{"gross_charge":4501.56,"discounted_cash":3376.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322771 = Hospital System Supply Identifier | 535986 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF ROT HNG E26","code_information":[{"code":"Sx00-5880-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322776","type":"LOCAL"},{"code":"535991","type":"LOCAL"}],"standard_charges":[{"gross_charge":4501.56,"discounted_cash":3376.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322776 = Hospital System Supply Identifier | 535991 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF ROT HNG E23","code_information":[{"code":"Sx00-5880-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322775","type":"LOCAL"},{"code":"535990","type":"LOCAL"}],"standard_charges":[{"gross_charge":4501.56,"discounted_cash":3376.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322775 = Hospital System Supply Identifier | 535990 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF ROT HNG E20","code_information":[{"code":"Sx00-5880-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322774","type":"LOCAL"},{"code":"535989","type":"LOCAL"}],"standard_charges":[{"gross_charge":4501.56,"discounted_cash":3376.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322774 = Hospital System Supply Identifier | 535989 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF ROT HNG E12","code_information":[{"code":"Sx00-5880-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322772","type":"LOCAL"},{"code":"535987","type":"LOCAL"}],"standard_charges":[{"gross_charge":4501.56,"discounted_cash":3376.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322772 = Hospital System Supply Identifier | 535987 = Lawson ID"}]},{"description":"IMP KNEE TIB INS HNG SZ4 17MM","code_information":[{"code":"Sx00-5880-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325545","type":"LOCAL"},{"code":"354350","type":"LOCAL"}],"standard_charges":[{"gross_charge":4501.56,"discounted_cash":3376.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 325545 = Hospital System Supply Identifier | 354350 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF ROT HNG E14","code_information":[{"code":"Sx00-5880-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322773","type":"LOCAL"},{"code":"535988","type":"LOCAL"}],"standard_charges":[{"gross_charge":4501.56,"discounted_cash":3376.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322773 = Hospital System Supply Identifier | 535988 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF ROT HNG F12","code_information":[{"code":"Sx00-5880-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322777","type":"LOCAL"},{"code":"535992","type":"LOCAL"}],"standard_charges":[{"gross_charge":4501.56,"discounted_cash":3376.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322777 = Hospital System Supply Identifier | 535992 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF ROT HNG F14","code_information":[{"code":"Sx00-5880-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322778","type":"LOCAL"},{"code":"535993","type":"LOCAL"}],"standard_charges":[{"gross_charge":4501.56,"discounted_cash":3376.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322778 = Hospital System Supply Identifier | 535993 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF ROT HNG F17","code_information":[{"code":"Sx00-5880-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322779","type":"LOCAL"},{"code":"535994","type":"LOCAL"}],"standard_charges":[{"gross_charge":4501.56,"discounted_cash":3376.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322779 = Hospital System Supply Identifier | 535994 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF ROT HNG F20","code_information":[{"code":"Sx00-5880-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322780","type":"LOCAL"},{"code":"535995","type":"LOCAL"}],"standard_charges":[{"gross_charge":4501.56,"discounted_cash":3376.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322780 = Hospital System Supply Identifier | 535995 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF ROT HNG F23","code_information":[{"code":"Sx00-5880-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322781","type":"LOCAL"},{"code":"535996","type":"LOCAL"}],"standard_charges":[{"gross_charge":4501.56,"discounted_cash":3376.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322781 = Hospital System Supply Identifier | 535996 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF ROT HNG F26","code_information":[{"code":"Sx00-5880-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322782","type":"LOCAL"},{"code":"535997","type":"LOCAL"}],"standard_charges":[{"gross_charge":4501.56,"discounted_cash":3376.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322782 = Hospital System Supply Identifier | 535997 = Lawson ID"}]},{"description":"IMP KNEE FEM HNG ROT SVC SZF","code_information":[{"code":"Sx00-5880-090","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322787","type":"LOCAL"},{"code":"536002","type":"LOCAL"}],"standard_charges":[{"gross_charge":3210.9,"discounted_cash":2408.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322787 = Hospital System Supply Identifier | 536002 = Lawson ID"}]},{"description":"IMP KNEE FEM HNG ROT SVC SZE","code_information":[{"code":"Sx00-5880-090","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322786","type":"LOCAL"},{"code":"536001","type":"LOCAL"}],"standard_charges":[{"gross_charge":3210.9,"discounted_cash":2408.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322786 = Hospital System Supply Identifier | 536001 = Lawson ID"}]},{"description":"IMP KNEE FEM HNG ROT SVC SZD","code_information":[{"code":"Sx00-5880-090","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322785","type":"LOCAL"},{"code":"536000","type":"LOCAL"}],"standard_charges":[{"gross_charge":3210.9,"discounted_cash":2408.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322785 = Hospital System Supply Identifier | 536000 = Lawson ID"}]},{"description":"COMPONENT FEMORAL KNEE CEMENTED ROTATING HINGE SIZE NEXGEN 00588009013","code_information":[{"code":"Sx00-5880-090","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1555848","type":"LOCAL"},{"code":"1108807","type":"LOCAL"}],"standard_charges":[{"gross_charge":3210.9,"discounted_cash":2408.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1555848 = Hospital System Supply Identifier | 1108807 = Lawson ID"}]},{"description":"IMP KNEE FEM HNG ROT SVC SZB","code_information":[{"code":"Sx00-5880-090","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322783","type":"LOCAL"},{"code":"535998","type":"LOCAL"}],"standard_charges":[{"gross_charge":2427.3,"discounted_cash":1820.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322783 = Hospital System Supply Identifier | 535998 = Lawson ID"}]},{"description":"COMPONENT FEMORAL KNEE CEMENTED ROTATING HINGE SIZE NEXGEN 00588009012","code_information":[{"code":"Sx00-5880-090","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1555839","type":"LOCAL"},{"code":"1108723","type":"LOCAL"}],"standard_charges":[{"gross_charge":1842.4,"discounted_cash":1381.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1555839 = Hospital System Supply Identifier | 1108723 = Lawson ID"}]},{"description":"IMP KNEE FEM HNG ROT SVC SZC","code_information":[{"code":"Sx00-5880-090","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322784","type":"LOCAL"},{"code":"535999","type":"LOCAL"}],"standard_charges":[{"gross_charge":3649.75,"discounted_cash":2737.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322784 = Hospital System Supply Identifier | 535999 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN CR SZ3 14","code_information":[{"code":"Sx00-5886-043","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303331","type":"LOCAL"},{"code":"522288","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303331 = Hospital System Supply Identifier | 522288 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN CR SZ3 10MM","code_information":[{"code":"Sx00-5886-043","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"162155","type":"LOCAL"},{"code":"360371","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 162155 = Hospital System Supply Identifier | 360371 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN CR SZ3 12","code_information":[{"code":"Sx00-5886-043","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303330","type":"LOCAL"},{"code":"522287","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303330 = Hospital System Supply Identifier | 522287 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN CR SZ3 17","code_information":[{"code":"Sx00-5886-043","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303332","type":"LOCAL"},{"code":"522289","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303332 = Hospital System Supply Identifier | 522289 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN CR SZ4 14","code_information":[{"code":"Sx00-5886-044","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303333","type":"LOCAL"},{"code":"522290","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303333 = Hospital System Supply Identifier | 522290 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN CR SZ4 17MM","code_information":[{"code":"Sx00-5886-044","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"161395","type":"LOCAL"},{"code":"357147","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 161395 = Hospital System Supply Identifier | 357147 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP TRABEC SZ4","code_information":[{"code":"Sx00-5886-044","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"324186","type":"LOCAL"},{"code":"248929","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 324186 = Hospital System Supply Identifier | 248929 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT NXGN SZ14","code_information":[{"code":"Sx00-5886-044","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"149986","type":"LOCAL"},{"code":"237604","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 149986 = Hospital System Supply Identifier | 237604 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT NXGN SZ5 12","code_information":[{"code":"Sx00-5886-045","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"149987","type":"LOCAL"},{"code":"237605","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 149987 = Hospital System Supply Identifier | 237605 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN CR SZ5 10","code_information":[{"code":"Sx00-5886-045","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303334","type":"LOCAL"},{"code":"522291","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303334 = Hospital System Supply Identifier | 522291 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN CR SZ5 14","code_information":[{"code":"Sx00-5886-045","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303335","type":"LOCAL"},{"code":"522292","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303335 = Hospital System Supply Identifier | 522292 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN CR SZ5 17","code_information":[{"code":"Sx00-5886-045","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303336","type":"LOCAL"},{"code":"522293","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303336 = Hospital System Supply Identifier | 522293 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN SZ6 10MM","code_information":[{"code":"Sx00-5886-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"158500","type":"LOCAL"},{"code":"314597","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 158500 = Hospital System Supply Identifier | 314597 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT NXGN SZ6 14","code_information":[{"code":"Sx00-5886-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325642","type":"LOCAL"},{"code":"360606","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 325642 = Hospital System Supply Identifier | 360606 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN CR SZ6 12","code_information":[{"code":"Sx00-5886-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303337","type":"LOCAL"},{"code":"522294","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303337 = Hospital System Supply Identifier | 522294 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN CR SZ6 17","code_information":[{"code":"Sx00-5886-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303338","type":"LOCAL"},{"code":"522295","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303338 = Hospital System Supply Identifier | 522295 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN CR SZ7 17","code_information":[{"code":"Sx00-5886-047","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303341","type":"LOCAL"},{"code":"522298","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303341 = Hospital System Supply Identifier | 522298 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN CR SZ7 14","code_information":[{"code":"Sx00-5886-047","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303340","type":"LOCAL"},{"code":"522297","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303340 = Hospital System Supply Identifier | 522297 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT NXGN SZ7 12","code_information":[{"code":"Sx00-5886-047","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325643","type":"LOCAL"},{"code":"360607","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 325643 = Hospital System Supply Identifier | 360607 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN CR SZ7 10","code_information":[{"code":"Sx00-5886-047","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303339","type":"LOCAL"},{"code":"522296","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303339 = Hospital System Supply Identifier | 522296 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT NXGN SZ8 10","code_information":[{"code":"Sx00-5886-048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"164497","type":"LOCAL"},{"code":"370029","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 164497 = Hospital System Supply Identifier | 370029 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN CR SZ8 12","code_information":[{"code":"Sx00-5886-048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303342","type":"LOCAL"},{"code":"522299","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303342 = Hospital System Supply Identifier | 522299 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN CR SZ8 14","code_information":[{"code":"Sx00-5886-048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303343","type":"LOCAL"},{"code":"522300","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303343 = Hospital System Supply Identifier | 522300 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN CR SZ8 17","code_information":[{"code":"Sx00-5886-048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303344","type":"LOCAL"},{"code":"522301","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303344 = Hospital System Supply Identifier | 522301 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN SZ3 C/D 10","code_information":[{"code":"Sx00-5886-053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303345","type":"LOCAL"},{"code":"522302","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303345 = Hospital System Supply Identifier | 522302 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN SZ3 C/D 12","code_information":[{"code":"Sx00-5886-053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303346","type":"LOCAL"},{"code":"522303","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303346 = Hospital System Supply Identifier | 522303 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN SZ3 C/D 14","code_information":[{"code":"Sx00-5886-053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303347","type":"LOCAL"},{"code":"522304","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303347 = Hospital System Supply Identifier | 522304 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN SZ3 C/D 17","code_information":[{"code":"Sx00-5886-053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303348","type":"LOCAL"},{"code":"522305","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303348 = Hospital System Supply Identifier | 522305 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN SZ4 C/D 17","code_information":[{"code":"Sx00-5886-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303352","type":"LOCAL"},{"code":"522309","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303352 = Hospital System Supply Identifier | 522309 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN SZ4 C/D 14","code_information":[{"code":"Sx00-5886-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303351","type":"LOCAL"},{"code":"522308","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303351 = Hospital System Supply Identifier | 522308 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN SZ4 C/D 10","code_information":[{"code":"Sx00-5886-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303349","type":"LOCAL"},{"code":"522306","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303349 = Hospital System Supply Identifier | 522306 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN SZ4 C/D 12","code_information":[{"code":"Sx00-5886-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303350","type":"LOCAL"},{"code":"522307","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303350 = Hospital System Supply Identifier | 522307 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT NXGN SZ5 14","code_information":[{"code":"Sx00-5886-055","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"163384","type":"LOCAL"},{"code":"364407","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 163384 = Hospital System Supply Identifier | 364407 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN SZ5 E/F 10","code_information":[{"code":"Sx00-5886-055","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303353","type":"LOCAL"},{"code":"522310","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303353 = Hospital System Supply Identifier | 522310 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN SZ5 E/F 12","code_information":[{"code":"Sx00-5886-055","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303354","type":"LOCAL"},{"code":"522311","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303354 = Hospital System Supply Identifier | 522311 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN SZ5 E/F 17","code_information":[{"code":"Sx00-5886-055","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303355","type":"LOCAL"},{"code":"522312","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303355 = Hospital System Supply Identifier | 522312 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN SZ6 E/F 17","code_information":[{"code":"Sx00-5886-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303359","type":"LOCAL"},{"code":"522316","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303359 = Hospital System Supply Identifier | 522316 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN SZ6 E/F 10","code_information":[{"code":"Sx00-5886-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303356","type":"LOCAL"},{"code":"522313","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303356 = Hospital System Supply Identifier | 522313 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN SZ6 E/F 12","code_information":[{"code":"Sx00-5886-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303357","type":"LOCAL"},{"code":"522314","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303357 = Hospital System Supply Identifier | 522314 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN SZ6 E/F 14","code_information":[{"code":"Sx00-5886-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303358","type":"LOCAL"},{"code":"522315","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303358 = Hospital System Supply Identifier | 522315 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN SZ7 G/H 17","code_information":[{"code":"Sx00-5886-057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303363","type":"LOCAL"},{"code":"522320","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303363 = Hospital System Supply Identifier | 522320 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN SZ7 G/H 14","code_information":[{"code":"Sx00-5886-057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303362","type":"LOCAL"},{"code":"522319","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303362 = Hospital System Supply Identifier | 522319 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN SZ7 G/H 10","code_information":[{"code":"Sx00-5886-057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303360","type":"LOCAL"},{"code":"522317","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303360 = Hospital System Supply Identifier | 522317 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN SZ7 G/H 12","code_information":[{"code":"Sx00-5886-057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303361","type":"LOCAL"},{"code":"522318","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303361 = Hospital System Supply Identifier | 522318 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN SZ8 G/H 14","code_information":[{"code":"Sx00-5886-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303366","type":"LOCAL"},{"code":"522323","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303366 = Hospital System Supply Identifier | 522323 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN SZ8 G/H 10","code_information":[{"code":"Sx00-5886-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303364","type":"LOCAL"},{"code":"522321","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303364 = Hospital System Supply Identifier | 522321 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN SZ8 G/H 12","code_information":[{"code":"Sx00-5886-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303365","type":"LOCAL"},{"code":"522322","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303365 = Hospital System Supply Identifier | 522322 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN SZ8 G/H 17","code_information":[{"code":"Sx00-5886-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303367","type":"LOCAL"},{"code":"522324","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303367 = Hospital System Supply Identifier | 522324 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN SZ3 E/F 17","code_information":[{"code":"Sx00-5886-063","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303371","type":"LOCAL"},{"code":"522328","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303371 = Hospital System Supply Identifier | 522328 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN SZ3 E/F 14","code_information":[{"code":"Sx00-5886-063","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303370","type":"LOCAL"},{"code":"522327","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303370 = Hospital System Supply Identifier | 522327 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN SZ3 E/F 10","code_information":[{"code":"Sx00-5886-063","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303368","type":"LOCAL"},{"code":"522325","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303368 = Hospital System Supply Identifier | 522325 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN SZ3 E/F 12","code_information":[{"code":"Sx00-5886-063","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303369","type":"LOCAL"},{"code":"522326","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303369 = Hospital System Supply Identifier | 522326 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN SZ4 E/F 10","code_information":[{"code":"Sx00-5886-064","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303372","type":"LOCAL"},{"code":"522329","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303372 = Hospital System Supply Identifier | 522329 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN SZ4 E/F 12","code_information":[{"code":"Sx00-5886-064","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303373","type":"LOCAL"},{"code":"522330","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303373 = Hospital System Supply Identifier | 522330 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN SZ4 E/F 14","code_information":[{"code":"Sx00-5886-064","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303374","type":"LOCAL"},{"code":"522331","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303374 = Hospital System Supply Identifier | 522331 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN SZ4 E/F 17","code_information":[{"code":"Sx00-5886-064","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303375","type":"LOCAL"},{"code":"522332","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303375 = Hospital System Supply Identifier | 522332 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT SZ5 G/H 10","code_information":[{"code":"Sx00-5886-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303376","type":"LOCAL"},{"code":"522333","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303376 = Hospital System Supply Identifier | 522333 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT SZ5 G/H 12","code_information":[{"code":"Sx00-5886-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303377","type":"LOCAL"},{"code":"522334","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303377 = Hospital System Supply Identifier | 522334 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT SZ5 G/H 14","code_information":[{"code":"Sx00-5886-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303378","type":"LOCAL"},{"code":"522335","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303378 = Hospital System Supply Identifier | 522335 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT SZ5 G/H 17","code_information":[{"code":"Sx00-5886-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303379","type":"LOCAL"},{"code":"522336","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303379 = Hospital System Supply Identifier | 522336 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT SZ6 G/H 17","code_information":[{"code":"Sx00-5886-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303383","type":"LOCAL"},{"code":"522340","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303383 = Hospital System Supply Identifier | 522340 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT SZ6 G/H 14","code_information":[{"code":"Sx00-5886-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303382","type":"LOCAL"},{"code":"522339","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303382 = Hospital System Supply Identifier | 522339 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT SZ6 G/H 10","code_information":[{"code":"Sx00-5886-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303380","type":"LOCAL"},{"code":"522337","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303380 = Hospital System Supply Identifier | 522337 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT SZ6 G/H 12","code_information":[{"code":"Sx00-5886-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303381","type":"LOCAL"},{"code":"522338","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303381 = Hospital System Supply Identifier | 522338 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT SZ7 E/F 10","code_information":[{"code":"Sx00-5886-067","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303384","type":"LOCAL"},{"code":"522341","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303384 = Hospital System Supply Identifier | 522341 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT SZ7 E/F 12","code_information":[{"code":"Sx00-5886-067","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303385","type":"LOCAL"},{"code":"522342","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303385 = Hospital System Supply Identifier | 522342 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT SZ7 E/F 14","code_information":[{"code":"Sx00-5886-067","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303386","type":"LOCAL"},{"code":"522343","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303386 = Hospital System Supply Identifier | 522343 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT SZ7 E/F 17","code_information":[{"code":"Sx00-5886-067","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303387","type":"LOCAL"},{"code":"522344","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303387 = Hospital System Supply Identifier | 522344 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT SZ5 C/D 17","code_information":[{"code":"Sx00-5886-075","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303391","type":"LOCAL"},{"code":"522348","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303391 = Hospital System Supply Identifier | 522348 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT SZ5 C/D 14","code_information":[{"code":"Sx00-5886-075","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303390","type":"LOCAL"},{"code":"522347","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303390 = Hospital System Supply Identifier | 522347 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT SZ5 C/D 10","code_information":[{"code":"Sx00-5886-075","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303388","type":"LOCAL"},{"code":"522345","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303388 = Hospital System Supply Identifier | 522345 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT SZ5 C/D 12","code_information":[{"code":"Sx00-5886-075","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303389","type":"LOCAL"},{"code":"522346","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303389 = Hospital System Supply Identifier | 522346 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT SZ6 C/D 10","code_information":[{"code":"Sx00-5886-076","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303392","type":"LOCAL"},{"code":"522349","type":"LOCAL"}],"standard_charges":[{"gross_charge":4812.5,"discounted_cash":3609.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303392 = Hospital System Supply Identifier | 522349 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT SZ6 C/D 12","code_information":[{"code":"Sx00-5886-076","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303393","type":"LOCAL"},{"code":"522350","type":"LOCAL"}],"standard_charges":[{"gross_charge":4812.5,"discounted_cash":3609.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303393 = Hospital System Supply Identifier | 522350 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT SZ6 C/D 14","code_information":[{"code":"Sx00-5886-076","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303394","type":"LOCAL"},{"code":"522351","type":"LOCAL"}],"standard_charges":[{"gross_charge":4812.5,"discounted_cash":3609.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303394 = Hospital System Supply Identifier | 522351 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT SZ6 C/D 17","code_information":[{"code":"Sx00-5886-076","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303395","type":"LOCAL"},{"code":"522352","type":"LOCAL"}],"standard_charges":[{"gross_charge":4812.5,"discounted_cash":3609.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303395 = Hospital System Supply Identifier | 522352 = Lawson ID"}]},{"description":"HEAD FEMORAL IMPACTOR KNEE PERSONA","code_information":[{"code":"Sx00-5901-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1096772","type":"LOCAL"},{"code":"S651631","type":"LOCAL"}],"standard_charges":[{"gross_charge":782.49,"discounted_cash":586.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1096772 = Hospital System Supply Identifier | S651631 = Lawson ID"}]},{"description":"GUIDE SCREW HEAD HEX 3.2X33MM","code_information":[{"code":"Sx00-5901-035","type":"CDM"},{"code":"272","type":"RC"},{"code":"197206","type":"LOCAL"},{"code":"438096","type":"LOCAL"}],"standard_charges":[{"gross_charge":251.54,"discounted_cash":188.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 197206 = Hospital System Supply Identifier | 438096 = Lawson ID"}]},{"description":"SCREW HEX HD 3.5X27MM","code_information":[{"code":"Sx00-5901-035","type":"CDM"},{"code":"272","type":"RC"},{"code":"1019421","type":"LOCAL"},{"code":"869369","type":"LOCAL"}],"standard_charges":[{"gross_charge":248.58,"discounted_cash":186.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1019421 = Hospital System Supply Identifier | 869369 = Lawson ID"}]},{"description":"SCREW HEX HD 3.5X48MM","code_information":[{"code":"Sx00-5901-035","type":"CDM"},{"code":"272","type":"RC"},{"code":"1019422","type":"LOCAL"},{"code":"869370","type":"LOCAL"}],"standard_charges":[{"gross_charge":393.58,"discounted_cash":295.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1019422 = Hospital System Supply Identifier | 869370 = Lawson ID"}]},{"description":"ROD EXTERNAL FIXATION TELESCOPE CUT GUIDE PERSONA","code_information":[{"code":"Sx00-5907-080","type":"CDM"},{"code":"272","type":"RC"},{"code":"1102294","type":"LOCAL"},{"code":"S657293","type":"LOCAL"}],"standard_charges":[{"gross_charge":1622.77,"discounted_cash":1217.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1102294 = Hospital System Supply Identifier | S657293 = Lawson ID"}]},{"description":"ROD EXTERNAL FIXATION DISTAL EXTRAMEDULLARY PERSONA","code_information":[{"code":"Sx00-5907-080","type":"CDM"},{"code":"272","type":"RC"},{"code":"1102280","type":"LOCAL"},{"code":"S657296","type":"LOCAL"}],"standard_charges":[{"gross_charge":297.39,"discounted_cash":223.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1102280 = Hospital System Supply Identifier | S657296 = Lawson ID"}]},{"description":"SPACER FEMORAL STANDARD 10MM BLOCK MIS PERSONA","code_information":[{"code":"Sx00-5907-080","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1104821","type":"LOCAL"},{"code":"S652535","type":"LOCAL"}],"standard_charges":[{"gross_charge":328.16,"discounted_cash":246.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1104821 = Hospital System Supply Identifier | S652535 = Lawson ID"}]},{"description":"SPACER FEMORAL STANDARD 14MM BLOCK MIS PERSONA","code_information":[{"code":"Sx00-5907-080","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1104823","type":"LOCAL"},{"code":"S652536","type":"LOCAL"}],"standard_charges":[{"gross_charge":328.16,"discounted_cash":246.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1104823 = Hospital System Supply Identifier | S652536 = Lawson ID"}]},{"description":"SPACER FEMORAL STANDARD 12IN BLOCK MIS","code_information":[{"code":"Sx00-5907-080","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1104822","type":"LOCAL"},{"code":"S652537","type":"LOCAL"}],"standard_charges":[{"gross_charge":287.14,"discounted_cash":215.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1104822 = Hospital System Supply Identifier | S652537 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT FLUT SZ1","code_information":[{"code":"Sx00-5916-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303396","type":"LOCAL"},{"code":"522353","type":"LOCAL"}],"standard_charges":[{"gross_charge":2301.75,"discounted_cash":1726.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303396 = Hospital System Supply Identifier | 522353 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT FLUT SZ1","code_information":[{"code":"Sx00-5916-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303397","type":"LOCAL"},{"code":"522354","type":"LOCAL"}],"standard_charges":[{"gross_charge":1960.0,"discounted_cash":1470.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303397 = Hospital System Supply Identifier | 522354 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC AB/123 17MM","code_information":[{"code":"Sx00-5916-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303403","type":"LOCAL"},{"code":"522360","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303403 = Hospital System Supply Identifier | 522360 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC AB/123 20MM","code_information":[{"code":"Sx00-5916-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303404","type":"LOCAL"},{"code":"522361","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303404 = Hospital System Supply Identifier | 522361 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC AB/123 14MM","code_information":[{"code":"Sx00-5916-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303402","type":"LOCAL"},{"code":"522359","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303402 = Hospital System Supply Identifier | 522359 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT FLUT SZ2","code_information":[{"code":"Sx00-5916-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303399","type":"LOCAL"},{"code":"522356","type":"LOCAL"}],"standard_charges":[{"gross_charge":1960.0,"discounted_cash":1470.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303399 = Hospital System Supply Identifier | 522356 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC AB/123 10MM","code_information":[{"code":"Sx00-5916-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303400","type":"LOCAL"},{"code":"522357","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303400 = Hospital System Supply Identifier | 522357 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC AB/123 12MM","code_information":[{"code":"Sx00-5916-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303401","type":"LOCAL"},{"code":"522358","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303401 = Hospital System Supply Identifier | 522358 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT FLUT SZ2","code_information":[{"code":"Sx00-5916-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303398","type":"LOCAL"},{"code":"522355","type":"LOCAL"}],"standard_charges":[{"gross_charge":2301.75,"discounted_cash":1726.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303398 = Hospital System Supply Identifier | 522355 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC C/234 17MM","code_information":[{"code":"Sx00-5916-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303409","type":"LOCAL"},{"code":"522366","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303409 = Hospital System Supply Identifier | 522366 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC C/234 14MM","code_information":[{"code":"Sx00-5916-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303408","type":"LOCAL"},{"code":"522365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303408 = Hospital System Supply Identifier | 522365 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC C/234 12MM","code_information":[{"code":"Sx00-5916-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303407","type":"LOCAL"},{"code":"522364","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303407 = Hospital System Supply Identifier | 522364 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC C/234 20MM","code_information":[{"code":"Sx00-5916-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303410","type":"LOCAL"},{"code":"522367","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303410 = Hospital System Supply Identifier | 522367 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT FLUT SZ3","code_information":[{"code":"Sx00-5916-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303405","type":"LOCAL"},{"code":"522362","type":"LOCAL"}],"standard_charges":[{"gross_charge":1960.0,"discounted_cash":1470.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303405 = Hospital System Supply Identifier | 522362 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT STEM SZ3","code_information":[{"code":"Sx00-5916-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325644","type":"LOCAL"},{"code":"360608","type":"LOCAL"}],"standard_charges":[{"gross_charge":2301.75,"discounted_cash":1726.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 325644 = Hospital System Supply Identifier | 360608 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC C/23410MM","code_information":[{"code":"Sx00-5916-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303406","type":"LOCAL"},{"code":"522363","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303406 = Hospital System Supply Identifier | 522363 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 3-5 10MM","code_information":[{"code":"Sx00-5916-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329681","type":"LOCAL"},{"code":"360609","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329681 = Hospital System Supply Identifier | 360609 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT FLUT SZ 4","code_information":[{"code":"Sx00-5916-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303411","type":"LOCAL"},{"code":"522368","type":"LOCAL"}],"standard_charges":[{"gross_charge":2301.75,"discounted_cash":1726.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303411 = Hospital System Supply Identifier | 522368 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT FLUT SZ4","code_information":[{"code":"Sx00-5916-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303412","type":"LOCAL"},{"code":"522369","type":"LOCAL"}],"standard_charges":[{"gross_charge":1960.0,"discounted_cash":1470.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303412 = Hospital System Supply Identifier | 522369 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC D/345 12MM","code_information":[{"code":"Sx00-5916-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303413","type":"LOCAL"},{"code":"522370","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303413 = Hospital System Supply Identifier | 522370 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC D/345 14MM","code_information":[{"code":"Sx00-5916-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303414","type":"LOCAL"},{"code":"522371","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303414 = Hospital System Supply Identifier | 522371 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC D/345 17MM","code_information":[{"code":"Sx00-5916-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303415","type":"LOCAL"},{"code":"522372","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303415 = Hospital System Supply Identifier | 522372 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC D/345 20MM","code_information":[{"code":"Sx00-5916-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303416","type":"LOCAL"},{"code":"522373","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303416 = Hospital System Supply Identifier | 522373 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC E/456 17MM","code_information":[{"code":"Sx00-5916-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303422","type":"LOCAL"},{"code":"522379","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303422 = Hospital System Supply Identifier | 522379 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC E/456 20MM","code_information":[{"code":"Sx00-5916-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303423","type":"LOCAL"},{"code":"522380","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303423 = Hospital System Supply Identifier | 522380 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC E/456 14MM","code_information":[{"code":"Sx00-5916-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303421","type":"LOCAL"},{"code":"522378","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303421 = Hospital System Supply Identifier | 522378 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT FLUT SZ5","code_information":[{"code":"Sx00-5916-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303418","type":"LOCAL"},{"code":"522375","type":"LOCAL"}],"standard_charges":[{"gross_charge":1960.0,"discounted_cash":1470.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303418 = Hospital System Supply Identifier | 522375 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC E/456 10MM","code_information":[{"code":"Sx00-5916-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303419","type":"LOCAL"},{"code":"522376","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303419 = Hospital System Supply Identifier | 522376 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT FLUT SZ5","code_information":[{"code":"Sx00-5916-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303417","type":"LOCAL"},{"code":"522374","type":"LOCAL"}],"standard_charges":[{"gross_charge":2301.75,"discounted_cash":1726.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303417 = Hospital System Supply Identifier | 522374 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC E/456 12MM","code_information":[{"code":"Sx00-5916-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303420","type":"LOCAL"},{"code":"522377","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303420 = Hospital System Supply Identifier | 522377 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC F/567 20MM","code_information":[{"code":"Sx00-5916-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303430","type":"LOCAL"},{"code":"522387","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303430 = Hospital System Supply Identifier | 522387 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC F/567 14MM","code_information":[{"code":"Sx00-5916-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303428","type":"LOCAL"},{"code":"522385","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303428 = Hospital System Supply Identifier | 522385 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC F/567 12MM","code_information":[{"code":"Sx00-5916-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303427","type":"LOCAL"},{"code":"522384","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303427 = Hospital System Supply Identifier | 522384 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC F/567 17MM","code_information":[{"code":"Sx00-5916-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303429","type":"LOCAL"},{"code":"522386","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303429 = Hospital System Supply Identifier | 522386 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT FLUT SZ6","code_information":[{"code":"Sx00-5916-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303425","type":"LOCAL"},{"code":"522382","type":"LOCAL"}],"standard_charges":[{"gross_charge":1960.0,"discounted_cash":1470.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303425 = Hospital System Supply Identifier | 522382 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT FLUT SZ6","code_information":[{"code":"Sx00-5916-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303424","type":"LOCAL"},{"code":"522381","type":"LOCAL"}],"standard_charges":[{"gross_charge":2301.75,"discounted_cash":1726.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303424 = Hospital System Supply Identifier | 522381 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC F/567 10MM","code_information":[{"code":"Sx00-5916-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303426","type":"LOCAL"},{"code":"522383","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303426 = Hospital System Supply Identifier | 522383 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC G/678 17MM","code_information":[{"code":"Sx00-5916-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303436","type":"LOCAL"},{"code":"522393","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303436 = Hospital System Supply Identifier | 522393 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT FLUT SZ7","code_information":[{"code":"Sx00-5916-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303431","type":"LOCAL"},{"code":"522388","type":"LOCAL"}],"standard_charges":[{"gross_charge":2301.75,"discounted_cash":1726.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303431 = Hospital System Supply Identifier | 522388 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT FLUT SZ7","code_information":[{"code":"Sx00-5916-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303432","type":"LOCAL"},{"code":"522389","type":"LOCAL"}],"standard_charges":[{"gross_charge":1960.0,"discounted_cash":1470.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303432 = Hospital System Supply Identifier | 522389 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC G/678 10MM","code_information":[{"code":"Sx00-5916-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303433","type":"LOCAL"},{"code":"522390","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303433 = Hospital System Supply Identifier | 522390 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC G/678 12MM","code_information":[{"code":"Sx00-5916-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303434","type":"LOCAL"},{"code":"522391","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303434 = Hospital System Supply Identifier | 522391 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC G/678 14MM","code_information":[{"code":"Sx00-5916-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303435","type":"LOCAL"},{"code":"522392","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303435 = Hospital System Supply Identifier | 522392 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC G/678 20MM","code_information":[{"code":"Sx00-5916-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303437","type":"LOCAL"},{"code":"522394","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303437 = Hospital System Supply Identifier | 522394 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT FLUT SZ8","code_information":[{"code":"Sx00-5916-080","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303439","type":"LOCAL"},{"code":"522396","type":"LOCAL"}],"standard_charges":[{"gross_charge":1960.0,"discounted_cash":1470.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303439 = Hospital System Supply Identifier | 522396 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT FLUT SZ8","code_information":[{"code":"Sx00-5916-080","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303438","type":"LOCAL"},{"code":"522395","type":"LOCAL"}],"standard_charges":[{"gross_charge":2301.75,"discounted_cash":1726.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303438 = Hospital System Supply Identifier | 522395 = Lawson ID"}]},{"description":"IMP KNEE TIB INS SZ AB/123 10","code_information":[{"code":"Sx00-5917-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303440","type":"LOCAL"},{"code":"522397","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303440 = Hospital System Supply Identifier | 522397 = Lawson ID"}]},{"description":"IMP KNEE TIB INS SZ AB/123 12","code_information":[{"code":"Sx00-5917-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303441","type":"LOCAL"},{"code":"522398","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303441 = Hospital System Supply Identifier | 522398 = Lawson ID"}]},{"description":"IMP KNEE TIB INS SZ AB/123 14","code_information":[{"code":"Sx00-5917-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303442","type":"LOCAL"},{"code":"522399","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303442 = Hospital System Supply Identifier | 522399 = Lawson ID"}]},{"description":"IMP KNEE TIB INS SZ C/234 10MM","code_information":[{"code":"Sx00-5917-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303445","type":"LOCAL"},{"code":"522402","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303445 = Hospital System Supply Identifier | 522402 = Lawson ID"}]},{"description":"IMP KNEE TIB INS SZ C/234 14MM","code_information":[{"code":"Sx00-5917-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303447","type":"LOCAL"},{"code":"522404","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303447 = Hospital System Supply Identifier | 522404 = Lawson ID"}]},{"description":"IMP KNEE TIB INS SZ C/234 17MM","code_information":[{"code":"Sx00-5917-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303448","type":"LOCAL"},{"code":"522405","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303448 = Hospital System Supply Identifier | 522405 = Lawson ID"}]},{"description":"IMP KNEE TIB INS SZ C/234 20MM","code_information":[{"code":"Sx00-5917-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303449","type":"LOCAL"},{"code":"522406","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303449 = Hospital System Supply Identifier | 522406 = Lawson ID"}]},{"description":"IMP KNEE TIB INS SZ D/345 20MM","code_information":[{"code":"Sx00-5917-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303454","type":"LOCAL"},{"code":"522411","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303454 = Hospital System Supply Identifier | 522411 = Lawson ID"}]},{"description":"IMP KNEE TIB INS SZ D/345 17MM","code_information":[{"code":"Sx00-5917-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303453","type":"LOCAL"},{"code":"522410","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303453 = Hospital System Supply Identifier | 522410 = Lawson ID"}]},{"description":"IMP KNEE TIB INS SZ D/345 12MM","code_information":[{"code":"Sx00-5917-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303451","type":"LOCAL"},{"code":"522408","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303451 = Hospital System Supply Identifier | 522408 = Lawson ID"}]},{"description":"IMP KNEE TIB INS SZ D/345 10MM","code_information":[{"code":"Sx00-5917-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303450","type":"LOCAL"},{"code":"522407","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303450 = Hospital System Supply Identifier | 522407 = Lawson ID"}]},{"description":"IMP KNEE TIB INS SZ D/345 14MM","code_information":[{"code":"Sx00-5917-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303452","type":"LOCAL"},{"code":"522409","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303452 = Hospital System Supply Identifier | 522409 = Lawson ID"}]},{"description":"IMP KNEE TIB INS SZ E/456 10MM","code_information":[{"code":"Sx00-5917-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303455","type":"LOCAL"},{"code":"522412","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303455 = Hospital System Supply Identifier | 522412 = Lawson ID"}]},{"description":"IMP KNEE TIB INS SZ E/456 12MM","code_information":[{"code":"Sx00-5917-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303456","type":"LOCAL"},{"code":"522413","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303456 = Hospital System Supply Identifier | 522413 = Lawson ID"}]},{"description":"IMP KNEE TIB INS SZ E/456 14MM","code_information":[{"code":"Sx00-5917-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303457","type":"LOCAL"},{"code":"522414","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303457 = Hospital System Supply Identifier | 522414 = Lawson ID"}]},{"description":"IMP KNEE TIB INS SZ E/456 17MM","code_information":[{"code":"Sx00-5917-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303458","type":"LOCAL"},{"code":"522415","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303458 = Hospital System Supply Identifier | 522415 = Lawson ID"}]},{"description":"IMP KNEE TIB INS SZ E/456 20MM","code_information":[{"code":"Sx00-5917-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303459","type":"LOCAL"},{"code":"522416","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303459 = Hospital System Supply Identifier | 522416 = Lawson ID"}]},{"description":"IMP KNEE TIB INS SZ F/567 20MM","code_information":[{"code":"Sx00-5917-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303464","type":"LOCAL"},{"code":"522421","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303464 = Hospital System Supply Identifier | 522421 = Lawson ID"}]},{"description":"IMP KNEE TIB INS SZ F/567 14MM","code_information":[{"code":"Sx00-5917-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303462","type":"LOCAL"},{"code":"522419","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303462 = Hospital System Supply Identifier | 522419 = Lawson ID"}]},{"description":"IMP KNEE TIB INS SZ F/567 12MM","code_information":[{"code":"Sx00-5917-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303461","type":"LOCAL"},{"code":"522418","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303461 = Hospital System Supply Identifier | 522418 = Lawson ID"}]},{"description":"IMP KNEE TIB INS SZ F/567 10MM","code_information":[{"code":"Sx00-5917-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303460","type":"LOCAL"},{"code":"522417","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303460 = Hospital System Supply Identifier | 522417 = Lawson ID"}]},{"description":"IMP KNEE TIB INS SZ G/678 10MM","code_information":[{"code":"Sx00-5917-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303465","type":"LOCAL"},{"code":"522422","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303465 = Hospital System Supply Identifier | 522422 = Lawson ID"}]},{"description":"IMP KNEE TIB INS SZ G/678 12MM","code_information":[{"code":"Sx00-5917-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303466","type":"LOCAL"},{"code":"522423","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303466 = Hospital System Supply Identifier | 522423 = Lawson ID"}]},{"description":"IMP KNEE TIB INS SZ G/678 14MM","code_information":[{"code":"Sx00-5917-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303467","type":"LOCAL"},{"code":"522424","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303467 = Hospital System Supply Identifier | 522424 = Lawson ID"}]},{"description":"IMP KNEE TIB INS SZ G/678 17MM","code_information":[{"code":"Sx00-5917-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303468","type":"LOCAL"},{"code":"522425","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303468 = Hospital System Supply Identifier | 522425 = Lawson ID"}]},{"description":"IMP KNEE TIB INS SZ G/678 20MM","code_information":[{"code":"Sx00-5917-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303469","type":"LOCAL"},{"code":"522426","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303469 = Hospital System Supply Identifier | 522426 = Lawson ID"}]},{"description":"IMP KNEE FEM RT SZ1","code_information":[{"code":"Sx00-5926-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"198353","type":"LOCAL"},{"code":"443602","type":"LOCAL"}],"standard_charges":[{"gross_charge":5891.0,"discounted_cash":4418.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 198353 = Hospital System Supply Identifier | 443602 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP CEM SZ1 LT","code_information":[{"code":"Sx00-5926-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303470","type":"LOCAL"},{"code":"522427","type":"LOCAL"}],"standard_charges":[{"gross_charge":5891.0,"discounted_cash":4418.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303470 = Hospital System Supply Identifier | 522427 = Lawson ID"}]},{"description":"IMP KNEE FEM NXGN LT SZ2","code_information":[{"code":"Sx00-5926-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"196547","type":"LOCAL"},{"code":"412512","type":"LOCAL"}],"standard_charges":[{"gross_charge":5891.0,"discounted_cash":4418.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 196547 = Hospital System Supply Identifier | 412512 = Lawson ID"}]},{"description":"IMP KNEE FEM NXGN RT SZ2","code_information":[{"code":"Sx00-5926-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"195908","type":"LOCAL"},{"code":"395488","type":"LOCAL"}],"standard_charges":[{"gross_charge":5891.0,"discounted_cash":4418.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 195908 = Hospital System Supply Identifier | 395488 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZ3","code_information":[{"code":"Sx00-5926-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"194867","type":"LOCAL"},{"code":"355204","type":"LOCAL"}],"standard_charges":[{"gross_charge":5891.0,"discounted_cash":4418.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 194867 = Hospital System Supply Identifier | 355204 = Lawson ID"}]},{"description":"IMP KNEE FEM NXGN LT SZ3","code_information":[{"code":"Sx00-5926-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"196548","type":"LOCAL"},{"code":"412513","type":"LOCAL"}],"standard_charges":[{"gross_charge":5891.0,"discounted_cash":4418.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 196548 = Hospital System Supply Identifier | 412513 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZ4","code_information":[{"code":"Sx00-5926-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325953","type":"LOCAL"},{"code":"373922","type":"LOCAL"}],"standard_charges":[{"gross_charge":5891.0,"discounted_cash":4418.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 325953 = Hospital System Supply Identifier | 373922 = Lawson ID"}]},{"description":"IMP KNEE FEM NXGN LT SZ4","code_information":[{"code":"Sx00-5926-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"327193","type":"LOCAL"},{"code":"412514","type":"LOCAL"}],"standard_charges":[{"gross_charge":5891.0,"discounted_cash":4418.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 327193 = Hospital System Supply Identifier | 412514 = Lawson ID"}]},{"description":"IMP KNEE FEM NXGN LT SZ5","code_information":[{"code":"Sx00-5926-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"196549","type":"LOCAL"},{"code":"412515","type":"LOCAL"}],"standard_charges":[{"gross_charge":5891.0,"discounted_cash":4418.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 196549 = Hospital System Supply Identifier | 412515 = Lawson ID"}]},{"description":"IMP KNEE FEM NXGN RT SZ5","code_information":[{"code":"Sx00-5926-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"327194","type":"LOCAL"},{"code":"412516","type":"LOCAL"}],"standard_charges":[{"gross_charge":5891.0,"discounted_cash":4418.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 327194 = Hospital System Supply Identifier | 412516 = Lawson ID"}]},{"description":"BUR MILLING STD GENDER KNEE","code_information":[{"code":"Sx00-5927-050","type":"CDM"},{"code":"272","type":"RC"},{"code":"194868","type":"LOCAL"},{"code":"355205","type":"LOCAL"}],"standard_charges":[{"gross_charge":278.35,"discounted_cash":208.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 194868 = Hospital System Supply Identifier | 355205 = Lawson ID"}]},{"description":"DRILL KNEE FEM PEG/TAIL","code_information":[{"code":"Sx00-5927-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"449641","type":"LOCAL"},{"code":"421389","type":"LOCAL"}],"standard_charges":[{"gross_charge":451.22,"discounted_cash":338.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 449641 = Hospital System Supply Identifier | 421389 = Lawson ID"}]},{"description":"PIN HLDG SM HD NEXGEN 4/BX","code_information":[{"code":"Sx00-5941-006","type":"CDM"},{"code":"272","type":"RC"},{"code":"581897","type":"LOCAL"},{"code":"676009","type":"LOCAL"}],"standard_charges":[{"gross_charge":190.45,"discounted_cash":142.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 581897 = Hospital System Supply Identifier | 676009 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZC","code_information":[{"code":"Sx00-5950-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"323420","type":"LOCAL"},{"code":"223284","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 323420 = Hospital System Supply Identifier | 223284 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZC","code_information":[{"code":"Sx00-5950-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"323421","type":"LOCAL"},{"code":"223285","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 323421 = Hospital System Supply Identifier | 223285 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZC","code_information":[{"code":"Sx00-5950-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"179103","type":"LOCAL"},{"code":"223282","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 179103 = Hospital System Supply Identifier | 223282 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZC","code_information":[{"code":"Sx00-5950-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"323419","type":"LOCAL"},{"code":"223283","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 323419 = Hospital System Supply Identifier | 223283 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZD","code_information":[{"code":"Sx00-5950-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"146863","type":"LOCAL"},{"code":"223289","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 146863 = Hospital System Supply Identifier | 223289 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZD","code_information":[{"code":"Sx00-5950-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"323422","type":"LOCAL"},{"code":"223288","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 323422 = Hospital System Supply Identifier | 223288 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZD","code_information":[{"code":"Sx00-5950-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"179105","type":"LOCAL"},{"code":"223287","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 179105 = Hospital System Supply Identifier | 223287 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZD","code_information":[{"code":"Sx00-5950-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"179104","type":"LOCAL"},{"code":"223286","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 179104 = Hospital System Supply Identifier | 223286 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZE","code_information":[{"code":"Sx00-5950-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"146864","type":"LOCAL"},{"code":"223290","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 146864 = Hospital System Supply Identifier | 223290 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZE","code_information":[{"code":"Sx00-5950-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"179106","type":"LOCAL"},{"code":"223291","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 179106 = Hospital System Supply Identifier | 223291 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZE","code_information":[{"code":"Sx00-5950-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"178236","type":"LOCAL"},{"code":"223292","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 178236 = Hospital System Supply Identifier | 223292 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZE","code_information":[{"code":"Sx00-5950-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"323423","type":"LOCAL"},{"code":"223293","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 323423 = Hospital System Supply Identifier | 223293 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZF","code_information":[{"code":"Sx00-5950-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"179107","type":"LOCAL"},{"code":"223294","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 179107 = Hospital System Supply Identifier | 223294 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZF","code_information":[{"code":"Sx00-5950-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"179108","type":"LOCAL"},{"code":"223295","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 179108 = Hospital System Supply Identifier | 223295 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZF","code_information":[{"code":"Sx00-5950-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"323424","type":"LOCAL"},{"code":"223296","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 323424 = Hospital System Supply Identifier | 223296 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZF","code_information":[{"code":"Sx00-5950-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"179109","type":"LOCAL"},{"code":"223297","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 179109 = Hospital System Supply Identifier | 223297 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZG","code_information":[{"code":"Sx00-5950-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"179110","type":"LOCAL"},{"code":"223298","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 179110 = Hospital System Supply Identifier | 223298 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZG","code_information":[{"code":"Sx00-5950-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"179111","type":"LOCAL"},{"code":"223299","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 179111 = Hospital System Supply Identifier | 223299 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZG","code_information":[{"code":"Sx00-5950-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"323425","type":"LOCAL"},{"code":"223300","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 323425 = Hospital System Supply Identifier | 223300 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZG","code_information":[{"code":"Sx00-5950-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"179112","type":"LOCAL"},{"code":"223301","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 179112 = Hospital System Supply Identifier | 223301 = Lawson ID"}]},{"description":"IMP STEM MIS DROP DN 45 EXT","code_information":[{"code":"Sx00-5950-067","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202347","type":"LOCAL"},{"code":"452446","type":"LOCAL"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 202347 = Hospital System Supply Identifier | 452446 = Lawson ID"}]},{"description":"IMP STEM MIS DROP DN PLUG EXT","code_information":[{"code":"Sx00-5950-067","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202349","type":"LOCAL"},{"code":"452448","type":"LOCAL"}],"standard_charges":[{"gross_charge":2101.68,"discounted_cash":1576.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 202349 = Hospital System Supply Identifier | 452448 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZD","code_information":[{"code":"Sx00-5952-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325560","type":"LOCAL"},{"code":"354407","type":"LOCAL"}],"standard_charges":[{"gross_charge":3808.75,"discounted_cash":2856.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 325560 = Hospital System Supply Identifier | 354407 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZD","code_information":[{"code":"Sx00-5952-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325556","type":"LOCAL"},{"code":"354403","type":"LOCAL"}],"standard_charges":[{"gross_charge":3808.75,"discounted_cash":2856.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 325556 = Hospital System Supply Identifier | 354403 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZF","code_information":[{"code":"Sx00-5952-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"149127","type":"LOCAL"},{"code":"236427","type":"LOCAL"}],"standard_charges":[{"gross_charge":3808.75,"discounted_cash":2856.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 149127 = Hospital System Supply Identifier | 236427 = Lawson ID"}]},{"description":"IMP KNEE FEM INS NXGN CR F-MNS","code_information":[{"code":"Sx00-5952-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"149594","type":"LOCAL"},{"code":"237017","type":"LOCAL"}],"standard_charges":[{"gross_charge":3808.75,"discounted_cash":2856.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 149594 = Hospital System Supply Identifier | 237017 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZF","code_information":[{"code":"Sx00-5952-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325557","type":"LOCAL"},{"code":"354404","type":"LOCAL"}],"standard_charges":[{"gross_charge":3808.75,"discounted_cash":2856.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 325557 = Hospital System Supply Identifier | 354404 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZG","code_information":[{"code":"Sx00-5952-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325559","type":"LOCAL"},{"code":"354406","type":"LOCAL"}],"standard_charges":[{"gross_charge":3808.75,"discounted_cash":2856.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 325559 = Hospital System Supply Identifier | 354406 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZG","code_information":[{"code":"Sx00-5952-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"179211","type":"LOCAL"},{"code":"354408","type":"LOCAL"}],"standard_charges":[{"gross_charge":3808.75,"discounted_cash":2856.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 179211 = Hospital System Supply Identifier | 354408 = Lawson ID"}]},{"description":"IMP KNEE TIB INS NXGN CR 10MM","code_information":[{"code":"Sx00-5952-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"146885","type":"LOCAL"},{"code":"223569","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 146885 = Hospital System Supply Identifier | 223569 = Lawson ID"}]},{"description":"IMP KNEE TIB INS NXGN CR 12MM","code_information":[{"code":"Sx00-5952-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"146886","type":"LOCAL"},{"code":"223570","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 146886 = Hospital System Supply Identifier | 223570 = Lawson ID"}]},{"description":"IMP KNEE TIB INS NXGN CR 14MM","code_information":[{"code":"Sx00-5952-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"192144","type":"LOCAL"},{"code":"223571","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 192144 = Hospital System Supply Identifier | 223571 = Lawson ID"}]},{"description":"IMP TIB INS NXGN 3-4 10MM","code_information":[{"code":"Sx00-5952-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"146865","type":"LOCAL"},{"code":"223302","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 146865 = Hospital System Supply Identifier | 223302 = Lawson ID"}]},{"description":"IMP TIB INS NXGN 3-4 12MM","code_information":[{"code":"Sx00-5952-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"146866","type":"LOCAL"},{"code":"223303","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 146866 = Hospital System Supply Identifier | 223303 = Lawson ID"}]},{"description":"IMP TIB INS NXGN 3-4 14MM","code_information":[{"code":"Sx00-5952-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"146867","type":"LOCAL"},{"code":"223304","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 146867 = Hospital System Supply Identifier | 223304 = Lawson ID"}]},{"description":"IMP TIB INS NXGN 5-6 10MM","code_information":[{"code":"Sx00-5952-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"146868","type":"LOCAL"},{"code":"223307","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 146868 = Hospital System Supply Identifier | 223307 = Lawson ID"}]},{"description":"IMP TIB INS NXGN 5-6 12MM","code_information":[{"code":"Sx00-5952-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"179113","type":"LOCAL"},{"code":"223308","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 179113 = Hospital System Supply Identifier | 223308 = Lawson ID"}]},{"description":"IMP TIB INS NXGN 5-6 14MM","code_information":[{"code":"Sx00-5952-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"146869","type":"LOCAL"},{"code":"223309","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 146869 = Hospital System Supply Identifier | 223309 = Lawson ID"}]},{"description":"IMP TIB INS NXGN 7-10 12MM","code_information":[{"code":"Sx00-5952-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"179114","type":"LOCAL"},{"code":"223313","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 179114 = Hospital System Supply Identifier | 223313 = Lawson ID"}]},{"description":"IMP TIB INS NXGN 7-10 14MM","code_information":[{"code":"Sx00-5952-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"192119","type":"LOCAL"},{"code":"223314","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 192119 = Hospital System Supply Identifier | 223314 = Lawson ID"}]},{"description":"IMP TIB INS NXGN 7-10 10MM","code_information":[{"code":"Sx00-5952-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"178238","type":"LOCAL"},{"code":"223312","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 178238 = Hospital System Supply Identifier | 223312 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT MOD SZ2","code_information":[{"code":"Sx00-5954-027","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303484","type":"LOCAL"},{"code":"522441","type":"LOCAL"}],"standard_charges":[{"gross_charge":2232.0,"discounted_cash":1674.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303484 = Hospital System Supply Identifier | 522441 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT NXGN SZ4","code_information":[{"code":"Sx00-5954-037","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"328270","type":"LOCAL"},{"code":"441625","type":"LOCAL"}],"standard_charges":[{"gross_charge":2232.0,"discounted_cash":1674.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 328270 = Hospital System Supply Identifier | 441625 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT NXGN SZ3","code_information":[{"code":"Sx00-5954-037","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"327196","type":"LOCAL"},{"code":"412525","type":"LOCAL"}],"standard_charges":[{"gross_charge":2232.0,"discounted_cash":1674.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 327196 = Hospital System Supply Identifier | 412525 = Lawson ID"}]},{"description":"TIBIAL FIXED BEARING SZ 5","code_information":[{"code":"Sx00-5954-047","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329808","type":"LOCAL"},{"code":"379487","type":"LOCAL"}],"standard_charges":[{"gross_charge":2232.0,"discounted_cash":1674.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329808 = Hospital System Supply Identifier | 379487 = Lawson ID"}]},{"description":"TIBIAL FIXED BEARING SZ 6","code_information":[{"code":"Sx00-5954-047","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"179309","type":"LOCAL"},{"code":"441626","type":"LOCAL"}],"standard_charges":[{"gross_charge":2232.0,"discounted_cash":1674.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 179309 = Hospital System Supply Identifier | 441626 = Lawson ID"}]},{"description":"TIBIAL TRAY TRIBECULAR SZ 7","code_information":[{"code":"Sx00-5954-057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"662131","type":"LOCAL"},{"code":"376282","type":"LOCAL"}],"standard_charges":[{"gross_charge":2232.0,"discounted_cash":1674.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 662131 = Hospital System Supply Identifier | 376282 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT MOD SZ8","code_information":[{"code":"Sx00-5954-057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303485","type":"LOCAL"},{"code":"522442","type":"LOCAL"}],"standard_charges":[{"gross_charge":2232.0,"discounted_cash":1674.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303485 = Hospital System Supply Identifier | 522442 = Lawson ID"}]},{"description":"SCREW FLX MIS TRAB METAL","code_information":[{"code":"Sx00-5954-090","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"303486","type":"LOCAL"},{"code":"522443","type":"LOCAL"}],"standard_charges":[{"gross_charge":215.35,"discounted_cash":161.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303486 = Hospital System Supply Identifier | 522443 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZA","code_information":[{"code":"Sx00-5960-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303489","type":"LOCAL"},{"code":"522446","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303489 = Hospital System Supply Identifier | 522446 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZA","code_information":[{"code":"Sx00-5960-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303490","type":"LOCAL"},{"code":"522447","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303490 = Hospital System Supply Identifier | 522447 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZB","code_information":[{"code":"Sx00-5960-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"324421","type":"LOCAL"},{"code":"298189","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 324421 = Hospital System Supply Identifier | 298189 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZB","code_information":[{"code":"Sx00-5960-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"324420","type":"LOCAL"},{"code":"298188","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 324420 = Hospital System Supply Identifier | 298188 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZH","code_information":[{"code":"Sx00-5960-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"170312","type":"LOCAL"},{"code":"412542","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 170312 = Hospital System Supply Identifier | 412542 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP LPS-FLX SZH","code_information":[{"code":"Sx00-5960-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"171791","type":"LOCAL"},{"code":"439194","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 171791 = Hospital System Supply Identifier | 439194 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC AB 1-2 10MM","code_information":[{"code":"Sx00-5960-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303495","type":"LOCAL"},{"code":"522452","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303495 = Hospital System Supply Identifier | 522452 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC AB 1-2 12MM","code_information":[{"code":"Sx00-5960-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303496","type":"LOCAL"},{"code":"522453","type":"LOCAL"}],"standard_charges":[{"gross_charge":1128.0,"discounted_cash":846.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303496 = Hospital System Supply Identifier | 522453 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC AB 1-2 14MM","code_information":[{"code":"Sx00-5960-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303497","type":"LOCAL"},{"code":"522454","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303497 = Hospital System Supply Identifier | 522454 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC AB 1-2 17MM","code_information":[{"code":"Sx00-5960-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303498","type":"LOCAL"},{"code":"522455","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303498 = Hospital System Supply Identifier | 522455 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC AB 1-2 20MM","code_information":[{"code":"Sx00-5960-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303499","type":"LOCAL"},{"code":"522456","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303499 = Hospital System Supply Identifier | 522456 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC CD 1-2 17MM","code_information":[{"code":"Sx00-5960-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303503","type":"LOCAL"},{"code":"522460","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303503 = Hospital System Supply Identifier | 522460 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC CD 1-2 20MM","code_information":[{"code":"Sx00-5960-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303504","type":"LOCAL"},{"code":"522461","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303504 = Hospital System Supply Identifier | 522461 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC CD 1-2 14MM","code_information":[{"code":"Sx00-5960-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303502","type":"LOCAL"},{"code":"522459","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303502 = Hospital System Supply Identifier | 522459 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC CD 1-2 12MM","code_information":[{"code":"Sx00-5960-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303501","type":"LOCAL"},{"code":"522458","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303501 = Hospital System Supply Identifier | 522458 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC CD 1-2 10MM","code_information":[{"code":"Sx00-5960-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303500","type":"LOCAL"},{"code":"522457","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303500 = Hospital System Supply Identifier | 522457 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC CD 3-4 10MM","code_information":[{"code":"Sx00-5960-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303505","type":"LOCAL"},{"code":"522462","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303505 = Hospital System Supply Identifier | 522462 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC CD 3-4 12MM","code_information":[{"code":"Sx00-5960-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303506","type":"LOCAL"},{"code":"522463","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303506 = Hospital System Supply Identifier | 522463 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC CD 3-4 14MM","code_information":[{"code":"Sx00-5960-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303507","type":"LOCAL"},{"code":"522464","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303507 = Hospital System Supply Identifier | 522464 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC CD 3-4 17MM","code_information":[{"code":"Sx00-5960-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303508","type":"LOCAL"},{"code":"522465","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303508 = Hospital System Supply Identifier | 522465 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC CD 3-4 20MM","code_information":[{"code":"Sx00-5960-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303509","type":"LOCAL"},{"code":"522466","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303509 = Hospital System Supply Identifier | 522466 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC EF 3-4 10MM","code_information":[{"code":"Sx00-5960-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303510","type":"LOCAL"},{"code":"522467","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303510 = Hospital System Supply Identifier | 522467 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC EF 3-4 12MM","code_information":[{"code":"Sx00-5960-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303511","type":"LOCAL"},{"code":"522468","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303511 = Hospital System Supply Identifier | 522468 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC EF 3-4 14MM","code_information":[{"code":"Sx00-5960-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303512","type":"LOCAL"},{"code":"522469","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303512 = Hospital System Supply Identifier | 522469 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC EF 3-4 17MM","code_information":[{"code":"Sx00-5960-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303513","type":"LOCAL"},{"code":"522470","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303513 = Hospital System Supply Identifier | 522470 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC EF 3-4 20MM","code_information":[{"code":"Sx00-5960-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303514","type":"LOCAL"},{"code":"522471","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303514 = Hospital System Supply Identifier | 522471 = Lawson ID"}]},{"description":"IMP KNEE TIB INS NXGN SZ5-6 14","code_information":[{"code":"Sx00-5960-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"149063","type":"LOCAL"},{"code":"236350","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 149063 = Hospital System Supply Identifier | 236350 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC EF 5-6 10MM","code_information":[{"code":"Sx00-5960-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303515","type":"LOCAL"},{"code":"522472","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303515 = Hospital System Supply Identifier | 522472 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC EF 5-6 12MM","code_information":[{"code":"Sx00-5960-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303516","type":"LOCAL"},{"code":"522473","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303516 = Hospital System Supply Identifier | 522473 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC EF 5-6 17MM","code_information":[{"code":"Sx00-5960-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303517","type":"LOCAL"},{"code":"522474","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303517 = Hospital System Supply Identifier | 522474 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC EF 5-6 20MM","code_information":[{"code":"Sx00-5960-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303518","type":"LOCAL"},{"code":"522475","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303518 = Hospital System Supply Identifier | 522475 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC CD 5-6 20MM","code_information":[{"code":"Sx00-5960-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303523","type":"LOCAL"},{"code":"522480","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303523 = Hospital System Supply Identifier | 522480 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC CD 5-6 17MM","code_information":[{"code":"Sx00-5960-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303522","type":"LOCAL"},{"code":"522479","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303522 = Hospital System Supply Identifier | 522479 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC CD 5-6 10MM","code_information":[{"code":"Sx00-5960-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303519","type":"LOCAL"},{"code":"522476","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303519 = Hospital System Supply Identifier | 522476 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC CD 5-6 12MM","code_information":[{"code":"Sx00-5960-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303520","type":"LOCAL"},{"code":"522477","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303520 = Hospital System Supply Identifier | 522477 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC CD 5-6 14MM","code_information":[{"code":"Sx00-5960-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303521","type":"LOCAL"},{"code":"522478","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303521 = Hospital System Supply Identifier | 522478 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC GH 5-6 10MM","code_information":[{"code":"Sx00-5960-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303524","type":"LOCAL"},{"code":"522481","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303524 = Hospital System Supply Identifier | 522481 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC GH 5-6 12MM","code_information":[{"code":"Sx00-5960-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303525","type":"LOCAL"},{"code":"522482","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303525 = Hospital System Supply Identifier | 522482 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC GH 5-6 14MM","code_information":[{"code":"Sx00-5960-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303526","type":"LOCAL"},{"code":"522483","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303526 = Hospital System Supply Identifier | 522483 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC GH 5-6 17MM","code_information":[{"code":"Sx00-5960-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303527","type":"LOCAL"},{"code":"522484","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303527 = Hospital System Supply Identifier | 522484 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC GH 5-6 20MM","code_information":[{"code":"Sx00-5960-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303528","type":"LOCAL"},{"code":"522485","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303528 = Hospital System Supply Identifier | 522485 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC GH 7-10 20","code_information":[{"code":"Sx00-5960-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303533","type":"LOCAL"},{"code":"522490","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303533 = Hospital System Supply Identifier | 522490 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC GH 7-10 14","code_information":[{"code":"Sx00-5960-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303531","type":"LOCAL"},{"code":"522488","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303531 = Hospital System Supply Identifier | 522488 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC GH 7-10 17","code_information":[{"code":"Sx00-5960-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303532","type":"LOCAL"},{"code":"522489","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303532 = Hospital System Supply Identifier | 522489 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC GH 7-10 10","code_information":[{"code":"Sx00-5960-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303529","type":"LOCAL"},{"code":"522486","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303529 = Hospital System Supply Identifier | 522486 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC GH 7-10 12","code_information":[{"code":"Sx00-5960-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303530","type":"LOCAL"},{"code":"522487","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303530 = Hospital System Supply Identifier | 522487 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC EF 7-10 10","code_information":[{"code":"Sx00-5960-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303534","type":"LOCAL"},{"code":"522491","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303534 = Hospital System Supply Identifier | 522491 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC EF 7-10 12","code_information":[{"code":"Sx00-5960-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303535","type":"LOCAL"},{"code":"522492","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303535 = Hospital System Supply Identifier | 522492 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC EF 7-10 14","code_information":[{"code":"Sx00-5960-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303536","type":"LOCAL"},{"code":"522493","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303536 = Hospital System Supply Identifier | 522493 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC EF 7-10 17","code_information":[{"code":"Sx00-5960-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303537","type":"LOCAL"},{"code":"522494","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303537 = Hospital System Supply Identifier | 522494 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC EF 7-10 20","code_information":[{"code":"Sx00-5960-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303538","type":"LOCAL"},{"code":"522495","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303538 = Hospital System Supply Identifier | 522495 = Lawson ID"}]},{"description":"SCREW LOK MIS MOD LCCK","code_information":[{"code":"Sx00-5960-092","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"303540","type":"LOCAL"},{"code":"522497","type":"LOCAL"}],"standard_charges":[{"gross_charge":219.75,"discounted_cash":164.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303540 = Hospital System Supply Identifier | 522497 = Lawson ID"}]},{"description":"PLUG TAPIER STEM","code_information":[{"code":"Sx00-5960-099","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"145669","type":"LOCAL"},{"code":"223415","type":"LOCAL"}],"standard_charges":[{"gross_charge":146.5,"discounted_cash":109.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 145669 = Hospital System Supply Identifier | 223415 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL AB 1-2 20M","code_information":[{"code":"Sx00-5962-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329220","type":"LOCAL"},{"code":"298142","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329220 = Hospital System Supply Identifier | 298142 = Lawson ID"}]},{"description":"IMP KNEE TIB INS NXGN 1-2 23","code_information":[{"code":"Sx00-5962-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"449633","type":"LOCAL"},{"code":"401997","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 449633 = Hospital System Supply Identifier | 401997 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 1-2 17MM","code_information":[{"code":"Sx00-5962-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329219","type":"LOCAL"},{"code":"298141","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329219 = Hospital System Supply Identifier | 298141 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 1-2 10MM","code_information":[{"code":"Sx00-5962-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329216","type":"LOCAL"},{"code":"298138","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329216 = Hospital System Supply Identifier | 298138 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 1-2 12MM","code_information":[{"code":"Sx00-5962-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329217","type":"LOCAL"},{"code":"298139","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329217 = Hospital System Supply Identifier | 298139 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 1-2 14MM","code_information":[{"code":"Sx00-5962-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329218","type":"LOCAL"},{"code":"298140","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329218 = Hospital System Supply Identifier | 298140 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 1-2 10MM","code_information":[{"code":"Sx00-5962-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"169647","type":"LOCAL"},{"code":"298143","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 169647 = Hospital System Supply Identifier | 298143 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 1-2 12MM","code_information":[{"code":"Sx00-5962-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"154584","type":"LOCAL"},{"code":"298144","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 154584 = Hospital System Supply Identifier | 298144 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 1-2 14MM","code_information":[{"code":"Sx00-5962-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"145979","type":"LOCAL"},{"code":"298145","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 145979 = Hospital System Supply Identifier | 298145 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 1-2 17MM","code_information":[{"code":"Sx00-5962-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"154585","type":"LOCAL"},{"code":"298146","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 154585 = Hospital System Supply Identifier | 298146 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL CD 1-2 20M","code_information":[{"code":"Sx00-5962-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"193378","type":"LOCAL"},{"code":"298147","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 193378 = Hospital System Supply Identifier | 298147 = Lawson ID"}]},{"description":"IMP KNEE TIB INS NXGN CD1-2 23","code_information":[{"code":"Sx00-5962-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"196564","type":"LOCAL"},{"code":"412544","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 196564 = Hospital System Supply Identifier | 412544 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC NXGN 17","code_information":[{"code":"Sx00-5962-024","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"327307","type":"LOCAL"},{"code":"416876","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 327307 = Hospital System Supply Identifier | 416876 = Lawson ID"}]},{"description":"IMP KNEE ART SURF NXGN SZE 10","code_information":[{"code":"Sx00-5962-024","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"170362","type":"LOCAL"},{"code":"418244","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 170362 = Hospital System Supply Identifier | 418244 = Lawson ID"}]},{"description":"IMP KNEE ART SURF NXGN SZE 12","code_information":[{"code":"Sx00-5962-024","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"171771","type":"LOCAL"},{"code":"418245","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 171771 = Hospital System Supply Identifier | 418245 = Lawson ID"}]},{"description":"IMP KNEE ART SURF NXGN SZE 14","code_information":[{"code":"Sx00-5962-024","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"170363","type":"LOCAL"},{"code":"418246","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 170363 = Hospital System Supply Identifier | 418246 = Lawson ID"}]},{"description":"IMP KNEE SURF PROLNG E 1-2 20","code_information":[{"code":"Sx00-5962-024","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303552","type":"LOCAL"},{"code":"522509","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303552 = Hospital System Supply Identifier | 522509 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 3-4 20MM","code_information":[{"code":"Sx00-5962-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"193380","type":"LOCAL"},{"code":"298152","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 193380 = Hospital System Supply Identifier | 298152 = Lawson ID"}]},{"description":"IMP KNEE TIB INS NXGN 3-4 23MM","code_information":[{"code":"Sx00-5962-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"196565","type":"LOCAL"},{"code":"412545","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 196565 = Hospital System Supply Identifier | 412545 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 3-4 17MM","code_information":[{"code":"Sx00-5962-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"193379","type":"LOCAL"},{"code":"298151","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 193379 = Hospital System Supply Identifier | 298151 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 3-4 10MM","code_information":[{"code":"Sx00-5962-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"169648","type":"LOCAL"},{"code":"298148","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 169648 = Hospital System Supply Identifier | 298148 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 3-4 12MM","code_information":[{"code":"Sx00-5962-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"169649","type":"LOCAL"},{"code":"298149","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 169649 = Hospital System Supply Identifier | 298149 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 3-4 14MM","code_information":[{"code":"Sx00-5962-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"154586","type":"LOCAL"},{"code":"298150","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 154586 = Hospital System Supply Identifier | 298150 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 1-2 10MM","code_information":[{"code":"Sx00-5962-031","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329221","type":"LOCAL"},{"code":"298153","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329221 = Hospital System Supply Identifier | 298153 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 1-2 12MM","code_information":[{"code":"Sx00-5962-031","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329222","type":"LOCAL"},{"code":"298154","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329222 = Hospital System Supply Identifier | 298154 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 1-2 14MM","code_information":[{"code":"Sx00-5962-031","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329223","type":"LOCAL"},{"code":"298155","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329223 = Hospital System Supply Identifier | 298155 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 1-2 17MM","code_information":[{"code":"Sx00-5962-031","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329224","type":"LOCAL"},{"code":"298156","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329224 = Hospital System Supply Identifier | 298156 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 1-2 20MM","code_information":[{"code":"Sx00-5962-031","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329225","type":"LOCAL"},{"code":"298157","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329225 = Hospital System Supply Identifier | 298157 = Lawson ID"}]},{"description":"IMP KNEE TIB INS NXGN 3-4 23","code_information":[{"code":"Sx00-5962-031","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"449634","type":"LOCAL"},{"code":"401998","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 449634 = Hospital System Supply Identifier | 401998 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 3-4 10MM","code_information":[{"code":"Sx00-5962-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"154587","type":"LOCAL"},{"code":"298158","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 154587 = Hospital System Supply Identifier | 298158 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 3-4 12MM","code_information":[{"code":"Sx00-5962-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"154588","type":"LOCAL"},{"code":"298159","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 154588 = Hospital System Supply Identifier | 298159 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 3-4 14MM","code_information":[{"code":"Sx00-5962-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"154589","type":"LOCAL"},{"code":"298160","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 154589 = Hospital System Supply Identifier | 298160 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 3-4 17MM","code_information":[{"code":"Sx00-5962-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"154590","type":"LOCAL"},{"code":"298161","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 154590 = Hospital System Supply Identifier | 298161 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 3-4 20MM","code_information":[{"code":"Sx00-5962-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"193381","type":"LOCAL"},{"code":"298162","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 193381 = Hospital System Supply Identifier | 298162 = Lawson ID"}]},{"description":"IMP KNEE TIB INS NXGN 3-4 23MM","code_information":[{"code":"Sx00-5962-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"196566","type":"LOCAL"},{"code":"412546","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 196566 = Hospital System Supply Identifier | 412546 = Lawson ID"}]},{"description":"IMP KNEE SURF PROLNG G 3-4 20","code_information":[{"code":"Sx00-5962-034","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303555","type":"LOCAL"},{"code":"522512","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303555 = Hospital System Supply Identifier | 522512 = Lawson ID"}]},{"description":"IMP KNEE SURF PROLNG G 3-4 17","code_information":[{"code":"Sx00-5962-034","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303554","type":"LOCAL"},{"code":"522511","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303554 = Hospital System Supply Identifier | 522511 = Lawson ID"}]},{"description":"IMP KNEE SURF PROLNG G 3-4 14","code_information":[{"code":"Sx00-5962-034","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303553","type":"LOCAL"},{"code":"522510","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303553 = Hospital System Supply Identifier | 522510 = Lawson ID"}]},{"description":"IMP KNEE ART SURF NXGN SZG 10","code_information":[{"code":"Sx00-5962-034","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"327317","type":"LOCAL"},{"code":"418247","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 327317 = Hospital System Supply Identifier | 418247 = Lawson ID"}]},{"description":"IMP KNEE ART SURF NXGN SZG 12","code_information":[{"code":"Sx00-5962-034","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"170364","type":"LOCAL"},{"code":"418248","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 170364 = Hospital System Supply Identifier | 418248 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 5-6 10MM","code_information":[{"code":"Sx00-5962-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"154591","type":"LOCAL"},{"code":"298163","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 154591 = Hospital System Supply Identifier | 298163 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 5-6 12MM","code_information":[{"code":"Sx00-5962-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"154592","type":"LOCAL"},{"code":"298164","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 154592 = Hospital System Supply Identifier | 298164 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 5-6 17MM","code_information":[{"code":"Sx00-5962-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"154593","type":"LOCAL"},{"code":"298166","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 154593 = Hospital System Supply Identifier | 298166 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 5-6 20MM","code_information":[{"code":"Sx00-5962-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"154594","type":"LOCAL"},{"code":"298167","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 154594 = Hospital System Supply Identifier | 298167 = Lawson ID"}]},{"description":"IMP SURF PROLNG FLX 14 E F 5-6","code_information":[{"code":"Sx00-5962-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"166087","type":"LOCAL"},{"code":"390516","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 166087 = Hospital System Supply Identifier | 390516 = Lawson ID"}]},{"description":"IMP KNEE TIB INS NXGN 5-6 23MM","code_information":[{"code":"Sx00-5962-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"196567","type":"LOCAL"},{"code":"412547","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 196567 = Hospital System Supply Identifier | 412547 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 5-6 10MM","code_information":[{"code":"Sx00-5962-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"193382","type":"LOCAL"},{"code":"298168","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 193382 = Hospital System Supply Identifier | 298168 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 5-6 12MM","code_information":[{"code":"Sx00-5962-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"193383","type":"LOCAL"},{"code":"298169","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 193383 = Hospital System Supply Identifier | 298169 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 5-6 14MM","code_information":[{"code":"Sx00-5962-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"193384","type":"LOCAL"},{"code":"298170","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 193384 = Hospital System Supply Identifier | 298170 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 5-6 17MM","code_information":[{"code":"Sx00-5962-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"193385","type":"LOCAL"},{"code":"298171","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 193385 = Hospital System Supply Identifier | 298171 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 5-6 20MM","code_information":[{"code":"Sx00-5962-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"193386","type":"LOCAL"},{"code":"298172","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 193386 = Hospital System Supply Identifier | 298172 = Lawson ID"}]},{"description":"IMP KNEE TIB INS NXGN 5-6 23MM","code_information":[{"code":"Sx00-5962-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"196568","type":"LOCAL"},{"code":"412548","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 196568 = Hospital System Supply Identifier | 412548 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 5-6 20MM","code_information":[{"code":"Sx00-5962-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"193388","type":"LOCAL"},{"code":"298177","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 193388 = Hospital System Supply Identifier | 298177 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 5-6 17MM","code_information":[{"code":"Sx00-5962-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"193387","type":"LOCAL"},{"code":"298176","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 193387 = Hospital System Supply Identifier | 298176 = Lawson ID"}]},{"description":"IMP KNEE TIB INS NXGN 5-6 23MM","code_information":[{"code":"Sx00-5962-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"196569","type":"LOCAL"},{"code":"412549","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 196569 = Hospital System Supply Identifier | 412549 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 5-6 12MM","code_information":[{"code":"Sx00-5962-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"154596","type":"LOCAL"},{"code":"298174","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 154596 = Hospital System Supply Identifier | 298174 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 5-6 10MM","code_information":[{"code":"Sx00-5962-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"154595","type":"LOCAL"},{"code":"298173","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 154595 = Hospital System Supply Identifier | 298173 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 5-6 14MM","code_information":[{"code":"Sx00-5962-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"154597","type":"LOCAL"},{"code":"298175","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 154597 = Hospital System Supply Identifier | 298175 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 7-10 10MM","code_information":[{"code":"Sx00-5962-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"178298","type":"LOCAL"},{"code":"298178","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 178298 = Hospital System Supply Identifier | 298178 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 7-10 12MM","code_information":[{"code":"Sx00-5962-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"193389","type":"LOCAL"},{"code":"298179","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 193389 = Hospital System Supply Identifier | 298179 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 7-10 14MM","code_information":[{"code":"Sx00-5962-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"193390","type":"LOCAL"},{"code":"298180","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 193390 = Hospital System Supply Identifier | 298180 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 7-10 17MM","code_information":[{"code":"Sx00-5962-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"193391","type":"LOCAL"},{"code":"298181","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 193391 = Hospital System Supply Identifier | 298181 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 7-10 20MM","code_information":[{"code":"Sx00-5962-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"193392","type":"LOCAL"},{"code":"298182","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 193392 = Hospital System Supply Identifier | 298182 = Lawson ID"}]},{"description":"IMP KNEE TIB INS NXGN 7-10 23","code_information":[{"code":"Sx00-5962-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"196570","type":"LOCAL"},{"code":"412550","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 196570 = Hospital System Supply Identifier | 412550 = Lawson ID"}]},{"description":"IMP KNEE TIB INS NXGN 7-10 23","code_information":[{"code":"Sx00-5962-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"196571","type":"LOCAL"},{"code":"412551","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 196571 = Hospital System Supply Identifier | 412551 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 7-10 20MM","code_information":[{"code":"Sx00-5962-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"193395","type":"LOCAL"},{"code":"298187","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 193395 = Hospital System Supply Identifier | 298187 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 7-10 17MM","code_information":[{"code":"Sx00-5962-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"154599","type":"LOCAL"},{"code":"298186","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 154599 = Hospital System Supply Identifier | 298186 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 7-10 10MM","code_information":[{"code":"Sx00-5962-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"154598","type":"LOCAL"},{"code":"298183","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 154598 = Hospital System Supply Identifier | 298183 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 7-10 12MM","code_information":[{"code":"Sx00-5962-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"193393","type":"LOCAL"},{"code":"298184","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 193393 = Hospital System Supply Identifier | 298184 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 7-10 14MM","code_information":[{"code":"Sx00-5962-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"193394","type":"LOCAL"},{"code":"298185","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 193394 = Hospital System Supply Identifier | 298185 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZC","code_information":[{"code":"Sx00-5964-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"193396","type":"LOCAL"},{"code":"298190","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 193396 = Hospital System Supply Identifier | 298190 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZC","code_information":[{"code":"Sx00-5964-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"193397","type":"LOCAL"},{"code":"298191","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 193397 = Hospital System Supply Identifier | 298191 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZD","code_information":[{"code":"Sx00-5964-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"178299","type":"LOCAL"},{"code":"298193","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 178299 = Hospital System Supply Identifier | 298193 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZD","code_information":[{"code":"Sx00-5964-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"193398","type":"LOCAL"},{"code":"298192","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 193398 = Hospital System Supply Identifier | 298192 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZE","code_information":[{"code":"Sx00-5964-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"154600","type":"LOCAL"},{"code":"298195","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 154600 = Hospital System Supply Identifier | 298195 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZE","code_information":[{"code":"Sx00-5964-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"169650","type":"LOCAL"},{"code":"298194","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 169650 = Hospital System Supply Identifier | 298194 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZF","code_information":[{"code":"Sx00-5964-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"154601","type":"LOCAL"},{"code":"298197","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 154601 = Hospital System Supply Identifier | 298197 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZF","code_information":[{"code":"Sx00-5964-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"159832","type":"LOCAL"},{"code":"343847","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 159832 = Hospital System Supply Identifier | 343847 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZG","code_information":[{"code":"Sx00-5964-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"154602","type":"LOCAL"},{"code":"298198","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 154602 = Hospital System Supply Identifier | 298198 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZG","code_information":[{"code":"Sx00-5964-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"154603","type":"LOCAL"},{"code":"298199","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 154603 = Hospital System Supply Identifier | 298199 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 20 AB/1-2","code_information":[{"code":"Sx00-5964-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202294","type":"LOCAL"},{"code":"452392","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 202294 = Hospital System Supply Identifier | 452392 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 17 AB/1-2","code_information":[{"code":"Sx00-5964-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202288","type":"LOCAL"},{"code":"452386","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 202288 = Hospital System Supply Identifier | 452386 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 23 AB/1-2","code_information":[{"code":"Sx00-5964-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202303","type":"LOCAL"},{"code":"452401","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 202303 = Hospital System Supply Identifier | 452401 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 12 AB/1-2","code_information":[{"code":"Sx00-5964-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202277","type":"LOCAL"},{"code":"452375","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 202277 = Hospital System Supply Identifier | 452375 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 10 AB/1-2","code_information":[{"code":"Sx00-5964-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202274","type":"LOCAL"},{"code":"452372","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 202274 = Hospital System Supply Identifier | 452372 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 14 AB/1-2","code_information":[{"code":"Sx00-5964-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202281","type":"LOCAL"},{"code":"452379","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 202281 = Hospital System Supply Identifier | 452379 = Lawson ID"}]},{"description":"IMP TIB INS NXGN CD 1-2 10MM","code_information":[{"code":"Sx00-5964-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"194952","type":"LOCAL"},{"code":"360610","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 194952 = Hospital System Supply Identifier | 360610 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 12 CD/1-2","code_information":[{"code":"Sx00-5964-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202279","type":"LOCAL"},{"code":"452377","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 202279 = Hospital System Supply Identifier | 452377 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 14 CD/1-2","code_information":[{"code":"Sx00-5964-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202283","type":"LOCAL"},{"code":"452381","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 202283 = Hospital System Supply Identifier | 452381 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 17 CD/1-2","code_information":[{"code":"Sx00-5964-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202290","type":"LOCAL"},{"code":"452388","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 202290 = Hospital System Supply Identifier | 452388 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 20 CD/1-2","code_information":[{"code":"Sx00-5964-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202296","type":"LOCAL"},{"code":"452394","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 202296 = Hospital System Supply Identifier | 452394 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 23 CD/1-2","code_information":[{"code":"Sx00-5964-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202305","type":"LOCAL"},{"code":"452403","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 202305 = Hospital System Supply Identifier | 452403 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 20 CD/3-4","code_information":[{"code":"Sx00-5964-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202297","type":"LOCAL"},{"code":"452395","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 202297 = Hospital System Supply Identifier | 452395 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 23 CD/3-4","code_information":[{"code":"Sx00-5964-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202306","type":"LOCAL"},{"code":"452404","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 202306 = Hospital System Supply Identifier | 452404 = Lawson ID"}]},{"description":"IMP TIB INS NXGN CD 3-4 17MM","code_information":[{"code":"Sx00-5964-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"194956","type":"LOCAL"},{"code":"360614","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 194956 = Hospital System Supply Identifier | 360614 = Lawson ID"}]},{"description":"IMP TIB INS NXGN CD 3-4 10MM","code_information":[{"code":"Sx00-5964-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"194953","type":"LOCAL"},{"code":"360611","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 194953 = Hospital System Supply Identifier | 360611 = Lawson ID"}]},{"description":"IMP TIB INS NXGN CD 3-4 12MM","code_information":[{"code":"Sx00-5964-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"194954","type":"LOCAL"},{"code":"360612","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 194954 = Hospital System Supply Identifier | 360612 = Lawson ID"}]},{"description":"IMP TIB INS NXGN CD 3-4 14MM","code_information":[{"code":"Sx00-5964-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"194955","type":"LOCAL"},{"code":"360613","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 194955 = Hospital System Supply Identifier | 360613 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 10 AB/3-4","code_information":[{"code":"Sx00-5964-031","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202275","type":"LOCAL"},{"code":"452373","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 202275 = Hospital System Supply Identifier | 452373 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 12 AB/3-4","code_information":[{"code":"Sx00-5964-031","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202278","type":"LOCAL"},{"code":"452376","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 202278 = Hospital System Supply Identifier | 452376 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 14 AB/3-4","code_information":[{"code":"Sx00-5964-031","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202282","type":"LOCAL"},{"code":"452380","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 202282 = Hospital System Supply Identifier | 452380 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 17 AB/3-4","code_information":[{"code":"Sx00-5964-031","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202289","type":"LOCAL"},{"code":"452387","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 202289 = Hospital System Supply Identifier | 452387 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 20 AB/3-4","code_information":[{"code":"Sx00-5964-031","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202295","type":"LOCAL"},{"code":"452393","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 202295 = Hospital System Supply Identifier | 452393 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 23 AB/3-4","code_information":[{"code":"Sx00-5964-031","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202304","type":"LOCAL"},{"code":"452402","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 202304 = Hospital System Supply Identifier | 452402 = Lawson ID"}]},{"description":"IMP TIB INS NXGN EF 3-4 12MM","code_information":[{"code":"Sx00-5964-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"194958","type":"LOCAL"},{"code":"360616","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 194958 = Hospital System Supply Identifier | 360616 = Lawson ID"}]},{"description":"IMP TIB INS NXGN EF 3-4 14MM","code_information":[{"code":"Sx00-5964-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"194959","type":"LOCAL"},{"code":"360617","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 194959 = Hospital System Supply Identifier | 360617 = Lawson ID"}]},{"description":"IMP TIB INS NXGN EF 3-4 17MM","code_information":[{"code":"Sx00-5964-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"194960","type":"LOCAL"},{"code":"360618","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 194960 = Hospital System Supply Identifier | 360618 = Lawson ID"}]},{"description":"IMP TIB INS NXGN EF 3-4 20MM","code_information":[{"code":"Sx00-5964-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"194961","type":"LOCAL"},{"code":"360619","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 194961 = Hospital System Supply Identifier | 360619 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 23 EF/3-4","code_information":[{"code":"Sx00-5964-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202308","type":"LOCAL"},{"code":"452406","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 202308 = Hospital System Supply Identifier | 452406 = Lawson ID"}]},{"description":"IMP TIB INS NXGN EF 3-4 10MM","code_information":[{"code":"Sx00-5964-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"194957","type":"LOCAL"},{"code":"360615","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 194957 = Hospital System Supply Identifier | 360615 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 20 EF/5-6","code_information":[{"code":"Sx00-5964-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202299","type":"LOCAL"},{"code":"452397","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 202299 = Hospital System Supply Identifier | 452397 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 23 EF/5-6","code_information":[{"code":"Sx00-5964-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202309","type":"LOCAL"},{"code":"452407","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 202309 = Hospital System Supply Identifier | 452407 = Lawson ID"}]},{"description":"IMP TIB INS NXGN EF 5-6 10MM","code_information":[{"code":"Sx00-5964-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303556","type":"LOCAL"},{"code":"522513","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303556 = Hospital System Supply Identifier | 522513 = Lawson ID"}]},{"description":"IMP TIB INS NXGN EF 5-6 17MM","code_information":[{"code":"Sx00-5964-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"194964","type":"LOCAL"},{"code":"360622","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 194964 = Hospital System Supply Identifier | 360622 = Lawson ID"}]},{"description":"IMP TIB INS NXGN EF 5-6 12MM","code_information":[{"code":"Sx00-5964-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"194962","type":"LOCAL"},{"code":"360620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 194962 = Hospital System Supply Identifier | 360620 = Lawson ID"}]},{"description":"IMP TIB INS NXGN EF 5-6 14MM","code_information":[{"code":"Sx00-5964-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"194963","type":"LOCAL"},{"code":"360621","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 194963 = Hospital System Supply Identifier | 360621 = Lawson ID"}]},{"description":"IMP TIB INS NXGN CD 5-6 10MM","code_information":[{"code":"Sx00-5964-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"194965","type":"LOCAL"},{"code":"360623","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 194965 = Hospital System Supply Identifier | 360623 = Lawson ID"}]},{"description":"IMP TIB INS NXGN CD 5-6 17MM","code_information":[{"code":"Sx00-5964-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"194966","type":"LOCAL"},{"code":"360624","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 194966 = Hospital System Supply Identifier | 360624 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 12 CD/5-6","code_information":[{"code":"Sx00-5964-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202280","type":"LOCAL"},{"code":"452378","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 202280 = Hospital System Supply Identifier | 452378 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 14 CD/5-6","code_information":[{"code":"Sx00-5964-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202284","type":"LOCAL"},{"code":"452382","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 202284 = Hospital System Supply Identifier | 452382 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 20 CD/5-6","code_information":[{"code":"Sx00-5964-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202298","type":"LOCAL"},{"code":"452396","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 202298 = Hospital System Supply Identifier | 452396 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 23 CD/5-6","code_information":[{"code":"Sx00-5964-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202307","type":"LOCAL"},{"code":"452405","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 202307 = Hospital System Supply Identifier | 452405 = Lawson ID"}]},{"description":"IMP TIB INS NXGN GH 5-6 10MM","code_information":[{"code":"Sx00-5964-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"194967","type":"LOCAL"},{"code":"360625","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 194967 = Hospital System Supply Identifier | 360625 = Lawson ID"}]},{"description":"IMP TIB INS NXGN GH 5-6 12MM","code_information":[{"code":"Sx00-5964-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"194968","type":"LOCAL"},{"code":"360626","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 194968 = Hospital System Supply Identifier | 360626 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 14 GH/5-6","code_information":[{"code":"Sx00-5964-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202286","type":"LOCAL"},{"code":"452384","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 202286 = Hospital System Supply Identifier | 452384 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 17 GH/5-6","code_information":[{"code":"Sx00-5964-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202292","type":"LOCAL"},{"code":"452390","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 202292 = Hospital System Supply Identifier | 452390 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 20 GH/5-6","code_information":[{"code":"Sx00-5964-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202301","type":"LOCAL"},{"code":"452399","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 202301 = Hospital System Supply Identifier | 452399 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 23 GH/5-6","code_information":[{"code":"Sx00-5964-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202311","type":"LOCAL"},{"code":"452409","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 202311 = Hospital System Supply Identifier | 452409 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 20 GH/7-10","code_information":[{"code":"Sx00-5964-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202302","type":"LOCAL"},{"code":"452400","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 202302 = Hospital System Supply Identifier | 452400 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 17 GH/7-10","code_information":[{"code":"Sx00-5964-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202293","type":"LOCAL"},{"code":"452391","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 202293 = Hospital System Supply Identifier | 452391 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 23 GH/7-10","code_information":[{"code":"Sx00-5964-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202312","type":"LOCAL"},{"code":"452410","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 202312 = Hospital System Supply Identifier | 452410 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 10 GH/7-10","code_information":[{"code":"Sx00-5964-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202276","type":"LOCAL"},{"code":"452374","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 202276 = Hospital System Supply Identifier | 452374 = Lawson ID"}]},{"description":"IMP TIB INS NXGN GH 7-10 12MM","code_information":[{"code":"Sx00-5964-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"194969","type":"LOCAL"},{"code":"360627","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 194969 = Hospital System Supply Identifier | 360627 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 14 GH/7-10","code_information":[{"code":"Sx00-5964-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202287","type":"LOCAL"},{"code":"452385","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 202287 = Hospital System Supply Identifier | 452385 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 20 EF/7-10","code_information":[{"code":"Sx00-5964-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202300","type":"LOCAL"},{"code":"452398","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 202300 = Hospital System Supply Identifier | 452398 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 17 EF/7-10","code_information":[{"code":"Sx00-5964-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202291","type":"LOCAL"},{"code":"452389","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 202291 = Hospital System Supply Identifier | 452389 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 23 EF/7-10","code_information":[{"code":"Sx00-5964-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202310","type":"LOCAL"},{"code":"452408","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 202310 = Hospital System Supply Identifier | 452408 = Lawson ID"}]},{"description":"IMP TIB INS NXGN EF 7-10 12MM","code_information":[{"code":"Sx00-5964-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"194971","type":"LOCAL"},{"code":"360629","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 194971 = Hospital System Supply Identifier | 360629 = Lawson ID"}]},{"description":"IMP TIB INS NXGN EF 7-10 10MM","code_information":[{"code":"Sx00-5964-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"194970","type":"LOCAL"},{"code":"360628","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 194970 = Hospital System Supply Identifier | 360628 = Lawson ID"}]},{"description":"IMP KNEE SURF MOLD 14 EF/7-10","code_information":[{"code":"Sx00-5964-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202285","type":"LOCAL"},{"code":"452383","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 202285 = Hospital System Supply Identifier | 452383 = Lawson ID"}]},{"description":"IMP CR POLY TIB SIZE 3 YEL","code_information":[{"code":"Sx00-5966-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"662247","type":"LOCAL"},{"code":"446532","type":"LOCAL"}],"standard_charges":[{"gross_charge":2232.0,"discounted_cash":1674.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 662247 = Hospital System Supply Identifier | 446532 = Lawson ID"}]},{"description":"IMP CR POLY TIB SZ 3 YEL 10MM","code_information":[{"code":"Sx00-5966-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"328543","type":"LOCAL"},{"code":"458221","type":"LOCAL"}],"standard_charges":[{"gross_charge":2232.0,"discounted_cash":1674.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 328543 = Hospital System Supply Identifier | 458221 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT CR SZ3 14","code_information":[{"code":"Sx00-5966-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303557","type":"LOCAL"},{"code":"522514","type":"LOCAL"}],"standard_charges":[{"gross_charge":2232.0,"discounted_cash":1674.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303557 = Hospital System Supply Identifier | 522514 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT CR SZ3 17","code_information":[{"code":"Sx00-5966-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303558","type":"LOCAL"},{"code":"522515","type":"LOCAL"}],"standard_charges":[{"gross_charge":2232.0,"discounted_cash":1674.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303558 = Hospital System Supply Identifier | 522515 = Lawson ID"}]},{"description":"IMP KNEE-C TIB NXGN YEL SZ4 14","code_information":[{"code":"Sx00-5966-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"330547","type":"LOCAL"},{"code":"459446","type":"LOCAL"}],"standard_charges":[{"gross_charge":2232.0,"discounted_cash":1674.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 330547 = Hospital System Supply Identifier | 459446 = Lawson ID"}]},{"description":"IMP KNEE-C TIB BSPLT NX SZ4 10","code_information":[{"code":"Sx00-5966-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329891","type":"LOCAL"},{"code":"395490","type":"LOCAL"}],"standard_charges":[{"gross_charge":2232.0,"discounted_cash":1674.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329891 = Hospital System Supply Identifier | 395490 = Lawson ID"}]},{"description":"IMP KNEE-C TIB BSPLT NX SZ4 17","code_information":[{"code":"Sx00-5966-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329892","type":"LOCAL"},{"code":"395491","type":"LOCAL"}],"standard_charges":[{"gross_charge":2232.0,"discounted_cash":1674.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329892 = Hospital System Supply Identifier | 395491 = Lawson ID"}]},{"description":"IMP KNEE-C TIB BSPLT NX SZ4 12","code_information":[{"code":"Sx00-5966-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"330223","type":"LOCAL"},{"code":"427287","type":"LOCAL"}],"standard_charges":[{"gross_charge":2232.0,"discounted_cash":1674.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 330223 = Hospital System Supply Identifier | 427287 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT CR SZ5 17","code_information":[{"code":"Sx00-5966-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303559","type":"LOCAL"},{"code":"522516","type":"LOCAL"}],"standard_charges":[{"gross_charge":2232.0,"discounted_cash":1674.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303559 = Hospital System Supply Identifier | 522516 = Lawson ID"}]},{"description":"IMP KNEE TIB NXGN SZ5 GRN 10MM","code_information":[{"code":"Sx00-5966-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"330295","type":"LOCAL"},{"code":"447379","type":"LOCAL"}],"standard_charges":[{"gross_charge":2232.0,"discounted_cash":1674.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 330295 = Hospital System Supply Identifier | 447379 = Lawson ID"}]},{"description":"IMP KNEE-C TIB BSPLT NXGN","code_information":[{"code":"Sx00-5966-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329893","type":"LOCAL"},{"code":"395492","type":"LOCAL"}],"standard_charges":[{"gross_charge":2232.0,"discounted_cash":1674.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329893 = Hospital System Supply Identifier | 395492 = Lawson ID"}]},{"description":"IMP KNEE-C TIB BSPLT NX 10X74","code_information":[{"code":"Sx00-5966-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329894","type":"LOCAL"},{"code":"395493","type":"LOCAL"}],"standard_charges":[{"gross_charge":2232.0,"discounted_cash":1674.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329894 = Hospital System Supply Identifier | 395493 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT NXGN 10X74","code_information":[{"code":"Sx00-5966-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"324823","type":"LOCAL"},{"code":"324151","type":"LOCAL"}],"standard_charges":[{"gross_charge":2232.0,"discounted_cash":1674.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 324823 = Hospital System Supply Identifier | 324151 = Lawson ID"}]},{"description":"IMP KNEE-C TIB NXGN SZ6 14MM","code_information":[{"code":"Sx00-5966-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329895","type":"LOCAL"},{"code":"395494","type":"LOCAL"}],"standard_charges":[{"gross_charge":2232.0,"discounted_cash":1674.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329895 = Hospital System Supply Identifier | 395494 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT CR SZ6 12","code_information":[{"code":"Sx00-5966-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303560","type":"LOCAL"},{"code":"522517","type":"LOCAL"}],"standard_charges":[{"gross_charge":2232.0,"discounted_cash":1674.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303560 = Hospital System Supply Identifier | 522517 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT CR SZ6 17","code_information":[{"code":"Sx00-5966-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303561","type":"LOCAL"},{"code":"522518","type":"LOCAL"}],"standard_charges":[{"gross_charge":2232.0,"discounted_cash":1674.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303561 = Hospital System Supply Identifier | 522518 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT CR SZ7 17","code_information":[{"code":"Sx00-5966-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303563","type":"LOCAL"},{"code":"522520","type":"LOCAL"}],"standard_charges":[{"gross_charge":2232.0,"discounted_cash":1674.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303563 = Hospital System Supply Identifier | 522520 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT CR SZ7 12","code_information":[{"code":"Sx00-5966-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303562","type":"LOCAL"},{"code":"522519","type":"LOCAL"}],"standard_charges":[{"gross_charge":2232.0,"discounted_cash":1674.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303562 = Hospital System Supply Identifier | 522519 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT NXGN 10X82","code_information":[{"code":"Sx00-5966-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"324824","type":"LOCAL"},{"code":"324152","type":"LOCAL"}],"standard_charges":[{"gross_charge":2232.0,"discounted_cash":1674.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 324824 = Hospital System Supply Identifier | 324152 = Lawson ID"}]},{"description":"IMP CR POLY TIB SZ 7 BL 14MM","code_information":[{"code":"Sx00-5966-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"328544","type":"LOCAL"},{"code":"458222","type":"LOCAL"}],"standard_charges":[{"gross_charge":2232.0,"discounted_cash":1674.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 328544 = Hospital System Supply Identifier | 458222 = Lawson ID"}]},{"description":"IMP CR POLY TIB SZ 8 BL 10MM","code_information":[{"code":"Sx00-5966-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"328545","type":"LOCAL"},{"code":"458223","type":"LOCAL"}],"standard_charges":[{"gross_charge":2232.0,"discounted_cash":1674.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 328545 = Hospital System Supply Identifier | 458223 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT CR SZ8 12","code_information":[{"code":"Sx00-5966-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303564","type":"LOCAL"},{"code":"522521","type":"LOCAL"}],"standard_charges":[{"gross_charge":2232.0,"discounted_cash":1674.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303564 = Hospital System Supply Identifier | 522521 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT CR SZ8 14","code_information":[{"code":"Sx00-5966-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303565","type":"LOCAL"},{"code":"522522","type":"LOCAL"}],"standard_charges":[{"gross_charge":2232.0,"discounted_cash":1674.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303565 = Hospital System Supply Identifier | 522522 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT CR SZ8 17","code_information":[{"code":"Sx00-5966-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303566","type":"LOCAL"},{"code":"522523","type":"LOCAL"}],"standard_charges":[{"gross_charge":2232.0,"discounted_cash":1674.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303566 = Hospital System Supply Identifier | 522523 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP STD SZ C LT","code_information":[{"code":"Sx00-5966-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"193125","type":"LOCAL"},{"code":"247382","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 193125 = Hospital System Supply Identifier | 247382 = Lawson ID"}]},{"description":"IMP KNEE TIB INS NXGN RT SZC","code_information":[{"code":"Sx00-5966-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"196572","type":"LOCAL"},{"code":"412552","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 196572 = Hospital System Supply Identifier | 412552 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP STD SZ D RT","code_information":[{"code":"Sx00-5966-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"193122","type":"LOCAL"},{"code":"247373","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 193122 = Hospital System Supply Identifier | 247373 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP STD SZ D LT","code_information":[{"code":"Sx00-5966-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"193124","type":"LOCAL"},{"code":"247381","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 193124 = Hospital System Supply Identifier | 247381 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP STD SZ E RT","code_information":[{"code":"Sx00-5966-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"193117","type":"LOCAL"},{"code":"247272","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 193117 = Hospital System Supply Identifier | 247272 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP STD SZ E LT","code_information":[{"code":"Sx00-5966-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"193120","type":"LOCAL"},{"code":"247277","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 193120 = Hospital System Supply Identifier | 247277 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP STD SZ F LT","code_information":[{"code":"Sx00-5966-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"193121","type":"LOCAL"},{"code":"247279","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 193121 = Hospital System Supply Identifier | 247279 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP STD SZ F RT","code_information":[{"code":"Sx00-5966-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"193119","type":"LOCAL"},{"code":"247274","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 193119 = Hospital System Supply Identifier | 247274 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP STD SZ G LT","code_information":[{"code":"Sx00-5966-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"193108","type":"LOCAL"},{"code":"246743","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 193108 = Hospital System Supply Identifier | 246743 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NGEN RT SZG","code_information":[{"code":"Sx00-5966-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"193123","type":"LOCAL"},{"code":"247380","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 193123 = Hospital System Supply Identifier | 247380 = Lawson ID"}]},{"description":"SET TOTAL JOINT 0-3 MODULAR PLATE LEFT VARUS NEXGEN","code_information":[{"code":"Sx00-5967-055","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1104200","type":"LOCAL"},{"code":"S119277","type":"LOCAL"}],"standard_charges":[{"gross_charge":492.24,"discounted_cash":369.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1104200 = Hospital System Supply Identifier | S119277 = Lawson ID"}]},{"description":"IMP KNEE FEM LPSFLX RT SZC","code_information":[{"code":"Sx00-5968-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303567","type":"LOCAL"},{"code":"522524","type":"LOCAL"}],"standard_charges":[{"gross_charge":3878.0,"discounted_cash":2908.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303567 = Hospital System Supply Identifier | 522524 = Lawson ID"}]},{"description":"IMP KNEE FEM LPSFLX RT SZC","code_information":[{"code":"Sx00-5968-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303568","type":"LOCAL"},{"code":"522525","type":"LOCAL"}],"standard_charges":[{"gross_charge":3878.0,"discounted_cash":2908.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303568 = Hospital System Supply Identifier | 522525 = Lawson ID"}]},{"description":"IMP KNEE TIB INS NXGN RT SZD","code_information":[{"code":"Sx00-5968-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326824","type":"LOCAL"},{"code":"401999","type":"LOCAL"}],"standard_charges":[{"gross_charge":3878.0,"discounted_cash":2908.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 326824 = Hospital System Supply Identifier | 401999 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP LT SZ","code_information":[{"code":"Sx00-5968-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"327595","type":"LOCAL"},{"code":"419993","type":"LOCAL"}],"standard_charges":[{"gross_charge":3878.0,"discounted_cash":2908.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 327595 = Hospital System Supply Identifier | 419993 = Lawson ID"}]},{"description":"IMP KNEE TIB INS NXGN RT SZE","code_information":[{"code":"Sx00-5968-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326826","type":"LOCAL"},{"code":"402001","type":"LOCAL"}],"standard_charges":[{"gross_charge":3878.0,"discounted_cash":2908.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 326826 = Hospital System Supply Identifier | 402001 = Lawson ID"}]},{"description":"IMP KNEE TIB INS NXGN LT SZE","code_information":[{"code":"Sx00-5968-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326825","type":"LOCAL"},{"code":"402000","type":"LOCAL"}],"standard_charges":[{"gross_charge":3878.0,"discounted_cash":2908.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 326825 = Hospital System Supply Identifier | 402000 = Lawson ID"}]},{"description":"IMP KNEE TIB INS NXGN LT SZF","code_information":[{"code":"Sx00-5968-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326827","type":"LOCAL"},{"code":"402002","type":"LOCAL"}],"standard_charges":[{"gross_charge":3878.0,"discounted_cash":2908.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 326827 = Hospital System Supply Identifier | 402002 = Lawson ID"}]},{"description":"IMP KNEE TIB INS NXGN RT SZF","code_information":[{"code":"Sx00-5968-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326828","type":"LOCAL"},{"code":"402003","type":"LOCAL"}],"standard_charges":[{"gross_charge":3878.0,"discounted_cash":2908.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 326828 = Hospital System Supply Identifier | 402003 = Lawson ID"}]},{"description":"IMP KNEE TIB INS NXGN LT SZG","code_information":[{"code":"Sx00-5968-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"328339","type":"LOCAL"},{"code":"448628","type":"LOCAL"}],"standard_charges":[{"gross_charge":3878.0,"discounted_cash":2908.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 328339 = Hospital System Supply Identifier | 448628 = Lawson ID"}]},{"description":"IMP KNEE TIB INS NXGN RT SZG","code_information":[{"code":"Sx00-5968-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"328508","type":"LOCAL"},{"code":"457513","type":"LOCAL"}],"standard_charges":[{"gross_charge":3878.0,"discounted_cash":2908.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 328508 = Hospital System Supply Identifier | 457513 = Lawson ID"}]},{"description":"SPACER FEMORAL +3MM NSTRL REVISION TENSOR SS KNEE NEXGEN V-STAT","code_information":[{"code":"Sx00-5969-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1104790","type":"LOCAL"},{"code":"S652539","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1104790 = Hospital System Supply Identifier | S652539 = Lawson ID"}]},{"description":"SET PIN GDE CT PRSNA CR","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"848392","type":"LOCAL"},{"code":"780145","type":"LOCAL"}],"standard_charges":[{"gross_charge":3415.23,"discounted_cash":2561.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 848392 = Hospital System Supply Identifier | 780145 = Lawson ID"}]},{"description":"SET PIN GDE CT PRSNA PREF PS","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"848395","type":"LOCAL"},{"code":"780148","type":"LOCAL"}],"standard_charges":[{"gross_charge":3415.23,"discounted_cash":2561.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 848395 = Hospital System Supply Identifier | 780148 = Lawson ID"}]},{"description":"SET PIN GDE CT PRSNA PREF CR","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"848394","type":"LOCAL"},{"code":"780147","type":"LOCAL"}],"standard_charges":[{"gross_charge":3415.23,"discounted_cash":2561.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 848394 = Hospital System Supply Identifier | 780147 = Lawson ID"}]},{"description":"SET PIN GDE CT PRSNA PS","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"848393","type":"LOCAL"},{"code":"780146","type":"LOCAL"}],"standard_charges":[{"gross_charge":3415.23,"discounted_cash":2561.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 848393 = Hospital System Supply Identifier | 780146 = Lawson ID"}]},{"description":"SET PIN GDE PSI PRSNA PREF PS","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"848386","type":"LOCAL"},{"code":"780139","type":"LOCAL"}],"standard_charges":[{"gross_charge":3415.23,"discounted_cash":2561.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 848386 = Hospital System Supply Identifier | 780139 = Lawson ID"}]},{"description":"SET PIN GDE CT PSI NXGN LPS-FX","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"848390","type":"LOCAL"},{"code":"780143","type":"LOCAL"}],"standard_charges":[{"gross_charge":3415.23,"discounted_cash":2561.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 848390 = Hospital System Supply Identifier | 780143 = Lawson ID"}]},{"description":"SET PIN GDE CT PSI NXGN LPS","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"848389","type":"LOCAL"},{"code":"780142","type":"LOCAL"}],"standard_charges":[{"gross_charge":3415.23,"discounted_cash":2561.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 848389 = Hospital System Supply Identifier | 780142 = Lawson ID"}]},{"description":"SET PIN GDE CT PSI NXGN CR-FX","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"848388","type":"LOCAL"},{"code":"780141","type":"LOCAL"}],"standard_charges":[{"gross_charge":3415.23,"discounted_cash":2561.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 848388 = Hospital System Supply Identifier | 780141 = Lawson ID"}]},{"description":"SET PIN GDE CT PSI NXGN CR","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"848387","type":"LOCAL"},{"code":"780140","type":"LOCAL"}],"standard_charges":[{"gross_charge":3415.23,"discounted_cash":2561.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 848387 = Hospital System Supply Identifier | 780140 = Lawson ID"}]},{"description":"GUIDE PIN NEXGEN CR-FX","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"1019429","type":"LOCAL"},{"code":"869377","type":"LOCAL"}],"standard_charges":[{"gross_charge":2431.48,"discounted_cash":1823.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1019429 = Hospital System Supply Identifier | 869377 = Lawson ID"}]},{"description":"SET PIN GDE CT N-K FLEX","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"848391","type":"LOCAL"},{"code":"780144","type":"LOCAL"}],"standard_charges":[{"gross_charge":3415.23,"discounted_cash":2561.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 848391 = Hospital System Supply Identifier | 780144 = Lawson ID"}]},{"description":"GUIDE PIN NEXGEN LPS-FX","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"1019430","type":"LOCAL"},{"code":"869378","type":"LOCAL"}],"standard_charges":[{"gross_charge":2431.48,"discounted_cash":1823.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1019430 = Hospital System Supply Identifier | 869378 = Lawson ID"}]},{"description":"SET GUIDE PIN NEXGEN LPS-FX","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"1019438","type":"LOCAL"},{"code":"869386","type":"LOCAL"}],"standard_charges":[{"gross_charge":3415.23,"discounted_cash":2561.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1019438 = Hospital System Supply Identifier | 869386 = Lawson ID"}]},{"description":"GUIDE PIN NEXGEN PSN PS","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"1019432","type":"LOCAL"},{"code":"869380","type":"LOCAL"}],"standard_charges":[{"gross_charge":2431.48,"discounted_cash":1823.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1019432 = Hospital System Supply Identifier | 869380 = Lawson ID"}]},{"description":"GUIDE PIN NEXGEN PREF CR","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"1019433","type":"LOCAL"},{"code":"869381","type":"LOCAL"}],"standard_charges":[{"gross_charge":2431.48,"discounted_cash":1823.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1019433 = Hospital System Supply Identifier | 869381 = Lawson ID"}]},{"description":"GUIDE PIN NEXGEN PREF PS","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"1019434","type":"LOCAL"},{"code":"869382","type":"LOCAL"}],"standard_charges":[{"gross_charge":2431.48,"discounted_cash":1823.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1019434 = Hospital System Supply Identifier | 869382 = Lawson ID"}]},{"description":"GUIDE PIN NEXGEN CR-FX CT","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"1019435","type":"LOCAL"},{"code":"869383","type":"LOCAL"}],"standard_charges":[{"gross_charge":2431.48,"discounted_cash":1823.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1019435 = Hospital System Supply Identifier | 869383 = Lawson ID"}]},{"description":"GUIDE PIN NEXGEN LPS-FX CT","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"1019436","type":"LOCAL"},{"code":"869384","type":"LOCAL"}],"standard_charges":[{"gross_charge":2431.48,"discounted_cash":1823.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1019436 = Hospital System Supply Identifier | 869384 = Lawson ID"}]},{"description":"SET GUIDE PIN NEXGEN CR-FX","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"1019437","type":"LOCAL"},{"code":"869385","type":"LOCAL"}],"standard_charges":[{"gross_charge":3415.23,"discounted_cash":2561.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1019437 = Hospital System Supply Identifier | 869385 = Lawson ID"}]},{"description":"SET GUIDE PIN NEXGEN PSN CR","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"1019439","type":"LOCAL"},{"code":"869387","type":"LOCAL"}],"standard_charges":[{"gross_charge":3415.23,"discounted_cash":2561.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1019439 = Hospital System Supply Identifier | 869387 = Lawson ID"}]},{"description":"SET GUIDE PIN NEXGEN PSN PS","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"1019440","type":"LOCAL"},{"code":"869388","type":"LOCAL"}],"standard_charges":[{"gross_charge":3415.23,"discounted_cash":2561.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1019440 = Hospital System Supply Identifier | 869388 = Lawson ID"}]},{"description":"SET GUIDE PIN NEXGEN PREF CR","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"1019441","type":"LOCAL"},{"code":"869389","type":"LOCAL"}],"standard_charges":[{"gross_charge":3415.23,"discounted_cash":2561.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1019441 = Hospital System Supply Identifier | 869389 = Lawson ID"}]},{"description":"SET GUIDE PIN NEXGEN PREF PS","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"1019442","type":"LOCAL"},{"code":"869390","type":"LOCAL"}],"standard_charges":[{"gross_charge":3415.23,"discounted_cash":2561.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1019442 = Hospital System Supply Identifier | 869390 = Lawson ID"}]},{"description":"GUIDE PIN NEXGEN LPS-FX CT S","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"1019444","type":"LOCAL"},{"code":"869392","type":"LOCAL"}],"standard_charges":[{"gross_charge":3415.23,"discounted_cash":2561.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1019444 = Hospital System Supply Identifier | 869392 = Lawson ID"}]},{"description":"GUIDE PIN NEXGEN PSN CR","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"1019431","type":"LOCAL"},{"code":"869379","type":"LOCAL"}],"standard_charges":[{"gross_charge":2431.48,"discounted_cash":1823.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1019431 = Hospital System Supply Identifier | 869379 = Lawson ID"}]},{"description":"SET PIN GDE PSI PRSNA PREF CR","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"848385","type":"LOCAL"},{"code":"780138","type":"LOCAL"}],"standard_charges":[{"gross_charge":3415.23,"discounted_cash":2561.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 848385 = Hospital System Supply Identifier | 780138 = Lawson ID"}]},{"description":"GUIDE PIN NEXGEN CR-FX CT S","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"1019443","type":"LOCAL"},{"code":"869391","type":"LOCAL"}],"standard_charges":[{"gross_charge":3415.23,"discounted_cash":2561.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1019443 = Hospital System Supply Identifier | 869391 = Lawson ID"}]},{"description":"SET PIN GDE PSI PRSNA CR","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"848383","type":"LOCAL"},{"code":"780136","type":"LOCAL"}],"standard_charges":[{"gross_charge":3415.23,"discounted_cash":2561.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 848383 = Hospital System Supply Identifier | 780136 = Lawson ID"}]},{"description":"PIN GDE PAT SPEC LPS FLX","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"178720","type":"LOCAL"},{"code":"394976","type":"LOCAL"}],"standard_charges":[{"gross_charge":2431.48,"discounted_cash":1823.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 178720 = Hospital System Supply Identifier | 394976 = Lawson ID"}]},{"description":"PIN GDE FEM PSI PRSNA CR TIB","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"473211","type":"LOCAL"},{"code":"437792","type":"LOCAL"}],"standard_charges":[{"gross_charge":2431.48,"discounted_cash":1823.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 473211 = Hospital System Supply Identifier | 437792 = Lawson ID"}]},{"description":"BONE MODEL KNEE","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"179017","type":"LOCAL"},{"code":"441627","type":"LOCAL"}],"standard_charges":[{"gross_charge":1036.35,"discounted_cash":777.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 179017 = Hospital System Supply Identifier | 441627 = Lawson ID"}]},{"description":"PIN GUIDE","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"662248","type":"LOCAL"},{"code":"446534","type":"LOCAL"}],"standard_charges":[{"gross_charge":2431.48,"discounted_cash":1823.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 662248 = Hospital System Supply Identifier | 446534 = Lawson ID"}]},{"description":"CPI PIN GUIDE","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"662249","type":"LOCAL"},{"code":"446536","type":"LOCAL"}],"standard_charges":[{"gross_charge":2431.48,"discounted_cash":1823.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 662249 = Hospital System Supply Identifier | 446536 = Lawson ID"}]},{"description":"PIN MODEL","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"662250","type":"LOCAL"},{"code":"446538","type":"LOCAL"}],"standard_charges":[{"gross_charge":2431.48,"discounted_cash":1823.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 662250 = Hospital System Supply Identifier | 446538 = Lawson ID"}]},{"description":"PIN GUIDE","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"662251","type":"LOCAL"},{"code":"446539","type":"LOCAL"}],"standard_charges":[{"gross_charge":2431.48,"discounted_cash":1823.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 662251 = Hospital System Supply Identifier | 446539 = Lawson ID"}]},{"description":"GUIDE PT SPECIFIC CR","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"303569","type":"LOCAL"},{"code":"522526","type":"LOCAL"}],"standard_charges":[{"gross_charge":2431.48,"discounted_cash":1823.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303569 = Hospital System Supply Identifier | 522526 = Lawson ID"}]},{"description":"GUIDE PT SPECIFIC LPS","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"303570","type":"LOCAL"},{"code":"522527","type":"LOCAL"}],"standard_charges":[{"gross_charge":2431.48,"discounted_cash":1823.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303570 = Hospital System Supply Identifier | 522527 = Lawson ID"}]},{"description":"GUIDE SURG KT LPS CT PSI","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"303572","type":"LOCAL"},{"code":"522529","type":"LOCAL"}],"standard_charges":[{"gross_charge":2431.48,"discounted_cash":1823.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303572 = Hospital System Supply Identifier | 522529 = Lawson ID"}]},{"description":"GUIDE LPS FLEX CT PSI","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"303573","type":"LOCAL"},{"code":"522530","type":"LOCAL"}],"standard_charges":[{"gross_charge":2431.48,"discounted_cash":1823.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303573 = Hospital System Supply Identifier | 522530 = Lawson ID"}]},{"description":"SET PIN GDE PSI PRSNA PS","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"848384","type":"LOCAL"},{"code":"780137","type":"LOCAL"}],"standard_charges":[{"gross_charge":3415.23,"discounted_cash":2561.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 848384 = Hospital System Supply Identifier | 780137 = Lawson ID"}]},{"description":"GUIDE NK FLEX CT PSI","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"303574","type":"LOCAL"},{"code":"522531","type":"LOCAL"}],"standard_charges":[{"gross_charge":2431.48,"discounted_cash":1823.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303574 = Hospital System Supply Identifier | 522531 = Lawson ID"}]},{"description":"GUIDE PIN FEM TIB PRSNA PS","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"303576","type":"LOCAL"},{"code":"522533","type":"LOCAL"}],"standard_charges":[{"gross_charge":2431.48,"discounted_cash":1823.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303576 = Hospital System Supply Identifier | 522533 = Lawson ID"}]},{"description":"GUIDE PIN PSI PRSNA NGK PS","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"303577","type":"LOCAL"},{"code":"522534","type":"LOCAL"}],"standard_charges":[{"gross_charge":2285.01,"discounted_cash":1713.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303577 = Hospital System Supply Identifier | 522534 = Lawson ID"}]},{"description":"PIN GUIDE PSI PSN CR","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"449685","type":"LOCAL"},{"code":"659251","type":"LOCAL"}],"standard_charges":[{"gross_charge":2431.48,"discounted_cash":1823.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 449685 = Hospital System Supply Identifier | 659251 = Lawson ID"}]},{"description":"PIN GUIDE PSI PSN PREF CR","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"449686","type":"LOCAL"},{"code":"659252","type":"LOCAL"}],"standard_charges":[{"gross_charge":2431.48,"discounted_cash":1823.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 449686 = Hospital System Supply Identifier | 659252 = Lawson ID"}]},{"description":"PIN GUIDE PSI PSN PREF PS","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"449687","type":"LOCAL"},{"code":"659253","type":"LOCAL"}],"standard_charges":[{"gross_charge":2431.48,"discounted_cash":1823.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 449687 = Hospital System Supply Identifier | 659253 = Lawson ID"}]},{"description":"PIN GUIDE PSI PSN PREF PS","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"581896","type":"LOCAL"},{"code":"676008","type":"LOCAL"}],"standard_charges":[{"gross_charge":2431.48,"discounted_cash":1823.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 581896 = Hospital System Supply Identifier | 676008 = Lawson ID"}]},{"description":"SET PIN GDE NXGN CR","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"848378","type":"LOCAL"},{"code":"780131","type":"LOCAL"}],"standard_charges":[{"gross_charge":3415.23,"discounted_cash":2561.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 848378 = Hospital System Supply Identifier | 780131 = Lawson ID"}]},{"description":"SET PIN GDE NXGN CR-FX","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"848379","type":"LOCAL"},{"code":"780132","type":"LOCAL"}],"standard_charges":[{"gross_charge":3415.23,"discounted_cash":2561.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 848379 = Hospital System Supply Identifier | 780132 = Lawson ID"}]},{"description":"SET PIN GDE NXGN LPS","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"848380","type":"LOCAL"},{"code":"780133","type":"LOCAL"}],"standard_charges":[{"gross_charge":3415.23,"discounted_cash":2561.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 848380 = Hospital System Supply Identifier | 780133 = Lawson ID"}]},{"description":"SET PIN GDE NXGN LPS-FX","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"848381","type":"LOCAL"},{"code":"780134","type":"LOCAL"}],"standard_charges":[{"gross_charge":3415.23,"discounted_cash":2561.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 848381 = Hospital System Supply Identifier | 780134 = Lawson ID"}]},{"description":"SET PIN GDE N-K FLEX","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"848382","type":"LOCAL"},{"code":"780135","type":"LOCAL"}],"standard_charges":[{"gross_charge":3415.23,"discounted_cash":2561.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 848382 = Hospital System Supply Identifier | 780135 = Lawson ID"}]},{"description":"GUIDE PIN PSI PRSNA NGK CR","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"303575","type":"LOCAL"},{"code":"522532","type":"LOCAL"}],"standard_charges":[{"gross_charge":2285.01,"discounted_cash":1713.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303575 = Hospital System Supply Identifier | 522532 = Lawson ID"}]},{"description":"PIN GDE PAT SPEC CR FLX","code_information":[{"code":"Sx00-5970-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"329878","type":"LOCAL"},{"code":"394975","type":"LOCAL"}],"standard_charges":[{"gross_charge":2431.48,"discounted_cash":1823.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329878 = Hospital System Supply Identifier | 394975 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZC","code_information":[{"code":"Sx00-5970-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"160172","type":"LOCAL"},{"code":"347356","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 160172 = Hospital System Supply Identifier | 347356 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN SZC","code_information":[{"code":"Sx00-5970-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"148553","type":"LOCAL"},{"code":"235625","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 148553 = Hospital System Supply Identifier | 235625 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZD","code_information":[{"code":"Sx00-5970-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"148450","type":"LOCAL"},{"code":"235463","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 148450 = Hospital System Supply Identifier | 235463 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZD","code_information":[{"code":"Sx00-5970-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"148532","type":"LOCAL"},{"code":"235573","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 148532 = Hospital System Supply Identifier | 235573 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZE","code_information":[{"code":"Sx00-5970-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"148462","type":"LOCAL"},{"code":"235488","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 148462 = Hospital System Supply Identifier | 235488 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZE","code_information":[{"code":"Sx00-5970-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"148500","type":"LOCAL"},{"code":"235532","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 148500 = Hospital System Supply Identifier | 235532 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZF","code_information":[{"code":"Sx00-5970-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"160713","type":"LOCAL"},{"code":"353627","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 160713 = Hospital System Supply Identifier | 353627 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZF","code_information":[{"code":"Sx00-5970-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303578","type":"LOCAL"},{"code":"522535","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303578 = Hospital System Supply Identifier | 522535 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZG","code_information":[{"code":"Sx00-5970-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303580","type":"LOCAL"},{"code":"522537","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303580 = Hospital System Supply Identifier | 522537 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZH","code_information":[{"code":"Sx00-5970-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"192137","type":"LOCAL"},{"code":"223560","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 192137 = Hospital System Supply Identifier | 223560 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZH","code_information":[{"code":"Sx00-5970-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"192138","type":"LOCAL"},{"code":"223561","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 192138 = Hospital System Supply Identifier | 223561 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC CR 20MM","code_information":[{"code":"Sx00-5970-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303586","type":"LOCAL"},{"code":"522543","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303586 = Hospital System Supply Identifier | 522543 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC CR 17MM","code_information":[{"code":"Sx00-5970-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303585","type":"LOCAL"},{"code":"522542","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303585 = Hospital System Supply Identifier | 522542 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC CR 14MM","code_information":[{"code":"Sx00-5970-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303584","type":"LOCAL"},{"code":"522541","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303584 = Hospital System Supply Identifier | 522541 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC CR 9MM","code_information":[{"code":"Sx00-5970-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303581","type":"LOCAL"},{"code":"522538","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303581 = Hospital System Supply Identifier | 522538 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC CR 10MM","code_information":[{"code":"Sx00-5970-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303582","type":"LOCAL"},{"code":"522539","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303582 = Hospital System Supply Identifier | 522539 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC CR 12MM","code_information":[{"code":"Sx00-5970-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303583","type":"LOCAL"},{"code":"522540","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303583 = Hospital System Supply Identifier | 522540 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT NXGN SZ1","code_information":[{"code":"Sx00-5970-025","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303587","type":"LOCAL"},{"code":"522544","type":"LOCAL"}],"standard_charges":[{"gross_charge":1960.0,"discounted_cash":1470.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303587 = Hospital System Supply Identifier | 522544 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT NXGN SZ2","code_information":[{"code":"Sx00-5970-025","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303588","type":"LOCAL"},{"code":"522545","type":"LOCAL"}],"standard_charges":[{"gross_charge":1960.0,"discounted_cash":1470.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303588 = Hospital System Supply Identifier | 522545 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC CR YEL 17MM","code_information":[{"code":"Sx00-5970-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303593","type":"LOCAL"},{"code":"522550","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303593 = Hospital System Supply Identifier | 522550 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC CR YEL 20MM","code_information":[{"code":"Sx00-5970-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303594","type":"LOCAL"},{"code":"522551","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303594 = Hospital System Supply Identifier | 522551 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC CR YEL 14MM","code_information":[{"code":"Sx00-5970-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303592","type":"LOCAL"},{"code":"522549","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303592 = Hospital System Supply Identifier | 522549 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC CR YEL 12MM","code_information":[{"code":"Sx00-5970-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303591","type":"LOCAL"},{"code":"522548","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303591 = Hospital System Supply Identifier | 522548 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC CR YEL 10MM","code_information":[{"code":"Sx00-5970-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303590","type":"LOCAL"},{"code":"522547","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303590 = Hospital System Supply Identifier | 522547 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC CR YEL 9MM","code_information":[{"code":"Sx00-5970-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303589","type":"LOCAL"},{"code":"522546","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303589 = Hospital System Supply Identifier | 522546 = Lawson ID"}]},{"description":"PLATE TIB NEXGEN PGD YEL SZ3","code_information":[{"code":"Sx00-5970-035","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"330045","type":"LOCAL"},{"code":"410571","type":"LOCAL"}],"standard_charges":[{"gross_charge":1960.0,"discounted_cash":1470.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 330045 = Hospital System Supply Identifier | 410571 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT NXGN SZ4 LT","code_information":[{"code":"Sx00-5970-035","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"178839","type":"LOCAL"},{"code":"418250","type":"LOCAL"}],"standard_charges":[{"gross_charge":1960.0,"discounted_cash":1470.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 178839 = Hospital System Supply Identifier | 418250 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC CR GRN 17MM","code_information":[{"code":"Sx00-5970-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303597","type":"LOCAL"},{"code":"522554","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303597 = Hospital System Supply Identifier | 522554 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC CR GRN 14MM","code_information":[{"code":"Sx00-5970-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303596","type":"LOCAL"},{"code":"522553","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303596 = Hospital System Supply Identifier | 522553 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC CR GRN 20MM","code_information":[{"code":"Sx00-5970-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303598","type":"LOCAL"},{"code":"522555","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303598 = Hospital System Supply Identifier | 522555 = Lawson ID"}]},{"description":"IMP TIB INS NXGN SZ5-6 12MM","code_information":[{"code":"Sx00-5970-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329379","type":"LOCAL"},{"code":"324157","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329379 = Hospital System Supply Identifier | 324157 = Lawson ID"}]},{"description":"IMP KNEE TIB INS NXGN 10MM","code_information":[{"code":"Sx00-5970-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"324825","type":"LOCAL"},{"code":"324156","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 324825 = Hospital System Supply Identifier | 324156 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC CR GRN 9MM","code_information":[{"code":"Sx00-5970-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303595","type":"LOCAL"},{"code":"522552","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303595 = Hospital System Supply Identifier | 522552 = Lawson ID"}]},{"description":"IMP KNEE PEG TIB PLT SZ5","code_information":[{"code":"Sx00-5970-045","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"181663","type":"LOCAL"},{"code":"453462","type":"LOCAL"}],"standard_charges":[{"gross_charge":1960.0,"discounted_cash":1470.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 181663 = Hospital System Supply Identifier | 453462 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT NXGN SZ6","code_information":[{"code":"Sx00-5970-045","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303599","type":"LOCAL"},{"code":"522556","type":"LOCAL"}],"standard_charges":[{"gross_charge":1960.0,"discounted_cash":1470.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303599 = Hospital System Supply Identifier | 522556 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC CR BLU 9MM","code_information":[{"code":"Sx00-5970-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303600","type":"LOCAL"},{"code":"522557","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303600 = Hospital System Supply Identifier | 522557 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC CR BLU 10MM","code_information":[{"code":"Sx00-5970-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303601","type":"LOCAL"},{"code":"522558","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303601 = Hospital System Supply Identifier | 522558 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC CR BLU 12MM","code_information":[{"code":"Sx00-5970-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303602","type":"LOCAL"},{"code":"522559","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303602 = Hospital System Supply Identifier | 522559 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC CR BLU 14MM","code_information":[{"code":"Sx00-5970-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303603","type":"LOCAL"},{"code":"522560","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303603 = Hospital System Supply Identifier | 522560 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC CR BLU 17MM","code_information":[{"code":"Sx00-5970-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303604","type":"LOCAL"},{"code":"522561","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303604 = Hospital System Supply Identifier | 522561 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC CR BLU 20MM","code_information":[{"code":"Sx00-5970-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303605","type":"LOCAL"},{"code":"522562","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303605 = Hospital System Supply Identifier | 522562 = Lawson ID"}]},{"description":"IMP KNEE TIB PLT NXGN PGD SZ10","code_information":[{"code":"Sx00-5970-055","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303607","type":"LOCAL"},{"code":"522564","type":"LOCAL"}],"standard_charges":[{"gross_charge":1960.0,"discounted_cash":1470.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303607 = Hospital System Supply Identifier | 522564 = Lawson ID"}]},{"description":"IMP KNEE TIB PLT NXGN PGD SZ9","code_information":[{"code":"Sx00-5970-055","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303606","type":"LOCAL"},{"code":"522563","type":"LOCAL"}],"standard_charges":[{"gross_charge":1960.0,"discounted_cash":1470.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303606 = Hospital System Supply Identifier | 522563 = Lawson ID"}]},{"description":"IMP KNEE TIB PLT NXGN PGD SZ7","code_information":[{"code":"Sx00-5970-055","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329900","type":"LOCAL"},{"code":"395764","type":"LOCAL"}],"standard_charges":[{"gross_charge":1960.0,"discounted_cash":1470.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329900 = Hospital System Supply Identifier | 395764 = Lawson ID"}]},{"description":"IMP KNEE TIB PLT NXGN PGD SZ8","code_information":[{"code":"Sx00-5970-055","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329901","type":"LOCAL"},{"code":"395765","type":"LOCAL"}],"standard_charges":[{"gross_charge":1960.0,"discounted_cash":1470.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329901 = Hospital System Supply Identifier | 395765 = Lawson ID"}]},{"description":"COMPONENT PATELLAR 32 MM STANDARD 8.5 MM KNEE ULTEM PROVISIOINAL STRIPED PURPLE YELLOW GREEN BLUE NSTRL NEXGEN","code_information":[{"code":"Sx00-5971-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303608","type":"LOCAL"},{"code":"522565","type":"LOCAL"}],"standard_charges":[{"gross_charge":118.12,"discounted_cash":88.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303608 = Hospital System Supply Identifier | 522565 = Lawson ID"}]},{"description":"IMP KNEE PTELA THK SZ38 9.5MM","code_information":[{"code":"Sx00-5971-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303609","type":"LOCAL"},{"code":"522566","type":"LOCAL"}],"standard_charges":[{"gross_charge":143.32,"discounted_cash":107.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303609 = Hospital System Supply Identifier | 522566 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC CR 1-2 17MM","code_information":[{"code":"Sx00-5972-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303616","type":"LOCAL"},{"code":"522573","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303616 = Hospital System Supply Identifier | 522573 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC CR 1-2 14MM","code_information":[{"code":"Sx00-5972-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303615","type":"LOCAL"},{"code":"522572","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303615 = Hospital System Supply Identifier | 522572 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC CR 1-2 20MM","code_information":[{"code":"Sx00-5972-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303617","type":"LOCAL"},{"code":"522574","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303617 = Hospital System Supply Identifier | 522574 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC CR 1-2 10MM","code_information":[{"code":"Sx00-5972-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303613","type":"LOCAL"},{"code":"522570","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303613 = Hospital System Supply Identifier | 522570 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC CR 1-2 9MM","code_information":[{"code":"Sx00-5972-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303612","type":"LOCAL"},{"code":"522569","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303612 = Hospital System Supply Identifier | 522569 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC CR 1-2 12MM","code_information":[{"code":"Sx00-5972-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303614","type":"LOCAL"},{"code":"522571","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303614 = Hospital System Supply Identifier | 522571 = Lawson ID"}]},{"description":"ART SURF CR 12MM YEL","code_information":[{"code":"Sx00-5972-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"324171","type":"LOCAL"},{"code":"247270","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 324171 = Hospital System Supply Identifier | 247270 = Lawson ID"}]},{"description":"ART SURF CR 10MM YEL","code_information":[{"code":"Sx00-5972-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"324174","type":"LOCAL"},{"code":"247384","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 324174 = Hospital System Supply Identifier | 247384 = Lawson ID"}]},{"description":"ART SURF CR 14MM YEL","code_information":[{"code":"Sx00-5972-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"324175","type":"LOCAL"},{"code":"247385","type":"LOCAL"}],"standard_charges":[{"gross_charge":1128.0,"discounted_cash":846.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 324175 = Hospital System Supply Identifier | 247385 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC CR 3-4 09MM","code_information":[{"code":"Sx00-5972-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303618","type":"LOCAL"},{"code":"522575","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303618 = Hospital System Supply Identifier | 522575 = Lawson ID"}]},{"description":"NO USAGE - COMPONENT ARTICULAR SURFACE 17 MM KNEE UHMWPE CRUCIATE RETAINING YELLOW STRL NEXGEN","code_information":[{"code":"Sx00-5972-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303619","type":"LOCAL"},{"code":"522576","type":"LOCAL"}],"standard_charges":[{"gross_charge":1128.0,"discounted_cash":846.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303619 = Hospital System Supply Identifier | 522576 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC CR 3-4 20MM","code_information":[{"code":"Sx00-5972-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303620","type":"LOCAL"},{"code":"522577","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303620 = Hospital System Supply Identifier | 522577 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC CR 5-6 17MM","code_information":[{"code":"Sx00-5972-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303622","type":"LOCAL"},{"code":"522579","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303622 = Hospital System Supply Identifier | 522579 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC CR 5-6 20MM","code_information":[{"code":"Sx00-5972-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303623","type":"LOCAL"},{"code":"522580","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303623 = Hospital System Supply Identifier | 522580 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC CR 5-6 09MM","code_information":[{"code":"Sx00-5972-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303621","type":"LOCAL"},{"code":"522578","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303621 = Hospital System Supply Identifier | 522578 = Lawson ID"}]},{"description":"ART SURFACE CR 14MM GRN","code_information":[{"code":"Sx00-5972-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"324172","type":"LOCAL"},{"code":"247276","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 324172 = Hospital System Supply Identifier | 247276 = Lawson ID"}]},{"description":"ART SURFACE CR 10MM GRN","code_information":[{"code":"Sx00-5972-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"150722","type":"LOCAL"},{"code":"246742","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 150722 = Hospital System Supply Identifier | 246742 = Lawson ID"}]},{"description":"ART SURFACE CR 12MM GRN","code_information":[{"code":"Sx00-5972-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"324173","type":"LOCAL"},{"code":"247278","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 324173 = Hospital System Supply Identifier | 247278 = Lawson ID"}]},{"description":"IMP KNEE TIB INS NXGNSZ7-10 14","code_information":[{"code":"Sx00-5972-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"148493","type":"LOCAL"},{"code":"235524","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 148493 = Hospital System Supply Identifier | 235524 = Lawson ID"}]},{"description":"ART SURFACE CR 10MM BLUE","code_information":[{"code":"Sx00-5972-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"324176","type":"LOCAL"},{"code":"247386","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 324176 = Hospital System Supply Identifier | 247386 = Lawson ID"}]},{"description":"ART SURFACE CR 12MM BLUE","code_information":[{"code":"Sx00-5972-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"324177","type":"LOCAL"},{"code":"247388","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 324177 = Hospital System Supply Identifier | 247388 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC CR 7-10 09","code_information":[{"code":"Sx00-5972-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303624","type":"LOCAL"},{"code":"522581","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303624 = Hospital System Supply Identifier | 522581 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC CR 7-10 17","code_information":[{"code":"Sx00-5972-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303625","type":"LOCAL"},{"code":"522582","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303625 = Hospital System Supply Identifier | 522582 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC CR 7-10 20","code_information":[{"code":"Sx00-5972-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303626","type":"LOCAL"},{"code":"522583","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303626 = Hospital System Supply Identifier | 522583 = Lawson ID"}]},{"description":"PATELLA ALL POLY SZ 41MM","code_information":[{"code":"Sx00-5972-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"167954","type":"LOCAL"},{"code":"204696","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 167954 = Hospital System Supply Identifier | 204696 = Lawson ID"}]},{"description":"PATELLA ALL POLY SZ 35MM","code_information":[{"code":"Sx00-5972-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"167953","type":"LOCAL"},{"code":"204694","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 167953 = Hospital System Supply Identifier | 204694 = Lawson ID"}]},{"description":"IMP KNEE PTELA POLY NXGN 26MM","code_information":[{"code":"Sx00-5972-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303627","type":"LOCAL"},{"code":"522584","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303627 = Hospital System Supply Identifier | 522584 = Lawson ID"}]},{"description":"PATELLA ALL POLY 5972-65-29","code_information":[{"code":"Sx00-5972-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"167630","type":"LOCAL"},{"code":"202394","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 167630 = Hospital System Supply Identifier | 202394 = Lawson ID"}]},{"description":"IMP KNEE PTELA 9.5MM SZ38","code_information":[{"code":"Sx00-5972-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"166598","type":"LOCAL"},{"code":"145755","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 166598 = Hospital System Supply Identifier | 145755 = Lawson ID"}]},{"description":"PATELLA ALL POLY SZ 32MM","code_information":[{"code":"Sx00-5972-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"167934","type":"LOCAL"},{"code":"204413","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 167934 = Hospital System Supply Identifier | 204413 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC 6DRT YEL 10","code_information":[{"code":"Sx00-5973-038","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303628","type":"LOCAL"},{"code":"522585","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303628 = Hospital System Supply Identifier | 522585 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC 6DRT YEL 14","code_information":[{"code":"Sx00-5973-038","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303629","type":"LOCAL"},{"code":"522586","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303629 = Hospital System Supply Identifier | 522586 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC 6DRT GRN 10","code_information":[{"code":"Sx00-5973-048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303630","type":"LOCAL"},{"code":"522587","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303630 = Hospital System Supply Identifier | 522587 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC 6DRT GRN 12","code_information":[{"code":"Sx00-5973-048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303631","type":"LOCAL"},{"code":"522588","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303631 = Hospital System Supply Identifier | 522588 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC 6DLT GRN 14","code_information":[{"code":"Sx00-5973-049","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303634","type":"LOCAL"},{"code":"522591","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303634 = Hospital System Supply Identifier | 522591 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC 6DLT GRN 12","code_information":[{"code":"Sx00-5973-049","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303633","type":"LOCAL"},{"code":"522590","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303633 = Hospital System Supply Identifier | 522590 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC 6DLT GRN 10","code_information":[{"code":"Sx00-5973-049","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303632","type":"LOCAL"},{"code":"522589","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303632 = Hospital System Supply Identifier | 522589 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC 6DRT BLU 10","code_information":[{"code":"Sx00-5973-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303635","type":"LOCAL"},{"code":"522592","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303635 = Hospital System Supply Identifier | 522592 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC 6DRT BLU 14","code_information":[{"code":"Sx00-5973-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303636","type":"LOCAL"},{"code":"522593","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303636 = Hospital System Supply Identifier | 522593 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC 6DLT BLU 12","code_information":[{"code":"Sx00-5973-059","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303637","type":"LOCAL"},{"code":"522594","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303637 = Hospital System Supply Identifier | 522594 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC 6DLT BLU 14","code_information":[{"code":"Sx00-5973-059","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303638","type":"LOCAL"},{"code":"522595","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303638 = Hospital System Supply Identifier | 522595 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZC","code_information":[{"code":"Sx00-5976-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"327800","type":"LOCAL"},{"code":"426953","type":"LOCAL"}],"standard_charges":[{"gross_charge":15046.59,"discounted_cash":11284.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 327800 = Hospital System Supply Identifier | 426953 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZC","code_information":[{"code":"Sx00-5976-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321973","type":"LOCAL"},{"code":"535187","type":"LOCAL"}],"standard_charges":[{"gross_charge":15046.59,"discounted_cash":11284.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321973 = Hospital System Supply Identifier | 535187 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZD","code_information":[{"code":"Sx00-5976-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321974","type":"LOCAL"},{"code":"535188","type":"LOCAL"}],"standard_charges":[{"gross_charge":15046.59,"discounted_cash":11284.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321974 = Hospital System Supply Identifier | 535188 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZD","code_information":[{"code":"Sx00-5976-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321975","type":"LOCAL"},{"code":"535189","type":"LOCAL"}],"standard_charges":[{"gross_charge":15046.59,"discounted_cash":11284.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321975 = Hospital System Supply Identifier | 535189 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZF","code_information":[{"code":"Sx00-5976-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"324826","type":"LOCAL"},{"code":"324163","type":"LOCAL"}],"standard_charges":[{"gross_charge":15046.59,"discounted_cash":11284.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 324826 = Hospital System Supply Identifier | 324163 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZF","code_information":[{"code":"Sx00-5976-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321976","type":"LOCAL"},{"code":"535190","type":"LOCAL"}],"standard_charges":[{"gross_charge":15046.59,"discounted_cash":11284.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321976 = Hospital System Supply Identifier | 535190 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZG","code_information":[{"code":"Sx00-5976-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321977","type":"LOCAL"},{"code":"535191","type":"LOCAL"}],"standard_charges":[{"gross_charge":15046.59,"discounted_cash":11284.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321977 = Hospital System Supply Identifier | 535191 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZG","code_information":[{"code":"Sx00-5976-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321978","type":"LOCAL"},{"code":"535192","type":"LOCAL"}],"standard_charges":[{"gross_charge":15046.59,"discounted_cash":11284.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321978 = Hospital System Supply Identifier | 535192 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC NXGN 1-2 20","code_information":[{"code":"Sx00-5976-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303642","type":"LOCAL"},{"code":"522599","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303642 = Hospital System Supply Identifier | 522599 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC NXGN 1-2 14","code_information":[{"code":"Sx00-5976-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303640","type":"LOCAL"},{"code":"522597","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303640 = Hospital System Supply Identifier | 522597 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC NXGN 1-2 17","code_information":[{"code":"Sx00-5976-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303641","type":"LOCAL"},{"code":"522598","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303641 = Hospital System Supply Identifier | 522598 = Lawson ID"}]},{"description":"IMP KNEE ANT PURP SZ21 12MM","code_information":[{"code":"Sx00-5976-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"328574","type":"LOCAL"},{"code":"458721","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 328574 = Hospital System Supply Identifier | 458721 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC NXGN 1-2 10","code_information":[{"code":"Sx00-5976-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303639","type":"LOCAL"},{"code":"522596","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303639 = Hospital System Supply Identifier | 522596 = Lawson ID"}]},{"description":"IMP HIP ACET ARTC SURF","code_information":[{"code":"Sx00-5976-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"178792","type":"LOCAL"},{"code":"408027","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 178792 = Hospital System Supply Identifier | 408027 = Lawson ID"}]},{"description":"IMP HIP ACET ARTC SURF","code_information":[{"code":"Sx00-5976-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326673","type":"LOCAL"},{"code":"408028","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 326673 = Hospital System Supply Identifier | 408028 = Lawson ID"}]},{"description":"IMP KNEE ANT CNSTRN YEL SZ17","code_information":[{"code":"Sx00-5976-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202257","type":"LOCAL"},{"code":"452355","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 202257 = Hospital System Supply Identifier | 452355 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC 3-4 20MM","code_information":[{"code":"Sx00-5976-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"181666","type":"LOCAL"},{"code":"453465","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 181666 = Hospital System Supply Identifier | 453465 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC NXGN 3-4 14","code_information":[{"code":"Sx00-5976-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303644","type":"LOCAL"},{"code":"522601","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303644 = Hospital System Supply Identifier | 522601 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC NXGN 5-6 12","code_information":[{"code":"Sx00-5976-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303645","type":"LOCAL"},{"code":"522602","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303645 = Hospital System Supply Identifier | 522602 = Lawson ID"}]},{"description":"IMP TIB NXGN ANT CONSTR SZ GRN","code_information":[{"code":"Sx00-5976-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329807","type":"LOCAL"},{"code":"379486","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329807 = Hospital System Supply Identifier | 379486 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC NXGN 5-6 14","code_information":[{"code":"Sx00-5976-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303646","type":"LOCAL"},{"code":"522603","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303646 = Hospital System Supply Identifier | 522603 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC NXGN 5-6 17","code_information":[{"code":"Sx00-5976-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303647","type":"LOCAL"},{"code":"522604","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303647 = Hospital System Supply Identifier | 522604 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC NXGN 5-6 20","code_information":[{"code":"Sx00-5976-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303648","type":"LOCAL"},{"code":"522605","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303648 = Hospital System Supply Identifier | 522605 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC NXGN7-10 17","code_information":[{"code":"Sx00-5976-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303653","type":"LOCAL"},{"code":"522610","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303653 = Hospital System Supply Identifier | 522610 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC NXGN7-10 14","code_information":[{"code":"Sx00-5976-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303652","type":"LOCAL"},{"code":"522609","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303652 = Hospital System Supply Identifier | 522609 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC NXGN7-10 20","code_information":[{"code":"Sx00-5976-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303654","type":"LOCAL"},{"code":"522611","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303654 = Hospital System Supply Identifier | 522611 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC NXGN7-10 10","code_information":[{"code":"Sx00-5976-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303650","type":"LOCAL"},{"code":"522607","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303650 = Hospital System Supply Identifier | 522607 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC NXGN7-10 12","code_information":[{"code":"Sx00-5976-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303651","type":"LOCAL"},{"code":"522608","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303651 = Hospital System Supply Identifier | 522608 = Lawson ID"}]},{"description":"BIT DRILL 12.7MM NSTRL 5IN 1 CEMENT STEM SS KNEE TIBIA LCCK NEXGEN","code_information":[{"code":"Sx00-5977-010","type":"CDM"},{"code":"272","type":"RC"},{"code":"1090156","type":"LOCAL"},{"code":"S657329","type":"LOCAL"}],"standard_charges":[{"gross_charge":307.65,"discounted_cash":230.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1090156 = Hospital System Supply Identifier | S657329 = Lawson ID"}]},{"description":"BIT DRILL NEXGEN CEMENTED STEM","code_information":[{"code":"Sx00-5977-010","type":"CDM"},{"code":"272","type":"RC"},{"code":"449581","type":"LOCAL"},{"code":"313631","type":"LOCAL"}],"standard_charges":[{"gross_charge":410.2,"discounted_cash":307.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 449581 = Hospital System Supply Identifier | 313631 = Lawson ID"}]},{"description":"GUIDE DRILL PTELA 26/29MM","code_information":[{"code":"Sx00-5979-001","type":"CDM"},{"code":"272","type":"RC"},{"code":"202050","type":"LOCAL"},{"code":"452142","type":"LOCAL"}],"standard_charges":[{"gross_charge":3868.3,"discounted_cash":2901.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 202050 = Hospital System Supply Identifier | 452142 = Lawson ID"}]},{"description":"GUIDE DRILL PTELA 32/35MM","code_information":[{"code":"Sx00-5979-001","type":"CDM"},{"code":"272","type":"RC"},{"code":"202051","type":"LOCAL"},{"code":"452143","type":"LOCAL"}],"standard_charges":[{"gross_charge":732.97,"discounted_cash":549.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 202051 = Hospital System Supply Identifier | 452143 = Lawson ID"}]},{"description":"GUIDE DRILL PTELA 38/41MM","code_information":[{"code":"Sx00-5979-001","type":"CDM"},{"code":"272","type":"RC"},{"code":"202052","type":"LOCAL"},{"code":"452144","type":"LOCAL"}],"standard_charges":[{"gross_charge":553.77,"discounted_cash":415.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 202052 = Hospital System Supply Identifier | 452144 = Lawson ID"}]},{"description":"REAMER PTELA W/PILOT DRL SZ 26","code_information":[{"code":"Sx00-5979-077","type":"CDM"},{"code":"272","type":"RC"},{"code":"303656","type":"LOCAL"},{"code":"522613","type":"LOCAL"}],"standard_charges":[{"gross_charge":1016.61,"discounted_cash":762.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303656 = Hospital System Supply Identifier | 522613 = Lawson ID"}]},{"description":"REAMER PTELA W/PILOT DRL SZ 29","code_information":[{"code":"Sx00-5979-077","type":"CDM"},{"code":"272","type":"RC"},{"code":"303657","type":"LOCAL"},{"code":"522614","type":"LOCAL"}],"standard_charges":[{"gross_charge":1016.61,"discounted_cash":762.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303657 = Hospital System Supply Identifier | 522614 = Lawson ID"}]},{"description":"REAMER PTELA W/PILOT DRL SZ 32","code_information":[{"code":"Sx00-5979-077","type":"CDM"},{"code":"272","type":"RC"},{"code":"303658","type":"LOCAL"},{"code":"522615","type":"LOCAL"}],"standard_charges":[{"gross_charge":1016.61,"discounted_cash":762.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303658 = Hospital System Supply Identifier | 522615 = Lawson ID"}]},{"description":"REAMER PTELA W/PILOT DRL SZ 35","code_information":[{"code":"Sx00-5979-077","type":"CDM"},{"code":"272","type":"RC"},{"code":"303659","type":"LOCAL"},{"code":"522616","type":"LOCAL"}],"standard_charges":[{"gross_charge":1016.61,"discounted_cash":762.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303659 = Hospital System Supply Identifier | 522616 = Lawson ID"}]},{"description":"REAMER PTELA W/PILOT DRL SZ 38","code_information":[{"code":"Sx00-5979-077","type":"CDM"},{"code":"272","type":"RC"},{"code":"303660","type":"LOCAL"},{"code":"522617","type":"LOCAL"}],"standard_charges":[{"gross_charge":1016.61,"discounted_cash":762.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303660 = Hospital System Supply Identifier | 522617 = Lawson ID"}]},{"description":"REAMER PTELA W/PILOT DRL SZ 41","code_information":[{"code":"Sx00-5979-077","type":"CDM"},{"code":"272","type":"RC"},{"code":"303661","type":"LOCAL"},{"code":"522618","type":"LOCAL"}],"standard_charges":[{"gross_charge":1016.61,"discounted_cash":762.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303661 = Hospital System Supply Identifier | 522618 = Lawson ID"}]},{"description":"REAMER PTELA W/PILOT DRL SZ 46","code_information":[{"code":"Sx00-5979-077","type":"CDM"},{"code":"272","type":"RC"},{"code":"303662","type":"LOCAL"},{"code":"522619","type":"LOCAL"}],"standard_charges":[{"gross_charge":1016.61,"discounted_cash":762.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303662 = Hospital System Supply Identifier | 522619 = Lawson ID"}]},{"description":"REAMER PTELA W/PILOT DRL SZ 51","code_information":[{"code":"Sx00-5979-077","type":"CDM"},{"code":"272","type":"RC"},{"code":"303663","type":"LOCAL"},{"code":"522620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1016.61,"discounted_cash":762.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303663 = Hospital System Supply Identifier | 522620 = Lawson ID"}]},{"description":"BLADE REAM PTELA W/PIL HL SZ26","code_information":[{"code":"Sx00-5979-095","type":"CDM"},{"code":"272","type":"RC"},{"code":"303664","type":"LOCAL"},{"code":"522621","type":"LOCAL"}],"standard_charges":[{"gross_charge":348.67,"discounted_cash":261.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303664 = Hospital System Supply Identifier | 522621 = Lawson ID"}]},{"description":"BLADE PAT REAM PILOT-H 32MM","code_information":[{"code":"Sx00-5979-095","type":"CDM"},{"code":"272","type":"RC"},{"code":"194243","type":"LOCAL"},{"code":"333601","type":"LOCAL"}],"standard_charges":[{"gross_charge":348.67,"discounted_cash":261.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 194243 = Hospital System Supply Identifier | 333601 = Lawson ID"}]},{"description":"BLADE PAT REAM PILOT-H 29MM","code_information":[{"code":"Sx00-5979-095","type":"CDM"},{"code":"272","type":"RC"},{"code":"325030","type":"LOCAL"},{"code":"333600","type":"LOCAL"}],"standard_charges":[{"gross_charge":348.67,"discounted_cash":261.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 325030 = Hospital System Supply Identifier | 333600 = Lawson ID"}]},{"description":"REAMER PTELA 51MM","code_information":[{"code":"Sx00-5979-095","type":"CDM"},{"code":"272","type":"RC"},{"code":"145874","type":"LOCAL"},{"code":"255263","type":"LOCAL"}],"standard_charges":[{"gross_charge":348.67,"discounted_cash":261.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 145874 = Hospital System Supply Identifier | 255263 = Lawson ID"}]},{"description":"REAMER PTELA 38MM","code_information":[{"code":"Sx00-5979-095","type":"CDM"},{"code":"272","type":"RC"},{"code":"149149","type":"LOCAL"},{"code":"236452","type":"LOCAL"}],"standard_charges":[{"gross_charge":348.67,"discounted_cash":261.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 149149 = Hospital System Supply Identifier | 236452 = Lawson ID"}]},{"description":"REAMER PTELA 46MM","code_information":[{"code":"Sx00-5979-095","type":"CDM"},{"code":"272","type":"RC"},{"code":"145716","type":"LOCAL"},{"code":"232505","type":"LOCAL"}],"standard_charges":[{"gross_charge":348.67,"discounted_cash":261.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 145716 = Hospital System Supply Identifier | 232505 = Lawson ID"}]},{"description":"REAMER PTELA 41MM","code_information":[{"code":"Sx00-5979-095","type":"CDM"},{"code":"272","type":"RC"},{"code":"145710","type":"LOCAL"},{"code":"232163","type":"LOCAL"}],"standard_charges":[{"gross_charge":348.67,"discounted_cash":261.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 145710 = Hospital System Supply Identifier | 232163 = Lawson ID"}]},{"description":"REAMER PTELA 35MM","code_information":[{"code":"Sx00-5979-095","type":"CDM"},{"code":"272","type":"RC"},{"code":"149913","type":"LOCAL"},{"code":"237469","type":"LOCAL"}],"standard_charges":[{"gross_charge":348.67,"discounted_cash":261.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 149913 = Hospital System Supply Identifier | 237469 = Lawson ID"}]},{"description":"PLATE TIBIA SIZE 1 5980-27-01","code_information":[{"code":"Sx00-5980-027","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"145627","type":"LOCAL"},{"code":"202631","type":"LOCAL"}],"standard_charges":[{"gross_charge":1960.0,"discounted_cash":1470.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 145627 = Hospital System Supply Identifier | 202631 = Lawson ID"}]},{"description":"IMP TIB BSPLT CRUC NXGN SZ2","code_information":[{"code":"Sx00-5980-027","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"145646","type":"LOCAL"},{"code":"205287","type":"LOCAL"}],"standard_charges":[{"gross_charge":1960.0,"discounted_cash":1470.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 145646 = Hospital System Supply Identifier | 205287 = Lawson ID"}]},{"description":"COMPONENT STEM TIBAL PLATE 4","code_information":[{"code":"Sx00-5980-037","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"145614","type":"LOCAL"},{"code":"145758","type":"LOCAL"}],"standard_charges":[{"gross_charge":1960.0,"discounted_cash":1470.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 145614 = Hospital System Supply Identifier | 145758 = Lawson ID"}]},{"description":"IMP KNEE TIB COMP STEM PLT 3","code_information":[{"code":"Sx00-5980-037","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"145625","type":"LOCAL"},{"code":"202392","type":"LOCAL"}],"standard_charges":[{"gross_charge":1960.0,"discounted_cash":1470.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 145625 = Hospital System Supply Identifier | 202392 = Lawson ID"}]},{"description":"IMP TIB BSPLT POST NXGN SZ5","code_information":[{"code":"Sx00-5980-047","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"145626","type":"LOCAL"},{"code":"202629","type":"LOCAL"}],"standard_charges":[{"gross_charge":1960.0,"discounted_cash":1470.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 145626 = Hospital System Supply Identifier | 202629 = Lawson ID"}]},{"description":"COMPONENT STEM TIBIAL PLATE 6","code_information":[{"code":"Sx00-5980-047","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"145645","type":"LOCAL"},{"code":"204692","type":"LOCAL"}],"standard_charges":[{"gross_charge":1960.0,"discounted_cash":1470.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 145645 = Hospital System Supply Identifier | 204692 = Lawson ID"}]},{"description":"COMPONENT STEM TIBIAL PLATE 8","code_information":[{"code":"Sx00-5980-057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"167758","type":"LOCAL"},{"code":"203518","type":"LOCAL"}],"standard_charges":[{"gross_charge":1960.0,"discounted_cash":1470.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 167758 = Hospital System Supply Identifier | 203518 = Lawson ID"}]},{"description":"COMPONENT STEM TIBIAL PLATE 10","code_information":[{"code":"Sx00-5980-057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"191964","type":"LOCAL"},{"code":"204223","type":"LOCAL"}],"standard_charges":[{"gross_charge":1960.0,"discounted_cash":1470.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 191964 = Hospital System Supply Identifier | 204223 = Lawson ID"}]},{"description":"IMP TIB BSPLT NXGN LT SZ7","code_information":[{"code":"Sx00-5980-057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"167952","type":"LOCAL"},{"code":"204693","type":"LOCAL"}],"standard_charges":[{"gross_charge":1960.0,"discounted_cash":1470.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 167952 = Hospital System Supply Identifier | 204693 = Lawson ID"}]},{"description":"COMPONENT STEM TIBIAL PLATE 9","code_information":[{"code":"Sx00-5980-057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"191988","type":"LOCAL"},{"code":"205017","type":"LOCAL"}],"standard_charges":[{"gross_charge":1960.0,"discounted_cash":1470.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 191988 = Hospital System Supply Identifier | 205017 = Lawson ID"}]},{"description":"SCREW REPL LOK F/STM EXT","code_information":[{"code":"Sx00-5980-090","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"171792","type":"LOCAL"},{"code":"439195","type":"LOCAL"}],"standard_charges":[{"gross_charge":225.61,"discounted_cash":169.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 171792 = Hospital System Supply Identifier | 439195 = Lawson ID"}]},{"description":"IMP TIB STEM NXGN PROVIS SZ4","code_information":[{"code":"Sx00-5981-037","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"330291","type":"LOCAL"},{"code":"440952","type":"LOCAL"}],"standard_charges":[{"gross_charge":329.62,"discounted_cash":247.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 330291 = Hospital System Supply Identifier | 440952 = Lawson ID"}]},{"description":"TRIAL KNEE 6 STD 74X50GRN STRI","code_information":[{"code":"Sx00-5981-047","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"929715","type":"LOCAL"},{"code":"813952","type":"LOCAL"}],"standard_charges":[{"gross_charge":266.63,"discounted_cash":199.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 929715 = Hospital System Supply Identifier | 813952 = Lawson ID"}]},{"description":"SCREW GUIDE 48MM STRL HEXAGON HEAD MIS QUAD-SPARING","code_information":[{"code":"Sx00-5983-040","type":"CDM"},{"code":"272","type":"RC"},{"code":"1103504","type":"LOCAL"},{"code":"S281814","type":"LOCAL"}],"standard_charges":[{"gross_charge":186.43,"discounted_cash":139.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1103504 = Hospital System Supply Identifier | S281814 = Lawson ID"}]},{"description":"SCREW HEADED NEXGEN 00598304033 SS 33MM","code_information":[{"code":"Sx00-5983-040","type":"CDM"},{"code":"272","type":"RC"},{"code":"1170808","type":"LOCAL"},{"code":"1004404","type":"LOCAL"}],"standard_charges":[{"gross_charge":186.43,"discounted_cash":139.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1170808 = Hospital System Supply Identifier | 1004404 = Lawson ID"}]},{"description":"GUIDE SURGICAL 27MM HEX HEAD SCREW","code_information":[{"code":"Sx00-5983-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"202219","type":"LOCAL"},{"code":"452317","type":"LOCAL"}],"standard_charges":[{"gross_charge":219.75,"discounted_cash":164.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 202219 = Hospital System Supply Identifier | 452317 = Lawson ID"}]},{"description":"SCREW HDLSS MIS 48MM","code_information":[{"code":"Sx00-5983-041","type":"CDM"},{"code":"272","type":"RC"},{"code":"662126","type":"LOCAL"},{"code":"360630","type":"LOCAL"}],"standard_charges":[{"gross_charge":186.43,"discounted_cash":139.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 662126 = Hospital System Supply Identifier | 360630 = Lawson ID"}]},{"description":"INST RETRAC COLLATERAL","code_information":[{"code":"Sx00-5983-082","type":"CDM"},{"code":"272","type":"RC"},{"code":"202106","type":"LOCAL"},{"code":"452202","type":"LOCAL"}],"standard_charges":[{"gross_charge":683.44,"discounted_cash":512.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 202106 = Hospital System Supply Identifier | 452202 = Lawson ID"}]},{"description":"BIT DRILL 18MM NSTRL STEM SS KNEE FEMUR NEXGEN","code_information":[{"code":"Sx00-5987-010","type":"CDM"},{"code":"272","type":"RC"},{"code":"1090165","type":"LOCAL"},{"code":"S657330","type":"LOCAL"}],"standard_charges":[{"gross_charge":389.69,"discounted_cash":292.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1090165 = Hospital System Supply Identifier | S657330 = Lawson ID"}]},{"description":"SCRDRVR HEX 2MM","code_information":[{"code":"Sx00-5987-071","type":"CDM"},{"code":"272","type":"RC"},{"code":"194001","type":"LOCAL"},{"code":"323762","type":"LOCAL"}],"standard_charges":[{"gross_charge":196.8,"discounted_cash":147.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 194001 = Hospital System Supply Identifier | 323762 = Lawson ID"}]},{"description":"NUT LOCK OFFSET NSTRL REVISION STEM SS KNEE FEMUR LCCK NEXGEN","code_information":[{"code":"Sx00-5987-080","type":"CDM"},{"code":"272","type":"RC"},{"code":"1099592","type":"LOCAL"},{"code":"S651505","type":"LOCAL"}],"standard_charges":[{"gross_charge":174.33,"discounted_cash":130.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1099592 = Hospital System Supply Identifier | S651505 = Lawson ID"}]},{"description":"TRIAL KNEE SHORT 6MM 3.5MM NSTRL AUGMENT SCREW HEXAGONAL HEAD FEMORAL PROVISIONAL NEXGEN","code_information":[{"code":"Sx00-5987-085","type":"CDM"},{"code":"272","type":"RC"},{"code":"662252","type":"LOCAL"},{"code":"446540","type":"LOCAL"}],"standard_charges":[{"gross_charge":366.25,"discounted_cash":274.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 662252 = Hospital System Supply Identifier | 446540 = Lawson ID"}]},{"description":"SCRDRVR HEX FEM AUG 3.5MM","code_information":[{"code":"Sx00-5987-089","type":"CDM"},{"code":"272","type":"RC"},{"code":"202339","type":"LOCAL"},{"code":"452438","type":"LOCAL"}],"standard_charges":[{"gross_charge":502.49,"discounted_cash":376.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 202339 = Hospital System Supply Identifier | 452438 = Lawson ID"}]},{"description":"IMP AUG DST NXGN SZ C/D 10MM","code_information":[{"code":"Sx00-5987-090","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202038","type":"LOCAL"},{"code":"452130","type":"LOCAL"}],"standard_charges":[{"gross_charge":297.39,"discounted_cash":223.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 202038 = Hospital System Supply Identifier | 452130 = Lawson ID"}]},{"description":"IMP AUG DST NXGN SZ C/D 5MM","code_information":[{"code":"Sx00-5987-090","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202039","type":"LOCAL"},{"code":"452131","type":"LOCAL"}],"standard_charges":[{"gross_charge":297.39,"discounted_cash":223.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 202039 = Hospital System Supply Identifier | 452131 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG RT/LT SZ 1 20","code_information":[{"code":"Sx00-5988-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322791","type":"LOCAL"},{"code":"536006","type":"LOCAL"}],"standard_charges":[{"gross_charge":2957.92,"discounted_cash":2218.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322791 = Hospital System Supply Identifier | 536006 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG LT/RT SZ 1 20","code_information":[{"code":"Sx00-5988-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322793","type":"LOCAL"},{"code":"536008","type":"LOCAL"}],"standard_charges":[{"gross_charge":2957.92,"discounted_cash":2218.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322793 = Hospital System Supply Identifier | 536008 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG RT/LT SZ1 15","code_information":[{"code":"Sx00-5988-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322790","type":"LOCAL"},{"code":"536005","type":"LOCAL"}],"standard_charges":[{"gross_charge":2714.67,"discounted_cash":2036.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322790 = Hospital System Supply Identifier | 536005 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG LT/RT SZ 1 15","code_information":[{"code":"Sx00-5988-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322792","type":"LOCAL"},{"code":"536007","type":"LOCAL"}],"standard_charges":[{"gross_charge":2714.67,"discounted_cash":2036.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322792 = Hospital System Supply Identifier | 536007 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG NXGN SZ1 5","code_information":[{"code":"Sx00-5988-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322788","type":"LOCAL"},{"code":"536003","type":"LOCAL"}],"standard_charges":[{"gross_charge":2743.96,"discounted_cash":2057.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322788 = Hospital System Supply Identifier | 536003 = Lawson ID"}]},{"description":"IMP TIB AUG NXGN FULL SZ1 10","code_information":[{"code":"Sx00-5988-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321979","type":"LOCAL"},{"code":"535193","type":"LOCAL"}],"standard_charges":[{"gross_charge":2030.0,"discounted_cash":1522.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321979 = Hospital System Supply Identifier | 535193 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG NXGN SZ1 10","code_information":[{"code":"Sx00-5988-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322789","type":"LOCAL"},{"code":"536004","type":"LOCAL"}],"standard_charges":[{"gross_charge":2743.96,"discounted_cash":2057.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322789 = Hospital System Supply Identifier | 536004 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG SZ2 15MM","code_information":[{"code":"Sx00-5988-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"327308","type":"LOCAL"},{"code":"416877","type":"LOCAL"}],"standard_charges":[{"gross_charge":2714.67,"discounted_cash":2036.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 327308 = Hospital System Supply Identifier | 416877 = Lawson ID"}]},{"description":"IMP TIB BLCK NXGN SZ2 10MM","code_information":[{"code":"Sx00-5988-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"198157","type":"LOCAL"},{"code":"443397","type":"LOCAL"}],"standard_charges":[{"gross_charge":2030.0,"discounted_cash":1522.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 198157 = Hospital System Supply Identifier | 443397 = Lawson ID"}]},{"description":"IMP TIB AUG NXGN BLCK SZ 2 5","code_information":[{"code":"Sx00-5988-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321984","type":"LOCAL"},{"code":"535198","type":"LOCAL"}],"standard_charges":[{"gross_charge":2030.0,"discounted_cash":1522.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321984 = Hospital System Supply Identifier | 535198 = Lawson ID"}]},{"description":"IMP TIB AUG NXGN BLCK SZ 2 10","code_information":[{"code":"Sx00-5988-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321985","type":"LOCAL"},{"code":"535199","type":"LOCAL"}],"standard_charges":[{"gross_charge":2030.0,"discounted_cash":1522.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321985 = Hospital System Supply Identifier | 535199 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG RT/LT SZ 2 15","code_information":[{"code":"Sx00-5988-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322794","type":"LOCAL"},{"code":"536009","type":"LOCAL"}],"standard_charges":[{"gross_charge":2714.67,"discounted_cash":2036.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322794 = Hospital System Supply Identifier | 536009 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG RT/LT SZ 2 20","code_information":[{"code":"Sx00-5988-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322795","type":"LOCAL"},{"code":"536010","type":"LOCAL"}],"standard_charges":[{"gross_charge":2957.92,"discounted_cash":2218.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322795 = Hospital System Supply Identifier | 536010 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG LT/RT SZ 2 20","code_information":[{"code":"Sx00-5988-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322796","type":"LOCAL"},{"code":"536011","type":"LOCAL"}],"standard_charges":[{"gross_charge":2957.92,"discounted_cash":2218.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322796 = Hospital System Supply Identifier | 536011 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG LT/RT SZ 3 20","code_information":[{"code":"Sx00-5988-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322800","type":"LOCAL"},{"code":"536015","type":"LOCAL"}],"standard_charges":[{"gross_charge":2957.92,"discounted_cash":2218.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322800 = Hospital System Supply Identifier | 536015 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG LT/RT SZ 3 15","code_information":[{"code":"Sx00-5988-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322799","type":"LOCAL"},{"code":"536014","type":"LOCAL"}],"standard_charges":[{"gross_charge":2714.67,"discounted_cash":2036.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322799 = Hospital System Supply Identifier | 536014 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG RT/LT SZ 3 20","code_information":[{"code":"Sx00-5988-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322798","type":"LOCAL"},{"code":"536013","type":"LOCAL"}],"standard_charges":[{"gross_charge":2957.92,"discounted_cash":2218.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322798 = Hospital System Supply Identifier | 536013 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG RT/LT SZ 3 15","code_information":[{"code":"Sx00-5988-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322797","type":"LOCAL"},{"code":"536012","type":"LOCAL"}],"standard_charges":[{"gross_charge":2714.67,"discounted_cash":2036.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322797 = Hospital System Supply Identifier | 536012 = Lawson ID"}]},{"description":"IMP TIB AUG NXGN HLF SZ3 5MM","code_information":[{"code":"Sx00-5988-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"146878","type":"LOCAL"},{"code":"223391","type":"LOCAL"}],"standard_charges":[{"gross_charge":2030.0,"discounted_cash":1522.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 146878 = Hospital System Supply Identifier | 223391 = Lawson ID"}]},{"description":"IMP KNEE TIB INS NXGN SZ3 10MM","code_information":[{"code":"Sx00-5988-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"196573","type":"LOCAL"},{"code":"412556","type":"LOCAL"}],"standard_charges":[{"gross_charge":2030.0,"discounted_cash":1522.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 196573 = Hospital System Supply Identifier | 412556 = Lawson ID"}]},{"description":"IMP TIB AUG NXGN HLF SZ3 10MM","code_information":[{"code":"Sx00-5988-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"192127","type":"LOCAL"},{"code":"223392","type":"LOCAL"}],"standard_charges":[{"gross_charge":2030.0,"discounted_cash":1522.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 192127 = Hospital System Supply Identifier | 223392 = Lawson ID"}]},{"description":"IMP TIB PLT WDG PRECT NXGN SZ3","code_information":[{"code":"Sx00-5988-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321986","type":"LOCAL"},{"code":"535200","type":"LOCAL"}],"standard_charges":[{"gross_charge":5480.0,"discounted_cash":4110.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321986 = Hospital System Supply Identifier | 535200 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG LT/RT SZ 4 20","code_information":[{"code":"Sx00-5988-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322801","type":"LOCAL"},{"code":"536016","type":"LOCAL"}],"standard_charges":[{"gross_charge":2957.92,"discounted_cash":2218.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322801 = Hospital System Supply Identifier | 536016 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG LT/RT SZ 4 20","code_information":[{"code":"Sx00-5988-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322802","type":"LOCAL"},{"code":"536017","type":"LOCAL"}],"standard_charges":[{"gross_charge":2957.92,"discounted_cash":2218.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322802 = Hospital System Supply Identifier | 536017 = Lawson ID"}]},{"description":"IMP TIB PLT WDG PRECT NXGN SZ4","code_information":[{"code":"Sx00-5988-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321991","type":"LOCAL"},{"code":"535205","type":"LOCAL"}],"standard_charges":[{"gross_charge":5480.0,"discounted_cash":4110.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 321991 = Hospital System Supply Identifier | 535205 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG SZ4 15MM","code_information":[{"code":"Sx00-5988-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326297","type":"LOCAL"},{"code":"395499","type":"LOCAL"}],"standard_charges":[{"gross_charge":2714.67,"discounted_cash":2036.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 326297 = Hospital System Supply Identifier | 395499 = Lawson ID"}]},{"description":"IMP TIB AUG NXGN HLF SZ4 15MM","code_information":[{"code":"Sx00-5988-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329381","type":"LOCAL"},{"code":"324178","type":"LOCAL"}],"standard_charges":[{"gross_charge":2714.67,"discounted_cash":2036.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329381 = Hospital System Supply Identifier | 324178 = Lawson ID"}]},{"description":"IMP TIB AUG NXGN HLF SZ4 10MM","code_information":[{"code":"Sx00-5988-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329030","type":"LOCAL"},{"code":"223394","type":"LOCAL"}],"standard_charges":[{"gross_charge":2030.0,"discounted_cash":1522.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329030 = Hospital System Supply Identifier | 223394 = Lawson ID"}]},{"description":"IMP TIB AUG NXGN HLF SZ4 5MM","code_information":[{"code":"Sx00-5988-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329029","type":"LOCAL"},{"code":"223393","type":"LOCAL"}],"standard_charges":[{"gross_charge":2030.0,"discounted_cash":1522.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329029 = Hospital System Supply Identifier | 223393 = Lawson ID"}]},{"description":"IMP TIB STEM NXGN PRE SZ4 10MM","code_information":[{"code":"Sx00-5988-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"194723","type":"LOCAL"},{"code":"347385","type":"LOCAL"}],"standard_charges":[{"gross_charge":2030.0,"discounted_cash":1522.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 194723 = Hospital System Supply Identifier | 347385 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG LT/RT SZ 5 20","code_information":[{"code":"Sx00-5988-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322804","type":"LOCAL"},{"code":"536019","type":"LOCAL"}],"standard_charges":[{"gross_charge":2957.92,"discounted_cash":2218.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322804 = Hospital System Supply Identifier | 536019 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG SZ5 15MM","code_information":[{"code":"Sx00-5988-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326830","type":"LOCAL"},{"code":"402005","type":"LOCAL"}],"standard_charges":[{"gross_charge":2714.67,"discounted_cash":2036.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 326830 = Hospital System Supply Identifier | 402005 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG SZ5 20MM","code_information":[{"code":"Sx00-5988-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326829","type":"LOCAL"},{"code":"402004","type":"LOCAL"}],"standard_charges":[{"gross_charge":2957.92,"discounted_cash":2218.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 326829 = Hospital System Supply Identifier | 402004 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG RT/LT SZ 5 15","code_information":[{"code":"Sx00-5988-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322803","type":"LOCAL"},{"code":"536018","type":"LOCAL"}],"standard_charges":[{"gross_charge":2714.67,"discounted_cash":2036.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322803 = Hospital System Supply Identifier | 536018 = Lawson ID"}]},{"description":"IMP TIB BSPLT MOD NXGN SZ5","code_information":[{"code":"Sx00-5988-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329380","type":"LOCAL"},{"code":"324173","type":"LOCAL"}],"standard_charges":[{"gross_charge":5480.0,"discounted_cash":4110.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329380 = Hospital System Supply Identifier | 324173 = Lawson ID"}]},{"description":"IMP TIB AUG NXGN HLF SZ5 10MM","code_information":[{"code":"Sx00-5988-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"178245","type":"LOCAL"},{"code":"223396","type":"LOCAL"}],"standard_charges":[{"gross_charge":2030.0,"discounted_cash":1522.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 178245 = Hospital System Supply Identifier | 223396 = Lawson ID"}]},{"description":"IMP TIB AUG NXGN HLF SZ5 5MM","code_information":[{"code":"Sx00-5988-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329031","type":"LOCAL"},{"code":"223395","type":"LOCAL"}],"standard_charges":[{"gross_charge":2030.0,"discounted_cash":1522.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329031 = Hospital System Supply Identifier | 223395 = Lawson ID"}]},{"description":"IMP TIB STEM NXGN PRE SZ5 10MM","code_information":[{"code":"Sx00-5988-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329382","type":"LOCAL"},{"code":"324179","type":"LOCAL"}],"standard_charges":[{"gross_charge":2030.0,"discounted_cash":1522.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329382 = Hospital System Supply Identifier | 324179 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG LT/RT SZ 6 20","code_information":[{"code":"Sx00-5988-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322808","type":"LOCAL"},{"code":"536023","type":"LOCAL"}],"standard_charges":[{"gross_charge":2957.92,"discounted_cash":2218.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322808 = Hospital System Supply Identifier | 536023 = Lawson ID"}]},{"description":"IMP TIB AUG NXGN HLF SZ6 5MM","code_information":[{"code":"Sx00-5988-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329032","type":"LOCAL"},{"code":"223397","type":"LOCAL"}],"standard_charges":[{"gross_charge":2030.0,"discounted_cash":1522.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329032 = Hospital System Supply Identifier | 223397 = Lawson ID"}]},{"description":"IMP TIB AUG NXGN HLF SZ6 10MM","code_information":[{"code":"Sx00-5988-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329033","type":"LOCAL"},{"code":"223398","type":"LOCAL"}],"standard_charges":[{"gross_charge":2030.0,"discounted_cash":1522.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329033 = Hospital System Supply Identifier | 223398 = Lawson ID"}]},{"description":"TIBIAL COMP STEMMED SZ 6","code_information":[{"code":"Sx00-5988-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325957","type":"LOCAL"},{"code":"374594","type":"LOCAL"}],"standard_charges":[{"gross_charge":5480.0,"discounted_cash":4110.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 325957 = Hospital System Supply Identifier | 374594 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG SZ6 10MM","code_information":[{"code":"Sx00-5988-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326831","type":"LOCAL"},{"code":"402006","type":"LOCAL"}],"standard_charges":[{"gross_charge":2030.0,"discounted_cash":1522.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 326831 = Hospital System Supply Identifier | 402006 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG RT/LT SZ 6 15","code_information":[{"code":"Sx00-5988-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322805","type":"LOCAL"},{"code":"536020","type":"LOCAL"}],"standard_charges":[{"gross_charge":2714.67,"discounted_cash":2036.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322805 = Hospital System Supply Identifier | 536020 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG RT/LT SZ 6 20","code_information":[{"code":"Sx00-5988-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322806","type":"LOCAL"},{"code":"536021","type":"LOCAL"}],"standard_charges":[{"gross_charge":2957.92,"discounted_cash":2218.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322806 = Hospital System Supply Identifier | 536021 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG LT/RT SZ 6 15","code_information":[{"code":"Sx00-5988-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322807","type":"LOCAL"},{"code":"536022","type":"LOCAL"}],"standard_charges":[{"gross_charge":2714.67,"discounted_cash":2036.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322807 = Hospital System Supply Identifier | 536022 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG LT/RT SZ 7 15","code_information":[{"code":"Sx00-5988-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322811","type":"LOCAL"},{"code":"536026","type":"LOCAL"}],"standard_charges":[{"gross_charge":2714.67,"discounted_cash":2036.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322811 = Hospital System Supply Identifier | 536026 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG RT/LT SZ 7 20","code_information":[{"code":"Sx00-5988-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322810","type":"LOCAL"},{"code":"536025","type":"LOCAL"}],"standard_charges":[{"gross_charge":3016.3,"discounted_cash":2262.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322810 = Hospital System Supply Identifier | 536025 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG LT/RT SZ 7 20","code_information":[{"code":"Sx00-5988-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322812","type":"LOCAL"},{"code":"536027","type":"LOCAL"}],"standard_charges":[{"gross_charge":3016.3,"discounted_cash":2262.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322812 = Hospital System Supply Identifier | 536027 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG RT/LT SZ 7 15","code_information":[{"code":"Sx00-5988-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322809","type":"LOCAL"},{"code":"536024","type":"LOCAL"}],"standard_charges":[{"gross_charge":2714.67,"discounted_cash":2036.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322809 = Hospital System Supply Identifier | 536024 = Lawson ID"}]},{"description":"IMP TIB AUG NXGN HLF SZ7 5MM","code_information":[{"code":"Sx00-5988-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329034","type":"LOCAL"},{"code":"223399","type":"LOCAL"}],"standard_charges":[{"gross_charge":2030.0,"discounted_cash":1522.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329034 = Hospital System Supply Identifier | 223399 = Lawson ID"}]},{"description":"IMP TIB STEM NXGN PRE SZ7 10MM","code_information":[{"code":"Sx00-5988-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329383","type":"LOCAL"},{"code":"324181","type":"LOCAL"}],"standard_charges":[{"gross_charge":2030.0,"discounted_cash":1522.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329383 = Hospital System Supply Identifier | 324181 = Lawson ID"}]},{"description":"IMP TIB AUG NXGN HLF SZ7 10MM","code_information":[{"code":"Sx00-5988-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329035","type":"LOCAL"},{"code":"223400","type":"LOCAL"}],"standard_charges":[{"gross_charge":2030.0,"discounted_cash":1522.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329035 = Hospital System Supply Identifier | 223400 = Lawson ID"}]},{"description":"IMP KNEE TIB PLT WDG BL/STR SZ","code_information":[{"code":"Sx00-5988-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202326","type":"LOCAL"},{"code":"452424","type":"LOCAL"}],"standard_charges":[{"gross_charge":5480.0,"discounted_cash":4110.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 202326 = Hospital System Supply Identifier | 452424 = Lawson ID"}]},{"description":"IMP TIB AUG NXGN HLF SZ8 5MM","code_information":[{"code":"Sx00-5988-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329036","type":"LOCAL"},{"code":"223401","type":"LOCAL"}],"standard_charges":[{"gross_charge":2030.0,"discounted_cash":1522.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329036 = Hospital System Supply Identifier | 223401 = Lawson ID"}]},{"description":"IMP TIB AUG NXGN HLF SZ8 10MM","code_information":[{"code":"Sx00-5988-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329037","type":"LOCAL"},{"code":"223402","type":"LOCAL"}],"standard_charges":[{"gross_charge":2030.0,"discounted_cash":1522.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329037 = Hospital System Supply Identifier | 223402 = Lawson ID"}]},{"description":"IMP TIB PLT WDG PRECT NXGN SZ8","code_information":[{"code":"Sx00-5988-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322008","type":"LOCAL"},{"code":"535222","type":"LOCAL"}],"standard_charges":[{"gross_charge":5480.0,"discounted_cash":4110.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322008 = Hospital System Supply Identifier | 535222 = Lawson ID"}]},{"description":"IMP TIB AUG NXGN FULL SZ8 10","code_information":[{"code":"Sx00-5988-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322009","type":"LOCAL"},{"code":"535223","type":"LOCAL"}],"standard_charges":[{"gross_charge":2030.0,"discounted_cash":1522.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322009 = Hospital System Supply Identifier | 535223 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG RT/LT SZ 8 15","code_information":[{"code":"Sx00-5988-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322813","type":"LOCAL"},{"code":"536028","type":"LOCAL"}],"standard_charges":[{"gross_charge":2587.72,"discounted_cash":1940.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322813 = Hospital System Supply Identifier | 536028 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG RT/LT SZ 8 20","code_information":[{"code":"Sx00-5988-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322814","type":"LOCAL"},{"code":"536029","type":"LOCAL"}],"standard_charges":[{"gross_charge":3016.3,"discounted_cash":2262.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322814 = Hospital System Supply Identifier | 536029 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG LT/RT SZ 8 15","code_information":[{"code":"Sx00-5988-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322815","type":"LOCAL"},{"code":"536030","type":"LOCAL"}],"standard_charges":[{"gross_charge":2743.96,"discounted_cash":2057.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322815 = Hospital System Supply Identifier | 536030 = Lawson ID"}]},{"description":"IMP KNEE TIB AUG LT/RT SZ 8 20","code_information":[{"code":"Sx00-5988-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322816","type":"LOCAL"},{"code":"536031","type":"LOCAL"}],"standard_charges":[{"gross_charge":3016.3,"discounted_cash":2262.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322816 = Hospital System Supply Identifier | 536031 = Lawson ID"}]},{"description":"IMP KNEE FEM STEM NXGN STD 24M","code_information":[{"code":"Sx00-5988-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"323477","type":"LOCAL"},{"code":"223414","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 323477 = Hospital System Supply Identifier | 223414 = Lawson ID"}]},{"description":"IMP TIB STEM EXT NXGN 22MM","code_information":[{"code":"Sx00-5988-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329040","type":"LOCAL"},{"code":"223413","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329040 = Hospital System Supply Identifier | 223413 = Lawson ID"}]},{"description":"IMP TIB STEM EXT NXGN 20MM","code_information":[{"code":"Sx00-5988-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329039","type":"LOCAL"},{"code":"223412","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329039 = Hospital System Supply Identifier | 223412 = Lawson ID"}]},{"description":"IMP TIB STEM EXT NXGN 18MM","code_information":[{"code":"Sx00-5988-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"146881","type":"LOCAL"},{"code":"223411","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 146881 = Hospital System Supply Identifier | 223411 = Lawson ID"}]},{"description":"IMP TIB STEM EXT NXGN 16MM","code_information":[{"code":"Sx00-5988-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329038","type":"LOCAL"},{"code":"223409","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329038 = Hospital System Supply Identifier | 223409 = Lawson ID"}]},{"description":"IMP TIB STEM EXT NXGN 17MM","code_information":[{"code":"Sx00-5988-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"169563","type":"LOCAL"},{"code":"223410","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 169563 = Hospital System Supply Identifier | 223410 = Lawson ID"}]},{"description":"IMP TIB STEM EXT NXGN 14MM","code_information":[{"code":"Sx00-5988-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"146880","type":"LOCAL"},{"code":"223407","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 146880 = Hospital System Supply Identifier | 223407 = Lawson ID"}]},{"description":"IMP TIB STEM EXT NXGN 13MM","code_information":[{"code":"Sx00-5988-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"146879","type":"LOCAL"},{"code":"223406","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 146879 = Hospital System Supply Identifier | 223406 = Lawson ID"}]},{"description":"IMP TIB STEM EXT NXGN 12MM","code_information":[{"code":"Sx00-5988-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"192130","type":"LOCAL"},{"code":"223405","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 192130 = Hospital System Supply Identifier | 223405 = Lawson ID"}]},{"description":"IMP TIB STEM EXT NXGN 11MM","code_information":[{"code":"Sx00-5988-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"192129","type":"LOCAL"},{"code":"223404","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 192129 = Hospital System Supply Identifier | 223404 = Lawson ID"}]},{"description":"IMP TIB STEM EXT NXGN 10MM","code_information":[{"code":"Sx00-5988-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"192128","type":"LOCAL"},{"code":"223403","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 192128 = Hospital System Supply Identifier | 223403 = Lawson ID"}]},{"description":"IMP TIB STEM EXT NXGN 15MM","code_information":[{"code":"Sx00-5988-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"169562","type":"LOCAL"},{"code":"223408","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 169562 = Hospital System Supply Identifier | 223408 = Lawson ID"}]},{"description":"IMP TIB STEM EXT STR 18X200MM","code_information":[{"code":"Sx00-5988-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329150","type":"LOCAL"},{"code":"258420","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329150 = Hospital System Supply Identifier | 258420 = Lawson ID"}]},{"description":"IMP TIB STEM EXT STR 17X200MM","code_information":[{"code":"Sx00-5988-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329149","type":"LOCAL"},{"code":"258419","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329149 = Hospital System Supply Identifier | 258419 = Lawson ID"}]},{"description":"IMP TIB STEM EXT STR 15X200MM","code_information":[{"code":"Sx00-5988-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329147","type":"LOCAL"},{"code":"258417","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329147 = Hospital System Supply Identifier | 258417 = Lawson ID"}]},{"description":"IMP TIB STEM EXT STR 16X200MM","code_information":[{"code":"Sx00-5988-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329148","type":"LOCAL"},{"code":"258418","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329148 = Hospital System Supply Identifier | 258418 = Lawson ID"}]},{"description":"IMP TIB STEM EXT STR 13X200MM","code_information":[{"code":"Sx00-5988-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329146","type":"LOCAL"},{"code":"258415","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329146 = Hospital System Supply Identifier | 258415 = Lawson ID"}]},{"description":"IMP TIB STEM EXT STR 12X200MM","code_information":[{"code":"Sx00-5988-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329145","type":"LOCAL"},{"code":"258414","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329145 = Hospital System Supply Identifier | 258414 = Lawson ID"}]},{"description":"IMP TIB STEM EXT STR 14X200MM","code_information":[{"code":"Sx00-5988-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"193238","type":"LOCAL"},{"code":"258416","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 193238 = Hospital System Supply Identifier | 258416 = Lawson ID"}]},{"description":"IMP TIB STEM EXT NXGN 15X30MM","code_information":[{"code":"Sx00-5988-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"145671","type":"LOCAL"},{"code":"223555","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 145671 = Hospital System Supply Identifier | 223555 = Lawson ID"}]},{"description":"IMP TIB STEM EXT STR 12.7X300","code_information":[{"code":"Sx00-5988-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"330570","type":"LOCAL"},{"code":"462721","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 330570 = Hospital System Supply Identifier | 462721 = Lawson ID"}]},{"description":"IMP TIB STEM EXT FLUT 24X120MM","code_information":[{"code":"Sx00-5988-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322021","type":"LOCAL"},{"code":"535235","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322021 = Hospital System Supply Identifier | 535235 = Lawson ID"}]},{"description":"IMP TIB STEM EXT FLUT 20X120MM","code_information":[{"code":"Sx00-5988-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322020","type":"LOCAL"},{"code":"535234","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322020 = Hospital System Supply Identifier | 535234 = Lawson ID"}]},{"description":"IMP TIB STEM EXT FLUT 19X120MM","code_information":[{"code":"Sx00-5988-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322019","type":"LOCAL"},{"code":"535233","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322019 = Hospital System Supply Identifier | 535233 = Lawson ID"}]},{"description":"IMP TIB STEM EXT FLUT 18X120MM","code_information":[{"code":"Sx00-5988-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322018","type":"LOCAL"},{"code":"535232","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322018 = Hospital System Supply Identifier | 535232 = Lawson ID"}]},{"description":"IMP TIB STEM EXT FLUT 16X120MM","code_information":[{"code":"Sx00-5988-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322017","type":"LOCAL"},{"code":"535231","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322017 = Hospital System Supply Identifier | 535231 = Lawson ID"}]},{"description":"IMP TIB STEM EXT FLUT 15X120MM","code_information":[{"code":"Sx00-5988-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322016","type":"LOCAL"},{"code":"535230","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322016 = Hospital System Supply Identifier | 535230 = Lawson ID"}]},{"description":"IMP TIB STEM EXT FLUT 17X25MM","code_information":[{"code":"Sx00-5988-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329388","type":"LOCAL"},{"code":"324195","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329388 = Hospital System Supply Identifier | 324195 = Lawson ID"}]},{"description":"IMP TIB STEM EXT FLUT 22X75MM","code_information":[{"code":"Sx00-5988-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329389","type":"LOCAL"},{"code":"324196","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329389 = Hospital System Supply Identifier | 324196 = Lawson ID"}]},{"description":"IMP TIB STEM EXT FLUT 14X75MM","code_information":[{"code":"Sx00-5988-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329387","type":"LOCAL"},{"code":"324194","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329387 = Hospital System Supply Identifier | 324194 = Lawson ID"}]},{"description":"IMP TIB STEM EXT FLUT 13X75MM","code_information":[{"code":"Sx00-5988-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329386","type":"LOCAL"},{"code":"324193","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329386 = Hospital System Supply Identifier | 324193 = Lawson ID"}]},{"description":"IMP TIB STEM EXT FLUT 12X77MM","code_information":[{"code":"Sx00-5988-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329385","type":"LOCAL"},{"code":"324192","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329385 = Hospital System Supply Identifier | 324192 = Lawson ID"}]},{"description":"IMP TIB STEM EXT FLUT 1X75MM","code_information":[{"code":"Sx00-5988-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329384","type":"LOCAL"},{"code":"324191","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329384 = Hospital System Supply Identifier | 324191 = Lawson ID"}]},{"description":"IMP TIB STEM EXT FLUT 10X120MM","code_information":[{"code":"Sx00-5988-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322015","type":"LOCAL"},{"code":"535229","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322015 = Hospital System Supply Identifier | 535229 = Lawson ID"}]},{"description":"IMP TIB STEM EXT FLUT 16X175MM","code_information":[{"code":"Sx00-5988-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322027","type":"LOCAL"},{"code":"535241","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322027 = Hospital System Supply Identifier | 535241 = Lawson ID"}]},{"description":"IMP TIB STEM EXT FLUT 15X175MM","code_information":[{"code":"Sx00-5988-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322026","type":"LOCAL"},{"code":"535240","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322026 = Hospital System Supply Identifier | 535240 = Lawson ID"}]},{"description":"IMP TIB STEM EXT FLUT 14X175MM","code_information":[{"code":"Sx00-5988-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322025","type":"LOCAL"},{"code":"535239","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322025 = Hospital System Supply Identifier | 535239 = Lawson ID"}]},{"description":"IMP TIB STEM EXT FLUT 12X175MM","code_information":[{"code":"Sx00-5988-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322024","type":"LOCAL"},{"code":"535238","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322024 = Hospital System Supply Identifier | 535238 = Lawson ID"}]},{"description":"IMP TIB STEM EXT FLUT 11X175MM","code_information":[{"code":"Sx00-5988-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322023","type":"LOCAL"},{"code":"535237","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322023 = Hospital System Supply Identifier | 535237 = Lawson ID"}]},{"description":"IMP TIB STEM EXT STR 20X130MM","code_information":[{"code":"Sx00-5988-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329393","type":"LOCAL"},{"code":"324200","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329393 = Hospital System Supply Identifier | 324200 = Lawson ID"}]},{"description":"IMP TIB STEM EXT FLUT 19X130MM","code_information":[{"code":"Sx00-5988-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329760","type":"LOCAL"},{"code":"363975","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329760 = Hospital System Supply Identifier | 363975 = Lawson ID"}]},{"description":"IMP TIB STEM EXT FLUT 22X175MM","code_information":[{"code":"Sx00-5988-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322028","type":"LOCAL"},{"code":"535242","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322028 = Hospital System Supply Identifier | 535242 = Lawson ID"}]},{"description":"IMP TIB STEM EXT FLUT 18X130MM","code_information":[{"code":"Sx00-5988-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329392","type":"LOCAL"},{"code":"324199","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329392 = Hospital System Supply Identifier | 324199 = Lawson ID"}]},{"description":"IMP TIB STEM EXT FLUT 17X175MM","code_information":[{"code":"Sx00-5988-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329391","type":"LOCAL"},{"code":"324198","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329391 = Hospital System Supply Identifier | 324198 = Lawson ID"}]},{"description":"IMP TIB STEM EXT FLUT 13X175MM","code_information":[{"code":"Sx00-5988-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329390","type":"LOCAL"},{"code":"324197","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329390 = Hospital System Supply Identifier | 324197 = Lawson ID"}]},{"description":"IMP TIB STEM EXT FLUT 10X175MM","code_information":[{"code":"Sx00-5988-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322022","type":"LOCAL"},{"code":"535236","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322022 = Hospital System Supply Identifier | 535236 = Lawson ID"}]},{"description":"IMP TIB STEM EXT FLUT 24X175MM","code_information":[{"code":"Sx00-5988-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322029","type":"LOCAL"},{"code":"535243","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322029 = Hospital System Supply Identifier | 535243 = Lawson ID"}]},{"description":"IMP TIB STEM EXT FLUT 13X75MM","code_information":[{"code":"Sx00-5988-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322030","type":"LOCAL"},{"code":"535244","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322030 = Hospital System Supply Identifier | 535244 = Lawson ID"}]},{"description":"IMP TIB STEM EXT FLUT 13X105MM","code_information":[{"code":"Sx00-5988-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322031","type":"LOCAL"},{"code":"535245","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322031 = Hospital System Supply Identifier | 535245 = Lawson ID"}]},{"description":"IMP TIB STEM EXT FLUT 13X145MM","code_information":[{"code":"Sx00-5988-019","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322032","type":"LOCAL"},{"code":"535246","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322032 = Hospital System Supply Identifier | 535246 = Lawson ID"}]},{"description":"IMP TIB STEM EXT NXGN OFF 17MM","code_information":[{"code":"Sx00-5988-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329043","type":"LOCAL"},{"code":"223553","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329043 = Hospital System Supply Identifier | 223553 = Lawson ID"}]},{"description":"IMP TIB STEM EXT NXGN OFF 16MM","code_information":[{"code":"Sx00-5988-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329042","type":"LOCAL"},{"code":"223552","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329042 = Hospital System Supply Identifier | 223552 = Lawson ID"}]},{"description":"IMP TIB STEM EXT NXGN OFF 15MM","code_information":[{"code":"Sx00-5988-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"192133","type":"LOCAL"},{"code":"223551","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 192133 = Hospital System Supply Identifier | 223551 = Lawson ID"}]},{"description":"IMP TIB STEM EXT NXGN OFF 18MM","code_information":[{"code":"Sx00-5988-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329044","type":"LOCAL"},{"code":"223554","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329044 = Hospital System Supply Identifier | 223554 = Lawson ID"}]},{"description":"IMP TIB STEM EXT NXGN OFF 13MM","code_information":[{"code":"Sx00-5988-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329041","type":"LOCAL"},{"code":"223549","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329041 = Hospital System Supply Identifier | 223549 = Lawson ID"}]},{"description":"IMP TIB STEM EXT NXGN OFF 12MM","code_information":[{"code":"Sx00-5988-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"145670","type":"LOCAL"},{"code":"223548","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 145670 = Hospital System Supply Identifier | 223548 = Lawson ID"}]},{"description":"IMP TIB STEM EXT NXGN OFF 11MM","code_information":[{"code":"Sx00-5988-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"192131","type":"LOCAL"},{"code":"223547","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 192131 = Hospital System Supply Identifier | 223547 = Lawson ID"}]},{"description":"IMP TIB STEM EXT NXGN OFF 14MM","code_information":[{"code":"Sx00-5988-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"192132","type":"LOCAL"},{"code":"223550","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 192132 = Hospital System Supply Identifier | 223550 = Lawson ID"}]},{"description":"IMP TIB STEM EXT NXGN SZ12","code_information":[{"code":"Sx00-5988-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"192154","type":"LOCAL"},{"code":"228911","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 192154 = Hospital System Supply Identifier | 228911 = Lawson ID"}]},{"description":"IMP TIB STEM EXT NXGN SZ13","code_information":[{"code":"Sx00-5988-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329045","type":"LOCAL"},{"code":"228912","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329045 = Hospital System Supply Identifier | 228912 = Lawson ID"}]},{"description":"IMP TIB STEM EXT NXGN SZ14","code_information":[{"code":"Sx00-5988-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329046","type":"LOCAL"},{"code":"228913","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329046 = Hospital System Supply Identifier | 228913 = Lawson ID"}]},{"description":"IMP TIB STEM EXT NXGN SZ15","code_information":[{"code":"Sx00-5988-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"171765","type":"LOCAL"},{"code":"228914","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 171765 = Hospital System Supply Identifier | 228914 = Lawson ID"}]},{"description":"IMP TIB STEM EXT NXGN SZ16","code_information":[{"code":"Sx00-5988-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"169565","type":"LOCAL"},{"code":"228915","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 169565 = Hospital System Supply Identifier | 228915 = Lawson ID"}]},{"description":"IMP TIB STEM EXT NXGN SZ17","code_information":[{"code":"Sx00-5988-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329047","type":"LOCAL"},{"code":"228916","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329047 = Hospital System Supply Identifier | 228916 = Lawson ID"}]},{"description":"IMP TIB STEM EXT NXGN SZ18","code_information":[{"code":"Sx00-5988-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329048","type":"LOCAL"},{"code":"228917","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329048 = Hospital System Supply Identifier | 228917 = Lawson ID"}]},{"description":"SCREW SET FEM NXGN","code_information":[{"code":"Sx00-5988-090","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"322033","type":"LOCAL"},{"code":"535247","type":"LOCAL"}],"standard_charges":[{"gross_charge":297.39,"discounted_cash":223.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322033 = Hospital System Supply Identifier | 535247 = Lawson ID"}]},{"description":"SCREW TIB WDG ATTCH NXGN","code_information":[{"code":"Sx00-5988-091","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"322034","type":"LOCAL"},{"code":"535248","type":"LOCAL"}],"standard_charges":[{"gross_charge":297.39,"discounted_cash":223.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322034 = Hospital System Supply Identifier | 535248 = Lawson ID"}]},{"description":"SCREW FEM AUG NXGN","code_information":[{"code":"Sx00-5988-092","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"322035","type":"LOCAL"},{"code":"535249","type":"LOCAL"}],"standard_charges":[{"gross_charge":297.39,"discounted_cash":223.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322035 = Hospital System Supply Identifier | 535249 = Lawson ID"}]},{"description":"BLOCK AUGMENTATION 1 FULL 10MM TIBIA NEXGEN","code_information":[{"code":"Sx00-5989-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1090381","type":"LOCAL"},{"code":"S652392","type":"LOCAL"}],"standard_charges":[{"gross_charge":481.98,"discounted_cash":361.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1090381 = Hospital System Supply Identifier | S652392 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 2 10MM NSTRL FULL BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089623","type":"LOCAL"},{"code":"S652393","type":"LOCAL"}],"standard_charges":[{"gross_charge":481.98,"discounted_cash":361.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089623 = Hospital System Supply Identifier | S652393 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 2 20MM NSTRL REVISION ROTATE HINGE HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089628","type":"LOCAL"},{"code":"S652409","type":"LOCAL"}],"standard_charges":[{"gross_charge":802.3,"discounted_cash":601.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089628 = Hospital System Supply Identifier | S652409 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 2 15MM NSTRL REVISION ROTATE HINGE HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089626","type":"LOCAL"},{"code":"S652408","type":"LOCAL"}],"standard_charges":[{"gross_charge":802.3,"discounted_cash":601.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089626 = Hospital System Supply Identifier | S652408 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 2 10MM NSTRL REVISION ROTATE HINGE HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089624","type":"LOCAL"},{"code":"S652407","type":"LOCAL"}],"standard_charges":[{"gross_charge":802.3,"discounted_cash":601.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089624 = Hospital System Supply Identifier | S652407 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 7D 2 FULL WEDGE 7MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089712","type":"LOCAL"},{"code":"S652405","type":"LOCAL"}],"standard_charges":[{"gross_charge":225.61,"discounted_cash":169.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089712 = Hospital System Supply Identifier | S652405 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 22D 2 THIRD WEDGE 8.7MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089632","type":"LOCAL"},{"code":"S652404","type":"LOCAL"}],"standard_charges":[{"gross_charge":235.86,"discounted_cash":176.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089632 = Hospital System Supply Identifier | S652404 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 26D 2 HALF WEDGE 14MM NSTRL CELCON TIBIA NEXGEN","code_information":[{"code":"Sx00-5989-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089647","type":"LOCAL"},{"code":"S652403","type":"LOCAL"}],"standard_charges":[{"gross_charge":266.63,"discounted_cash":199.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089647 = Hospital System Supply Identifier | S652403 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 16D 2 HALF WEDGE 8.6MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089610","type":"LOCAL"},{"code":"S652402","type":"LOCAL"}],"standard_charges":[{"gross_charge":266.63,"discounted_cash":199.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089610 = Hospital System Supply Identifier | S652402 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 2 5MM NSTRL HALF BLOCK CELCON TIBIA NEXGEN","code_information":[{"code":"Sx00-5989-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089630","type":"LOCAL"},{"code":"S652406","type":"LOCAL"}],"standard_charges":[{"gross_charge":802.3,"discounted_cash":601.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089630 = Hospital System Supply Identifier | S652406 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 2 15MM NSTRL REVISION ROTATE HINGE HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089627","type":"LOCAL"},{"code":"S652400","type":"LOCAL"}],"standard_charges":[{"gross_charge":802.3,"discounted_cash":601.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089627 = Hospital System Supply Identifier | S652400 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 2 10MM NSTRL REVISION ROTATE HINGE HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089625","type":"LOCAL"},{"code":"S652399","type":"LOCAL"}],"standard_charges":[{"gross_charge":802.3,"discounted_cash":601.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089625 = Hospital System Supply Identifier | S652399 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 2 5MM NSTRL REVISION ROTATE HINGE HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089631","type":"LOCAL"},{"code":"S652398","type":"LOCAL"}],"standard_charges":[{"gross_charge":802.3,"discounted_cash":601.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089631 = Hospital System Supply Identifier | S652398 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 7D 2 FULL WEDGE 7MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089713","type":"LOCAL"},{"code":"S652397","type":"LOCAL"}],"standard_charges":[{"gross_charge":225.61,"discounted_cash":169.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089713 = Hospital System Supply Identifier | S652397 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 22D 2 THIRD WEDGE 8.7MM NSTRL CELCON TIBIA NEXGEN","code_information":[{"code":"Sx00-5989-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089633","type":"LOCAL"},{"code":"S652396","type":"LOCAL"}],"standard_charges":[{"gross_charge":235.86,"discounted_cash":176.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089633 = Hospital System Supply Identifier | S652396 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 26D 2 HALF WEDGE 14MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089646","type":"LOCAL"},{"code":"S652395","type":"LOCAL"}],"standard_charges":[{"gross_charge":266.63,"discounted_cash":199.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089646 = Hospital System Supply Identifier | S652395 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 16D 2 HALF WEDGE 8.6MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089611","type":"LOCAL"},{"code":"S652394","type":"LOCAL"}],"standard_charges":[{"gross_charge":266.63,"discounted_cash":199.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089611 = Hospital System Supply Identifier | S652394 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 2 20MM NSTRL REVISION ROTATE HINGE HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089629","type":"LOCAL"},{"code":"S652401","type":"LOCAL"}],"standard_charges":[{"gross_charge":802.3,"discounted_cash":601.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089629 = Hospital System Supply Identifier | S652401 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 22D 2 THIRD WEDGE 9.5MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089634","type":"LOCAL"},{"code":"S652421","type":"LOCAL"}],"standard_charges":[{"gross_charge":235.86,"discounted_cash":176.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089634 = Hospital System Supply Identifier | S652421 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 7D 3 FULL WEDGE 8MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089714","type":"LOCAL"},{"code":"S652422","type":"LOCAL"}],"standard_charges":[{"gross_charge":225.61,"discounted_cash":169.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089714 = Hospital System Supply Identifier | S652422 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 3 5MM NSTRL HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089670","type":"LOCAL"},{"code":"S652423","type":"LOCAL"}],"standard_charges":[{"gross_charge":802.3,"discounted_cash":601.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089670 = Hospital System Supply Identifier | S652423 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 3 10MM NSTRL HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089661","type":"LOCAL"},{"code":"S652424","type":"LOCAL"}],"standard_charges":[{"gross_charge":802.3,"discounted_cash":601.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089661 = Hospital System Supply Identifier | S652424 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 3 30MM NSTRL REVISION ROTATING HINGE HALF BLOCK CELCON TIBIA NEXGEN","code_information":[{"code":"Sx00-5989-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089668","type":"LOCAL"},{"code":"S652428","type":"LOCAL"}],"standard_charges":[{"gross_charge":802.3,"discounted_cash":601.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089668 = Hospital System Supply Identifier | S652428 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 3 20MM NSTRL REVISION ROTATE HINGE HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089666","type":"LOCAL"},{"code":"S652426","type":"LOCAL"}],"standard_charges":[{"gross_charge":802.3,"discounted_cash":601.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089666 = Hospital System Supply Identifier | S652426 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 3 30MM NSTRL REVISION ROTATING HINGE HALF BLOCK CELCON TIBIA NEXGEN","code_information":[{"code":"Sx00-5989-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089669","type":"LOCAL"},{"code":"S652427","type":"LOCAL"}],"standard_charges":[{"gross_charge":802.3,"discounted_cash":601.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089669 = Hospital System Supply Identifier | S652427 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 26D 3 HALF WEDGE 15MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089648","type":"LOCAL"},{"code":"S652420","type":"LOCAL"}],"standard_charges":[{"gross_charge":266.63,"discounted_cash":199.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089648 = Hospital System Supply Identifier | S652420 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 3 15MM NSTRL HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089664","type":"LOCAL"},{"code":"S652425","type":"LOCAL"}],"standard_charges":[{"gross_charge":802.3,"discounted_cash":601.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089664 = Hospital System Supply Identifier | S652425 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 16D 3 HALF WEDGE 9.5MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089612","type":"LOCAL"},{"code":"S652419","type":"LOCAL"}],"standard_charges":[{"gross_charge":266.63,"discounted_cash":199.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089612 = Hospital System Supply Identifier | S652419 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 26D 3 HALF WEDGE 15MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089649","type":"LOCAL"},{"code":"S652412","type":"LOCAL"}],"standard_charges":[{"gross_charge":266.63,"discounted_cash":199.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089649 = Hospital System Supply Identifier | S652412 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 3 15MM NSTRL HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089665","type":"LOCAL"},{"code":"S652417","type":"LOCAL"}],"standard_charges":[{"gross_charge":802.3,"discounted_cash":601.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089665 = Hospital System Supply Identifier | S652417 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 3 10MM NSTRL HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089662","type":"LOCAL"},{"code":"S652416","type":"LOCAL"}],"standard_charges":[{"gross_charge":802.3,"discounted_cash":601.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089662 = Hospital System Supply Identifier | S652416 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 3 5MM NSTRL HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089671","type":"LOCAL"},{"code":"S652415","type":"LOCAL"}],"standard_charges":[{"gross_charge":802.3,"discounted_cash":601.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089671 = Hospital System Supply Identifier | S652415 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 7D 3 FULL WEDGE 8MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089715","type":"LOCAL"},{"code":"S652414","type":"LOCAL"}],"standard_charges":[{"gross_charge":225.61,"discounted_cash":169.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089715 = Hospital System Supply Identifier | S652414 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 22D 2 THIRD WEDGE 9.5MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089635","type":"LOCAL"},{"code":"S652413","type":"LOCAL"}],"standard_charges":[{"gross_charge":235.86,"discounted_cash":176.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089635 = Hospital System Supply Identifier | S652413 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 16D 3 WEDGE 9.5MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089613","type":"LOCAL"},{"code":"S652411","type":"LOCAL"}],"standard_charges":[{"gross_charge":266.63,"discounted_cash":199.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089613 = Hospital System Supply Identifier | S652411 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 3 10MM NSTRL FULL BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089660","type":"LOCAL"},{"code":"S652410","type":"LOCAL"}],"standard_charges":[{"gross_charge":481.98,"discounted_cash":361.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089660 = Hospital System Supply Identifier | S652410 = Lawson ID"}]},{"description":"PLATE BONE 3 WEDGE NSTRL PLATE STEM CELCON TIBIA NEXGEN","code_information":[{"code":"Sx00-5989-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1100242","type":"LOCAL"},{"code":"S651493","type":"LOCAL"}],"standard_charges":[{"gross_charge":1852.2,"discounted_cash":1389.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1100242 = Hospital System Supply Identifier | S651493 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 3 20MM NSTRL REVISION ROTATE HINGE HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089667","type":"LOCAL"},{"code":"S652418","type":"LOCAL"}],"standard_charges":[{"gross_charge":802.3,"discounted_cash":601.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089667 = Hospital System Supply Identifier | S652418 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 4 15MM NSTRL HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089675","type":"LOCAL"},{"code":"S652444","type":"LOCAL"}],"standard_charges":[{"gross_charge":802.3,"discounted_cash":601.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089675 = Hospital System Supply Identifier | S652444 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 4 5MM NSTRL HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089681","type":"LOCAL"},{"code":"S652442","type":"LOCAL"}],"standard_charges":[{"gross_charge":802.3,"discounted_cash":601.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089681 = Hospital System Supply Identifier | S652442 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 4 10MM NSTRL HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089673","type":"LOCAL"},{"code":"S652443","type":"LOCAL"}],"standard_charges":[{"gross_charge":802.3,"discounted_cash":601.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089673 = Hospital System Supply Identifier | S652443 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 7D 4 FULL WEDGE 8MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089716","type":"LOCAL"},{"code":"S652441","type":"LOCAL"}],"standard_charges":[{"gross_charge":235.86,"discounted_cash":176.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089716 = Hospital System Supply Identifier | S652441 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 26D 4 HALF WEDGE 15MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089650","type":"LOCAL"},{"code":"S652431","type":"LOCAL"}],"standard_charges":[{"gross_charge":266.63,"discounted_cash":199.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089650 = Hospital System Supply Identifier | S652431 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 4 30MM NSTRL REVISION ROTATING HINGE HALF BLOCK CELCON TIBIA NEXGEN","code_information":[{"code":"Sx00-5989-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089680","type":"LOCAL"},{"code":"S652446","type":"LOCAL"}],"standard_charges":[{"gross_charge":802.3,"discounted_cash":601.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089680 = Hospital System Supply Identifier | S652446 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 4 30MM NSTRL REVISION ROTATING HINGE HALF BLOCK CELCON TIBIA NEXGEN","code_information":[{"code":"Sx00-5989-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089679","type":"LOCAL"},{"code":"S652447","type":"LOCAL"}],"standard_charges":[{"gross_charge":802.3,"discounted_cash":601.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089679 = Hospital System Supply Identifier | S652447 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 22D 4 THIRD WEDGE 9.5MM NSTRL REVISION ROTATING HINGE BLOCK CELCON TIBIA NEXGEN","code_information":[{"code":"Sx00-5989-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089637","type":"LOCAL"},{"code":"S652440","type":"LOCAL"}],"standard_charges":[{"gross_charge":235.86,"discounted_cash":176.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089637 = Hospital System Supply Identifier | S652440 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 4 20MM NSTRL HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089677","type":"LOCAL"},{"code":"S652445","type":"LOCAL"}],"standard_charges":[{"gross_charge":802.3,"discounted_cash":601.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089677 = Hospital System Supply Identifier | S652445 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 26D 4 HALF WEDGE 15MM NSTRL REVISION ROTATING HINGE BLOCK CELCON TIBIA NEXGEN","code_information":[{"code":"Sx00-5989-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089651","type":"LOCAL"},{"code":"S652439","type":"LOCAL"}],"standard_charges":[{"gross_charge":266.63,"discounted_cash":199.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089651 = Hospital System Supply Identifier | S652439 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 16D 4 HALF WEDGE 9.5MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089615","type":"LOCAL"},{"code":"S652430","type":"LOCAL"}],"standard_charges":[{"gross_charge":266.63,"discounted_cash":199.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089615 = Hospital System Supply Identifier | S652430 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 4 20MM NSTRL REVISION ROTATE HINGE HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089678","type":"LOCAL"},{"code":"S652437","type":"LOCAL"}],"standard_charges":[{"gross_charge":802.3,"discounted_cash":601.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089678 = Hospital System Supply Identifier | S652437 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 4 10MM NSTRL FULL BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089672","type":"LOCAL"},{"code":"S652429","type":"LOCAL"}],"standard_charges":[{"gross_charge":481.98,"discounted_cash":361.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089672 = Hospital System Supply Identifier | S652429 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 16D 4 HALF WEDGE 9.5MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089614","type":"LOCAL"},{"code":"S652438","type":"LOCAL"}],"standard_charges":[{"gross_charge":266.63,"discounted_cash":199.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089614 = Hospital System Supply Identifier | S652438 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 22D 4 THIRD WEDGE 9.5MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089636","type":"LOCAL"},{"code":"S652432","type":"LOCAL"}],"standard_charges":[{"gross_charge":235.86,"discounted_cash":176.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089636 = Hospital System Supply Identifier | S652432 = Lawson ID"}]},{"description":"PLATE BONE 4 WEDGE NSTRL PLATE STEM CELCON TIBIA NEXGEN","code_information":[{"code":"Sx00-5989-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1100258","type":"LOCAL"},{"code":"S651494","type":"LOCAL"}],"standard_charges":[{"gross_charge":1852.2,"discounted_cash":1389.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1100258 = Hospital System Supply Identifier | S651494 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 4 5MM NSTRL HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089682","type":"LOCAL"},{"code":"S652434","type":"LOCAL"}],"standard_charges":[{"gross_charge":802.3,"discounted_cash":601.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089682 = Hospital System Supply Identifier | S652434 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 4 10MM NSTRL HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089674","type":"LOCAL"},{"code":"S652435","type":"LOCAL"}],"standard_charges":[{"gross_charge":802.3,"discounted_cash":601.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089674 = Hospital System Supply Identifier | S652435 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 4 15MM NSTRL HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089676","type":"LOCAL"},{"code":"S652436","type":"LOCAL"}],"standard_charges":[{"gross_charge":802.3,"discounted_cash":601.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089676 = Hospital System Supply Identifier | S652436 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 7D 4 FULL WEDGE 8MM NSTRL CELCON TIBIA NEXGEN","code_information":[{"code":"Sx00-5989-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089717","type":"LOCAL"},{"code":"S652433","type":"LOCAL"}],"standard_charges":[{"gross_charge":235.86,"discounted_cash":176.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089717 = Hospital System Supply Identifier | S652433 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 22D 5 THIRD WEDGE 5MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089639","type":"LOCAL"},{"code":"S652458","type":"LOCAL"}],"standard_charges":[{"gross_charge":235.86,"discounted_cash":176.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089639 = Hospital System Supply Identifier | S652458 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 5 30MM NSTRL REVISION ROTATING HINGE HALF BLOCK CELCON TIBIA NEXGEN","code_information":[{"code":"Sx00-5989-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089689","type":"LOCAL"},{"code":"S652465","type":"LOCAL"}],"standard_charges":[{"gross_charge":802.3,"discounted_cash":601.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089689 = Hospital System Supply Identifier | S652465 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 5 30MM NSTRL REVISION ROTATING HINGE HALF BLOCK CELCON TIBIA NEXGEN","code_information":[{"code":"Sx00-5989-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089690","type":"LOCAL"},{"code":"S652464","type":"LOCAL"}],"standard_charges":[{"gross_charge":802.3,"discounted_cash":601.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089690 = Hospital System Supply Identifier | S652464 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 5 20MM NSTRL REVISION ROTATING HINGE HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089687","type":"LOCAL"},{"code":"S652463","type":"LOCAL"}],"standard_charges":[{"gross_charge":802.3,"discounted_cash":601.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089687 = Hospital System Supply Identifier | S652463 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 5 15MM NSTRL REVISION ROTATING HINGE HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089685","type":"LOCAL"},{"code":"S652462","type":"LOCAL"}],"standard_charges":[{"gross_charge":802.3,"discounted_cash":601.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089685 = Hospital System Supply Identifier | S652462 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 5 10MM NSTRL HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089683","type":"LOCAL"},{"code":"S652461","type":"LOCAL"}],"standard_charges":[{"gross_charge":802.3,"discounted_cash":601.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089683 = Hospital System Supply Identifier | S652461 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 5 5MM NSTRL HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089691","type":"LOCAL"},{"code":"S652460","type":"LOCAL"}],"standard_charges":[{"gross_charge":802.3,"discounted_cash":601.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089691 = Hospital System Supply Identifier | S652460 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 7D 5 FULL WEDGE 9MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089718","type":"LOCAL"},{"code":"S652459","type":"LOCAL"}],"standard_charges":[{"gross_charge":235.86,"discounted_cash":176.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089718 = Hospital System Supply Identifier | S652459 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 26D 5 HALF WEDGE 17MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089652","type":"LOCAL"},{"code":"S652457","type":"LOCAL"}],"standard_charges":[{"gross_charge":266.63,"discounted_cash":199.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089652 = Hospital System Supply Identifier | S652457 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 16D 5 HALF WEDGE 10.5MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089616","type":"LOCAL"},{"code":"S652456","type":"LOCAL"}],"standard_charges":[{"gross_charge":266.63,"discounted_cash":199.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089616 = Hospital System Supply Identifier | S652456 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 5 20MM NSTRL REVISION ROTATING HINGE HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089688","type":"LOCAL"},{"code":"S652455","type":"LOCAL"}],"standard_charges":[{"gross_charge":802.3,"discounted_cash":601.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089688 = Hospital System Supply Identifier | S652455 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 16D 5 HALF WEDGE 10.5MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089617","type":"LOCAL"},{"code":"S652448","type":"LOCAL"}],"standard_charges":[{"gross_charge":266.63,"discounted_cash":199.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089617 = Hospital System Supply Identifier | S652448 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 26D 5 HALF WEDGE 17MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089653","type":"LOCAL"},{"code":"S652449","type":"LOCAL"}],"standard_charges":[{"gross_charge":266.63,"discounted_cash":199.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089653 = Hospital System Supply Identifier | S652449 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 22D 5 THIRD WEDGE 10MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089638","type":"LOCAL"},{"code":"S652450","type":"LOCAL"}],"standard_charges":[{"gross_charge":235.86,"discounted_cash":176.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089638 = Hospital System Supply Identifier | S652450 = Lawson ID"}]},{"description":"PLATE BONE 5 WEDGE NSTRL PLATE STEM CELCON TIBIA NEXGEN","code_information":[{"code":"Sx00-5989-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1100267","type":"LOCAL"},{"code":"S651495","type":"LOCAL"}],"standard_charges":[{"gross_charge":1852.2,"discounted_cash":1389.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1100267 = Hospital System Supply Identifier | S651495 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 5 5MM NSTRL HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089692","type":"LOCAL"},{"code":"S652452","type":"LOCAL"}],"standard_charges":[{"gross_charge":802.3,"discounted_cash":601.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089692 = Hospital System Supply Identifier | S652452 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 5 10MM NSTRL HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089684","type":"LOCAL"},{"code":"S652453","type":"LOCAL"}],"standard_charges":[{"gross_charge":802.3,"discounted_cash":601.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089684 = Hospital System Supply Identifier | S652453 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 5 15MM NSTRL REVISION ROTATING HINGE HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089686","type":"LOCAL"},{"code":"S652454","type":"LOCAL"}],"standard_charges":[{"gross_charge":802.3,"discounted_cash":601.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089686 = Hospital System Supply Identifier | S652454 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 7D 5 FULL WEDGE 9MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089719","type":"LOCAL"},{"code":"S652451","type":"LOCAL"}],"standard_charges":[{"gross_charge":235.86,"discounted_cash":176.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089719 = Hospital System Supply Identifier | S652451 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 26D 6 HALF WEDGE 17MM NSTRL CELCON TIBIA NEXGEN","code_information":[{"code":"Sx00-5989-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089655","type":"LOCAL"},{"code":"S652476","type":"LOCAL"}],"standard_charges":[{"gross_charge":266.63,"discounted_cash":199.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089655 = Hospital System Supply Identifier | S652476 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 6 30MM NSTRL REVISION ROTATING HINGE HALF BLOCK CELCON TIBIA NEXGEN","code_information":[{"code":"Sx00-5989-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089700","type":"LOCAL"},{"code":"S652483","type":"LOCAL"}],"standard_charges":[{"gross_charge":802.3,"discounted_cash":601.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089700 = Hospital System Supply Identifier | S652483 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 6 20MM NSTRL REVISION ROTATING HINGE HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089698","type":"LOCAL"},{"code":"S652482","type":"LOCAL"}],"standard_charges":[{"gross_charge":802.3,"discounted_cash":601.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089698 = Hospital System Supply Identifier | S652482 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 6 15MM NSTRL REVISION ROTATING HINGE HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089696","type":"LOCAL"},{"code":"S652481","type":"LOCAL"}],"standard_charges":[{"gross_charge":802.3,"discounted_cash":601.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089696 = Hospital System Supply Identifier | S652481 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 6 10MM NSTRL HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089694","type":"LOCAL"},{"code":"S652480","type":"LOCAL"}],"standard_charges":[{"gross_charge":802.3,"discounted_cash":601.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089694 = Hospital System Supply Identifier | S652480 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 6 5MM NSTRL HALF BLOCK CELCON TIBIA NEXGEN","code_information":[{"code":"Sx00-5989-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089702","type":"LOCAL"},{"code":"S652479","type":"LOCAL"}],"standard_charges":[{"gross_charge":802.3,"discounted_cash":601.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089702 = Hospital System Supply Identifier | S652479 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 7D 6 FULL WEDGE 9MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089720","type":"LOCAL"},{"code":"S652478","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.37,"discounted_cash":192.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089720 = Hospital System Supply Identifier | S652478 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 22D 6 THIRD WEDGE 10MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089640","type":"LOCAL"},{"code":"S652477","type":"LOCAL"}],"standard_charges":[{"gross_charge":235.86,"discounted_cash":176.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089640 = Hospital System Supply Identifier | S652477 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 16D 6 HALF WEDGE 10.5MM NSTRL CELCON TIBIA NEXGEN","code_information":[{"code":"Sx00-5989-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089618","type":"LOCAL"},{"code":"S652475","type":"LOCAL"}],"standard_charges":[{"gross_charge":266.63,"discounted_cash":199.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089618 = Hospital System Supply Identifier | S652475 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 6 15MM NSTRL REVISION ROTATING HINGE HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089697","type":"LOCAL"},{"code":"S652473","type":"LOCAL"}],"standard_charges":[{"gross_charge":802.3,"discounted_cash":601.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089697 = Hospital System Supply Identifier | S652473 = Lawson ID"}]},{"description":"PLATE BONE 6 WEDGE NSTRL PLATE STEM CELCON TIBIA NEXGEN","code_information":[{"code":"Sx00-5989-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1100275","type":"LOCAL"},{"code":"S651496","type":"LOCAL"}],"standard_charges":[{"gross_charge":1852.2,"discounted_cash":1389.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1100275 = Hospital System Supply Identifier | S651496 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 6 10MM NSTRL FULL BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089693","type":"LOCAL"},{"code":"S652466","type":"LOCAL"}],"standard_charges":[{"gross_charge":481.98,"discounted_cash":361.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089693 = Hospital System Supply Identifier | S652466 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 16D 16 HALF WEDGE 10.5MM NSTRL CELCON TIBIA NEXGEN","code_information":[{"code":"Sx00-5989-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089609","type":"LOCAL"},{"code":"S652467","type":"LOCAL"}],"standard_charges":[{"gross_charge":266.63,"discounted_cash":199.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089609 = Hospital System Supply Identifier | S652467 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 26D 6 HALF WEDGE 17MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089654","type":"LOCAL"},{"code":"S652468","type":"LOCAL"}],"standard_charges":[{"gross_charge":266.63,"discounted_cash":199.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089654 = Hospital System Supply Identifier | S652468 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 6 20MM NSTRL REVISION ROTATING HINGE HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089699","type":"LOCAL"},{"code":"S652474","type":"LOCAL"}],"standard_charges":[{"gross_charge":802.3,"discounted_cash":601.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089699 = Hospital System Supply Identifier | S652474 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 7D 6 FULL WEDGE 9MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089721","type":"LOCAL"},{"code":"S652470","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.37,"discounted_cash":192.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089721 = Hospital System Supply Identifier | S652470 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 6 5MM NSTRL HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089701","type":"LOCAL"},{"code":"S652471","type":"LOCAL"}],"standard_charges":[{"gross_charge":802.3,"discounted_cash":601.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089701 = Hospital System Supply Identifier | S652471 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 6 10MM NSTRL HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089695","type":"LOCAL"},{"code":"S652472","type":"LOCAL"}],"standard_charges":[{"gross_charge":802.3,"discounted_cash":601.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089695 = Hospital System Supply Identifier | S652472 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 22D 6 THIRD WEDGE 10MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089641","type":"LOCAL"},{"code":"S652469","type":"LOCAL"}],"standard_charges":[{"gross_charge":235.86,"discounted_cash":176.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089641 = Hospital System Supply Identifier | S652469 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 16D 7 HALF WEDGE 11.5MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089619","type":"LOCAL"},{"code":"S652493","type":"LOCAL"}],"standard_charges":[{"gross_charge":266.63,"discounted_cash":199.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089619 = Hospital System Supply Identifier | S652493 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 7 20MM NSTRL REVISION ROTATING HINGE HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089708","type":"LOCAL"},{"code":"S652500","type":"LOCAL"}],"standard_charges":[{"gross_charge":802.3,"discounted_cash":601.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089708 = Hospital System Supply Identifier | S652500 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 7 15MM NSTRL REVISION ROTATING HINGE HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089706","type":"LOCAL"},{"code":"S652499","type":"LOCAL"}],"standard_charges":[{"gross_charge":802.3,"discounted_cash":601.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089706 = Hospital System Supply Identifier | S652499 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 7 10MM NSTRL HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089704","type":"LOCAL"},{"code":"S652498","type":"LOCAL"}],"standard_charges":[{"gross_charge":802.3,"discounted_cash":601.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089704 = Hospital System Supply Identifier | S652498 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 7 5MM NSTRL HALF BLOCK CELCON TIBIA NEXGEN","code_information":[{"code":"Sx00-5989-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089711","type":"LOCAL"},{"code":"S652497","type":"LOCAL"}],"standard_charges":[{"gross_charge":802.3,"discounted_cash":601.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089711 = Hospital System Supply Identifier | S652497 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 7D 7 FULL WEDGE 10MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089722","type":"LOCAL"},{"code":"S652496","type":"LOCAL"}],"standard_charges":[{"gross_charge":235.86,"discounted_cash":176.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089722 = Hospital System Supply Identifier | S652496 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 22D 7 THIRD WEDGE 10.5MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089642","type":"LOCAL"},{"code":"S652495","type":"LOCAL"}],"standard_charges":[{"gross_charge":235.86,"discounted_cash":176.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089642 = Hospital System Supply Identifier | S652495 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 26D 7 HALF WEDGE 18.5MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089656","type":"LOCAL"},{"code":"S652494","type":"LOCAL"}],"standard_charges":[{"gross_charge":266.63,"discounted_cash":199.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089656 = Hospital System Supply Identifier | S652494 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 7 15MM NSTRL REVISION ROTATING HINGE HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089707","type":"LOCAL"},{"code":"S652491","type":"LOCAL"}],"standard_charges":[{"gross_charge":802.3,"discounted_cash":601.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089707 = Hospital System Supply Identifier | S652491 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 7D 7 FULL WEDGE 10MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089723","type":"LOCAL"},{"code":"S652488","type":"LOCAL"}],"standard_charges":[{"gross_charge":235.86,"discounted_cash":176.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089723 = Hospital System Supply Identifier | S652488 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 7 10MM NSTRL HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089705","type":"LOCAL"},{"code":"S652490","type":"LOCAL"}],"standard_charges":[{"gross_charge":802.3,"discounted_cash":601.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089705 = Hospital System Supply Identifier | S652490 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 7 5MM NSTRL HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089710","type":"LOCAL"},{"code":"S652489","type":"LOCAL"}],"standard_charges":[{"gross_charge":802.3,"discounted_cash":601.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089710 = Hospital System Supply Identifier | S652489 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 22D 7 THIRD WEDGE 10.5MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089643","type":"LOCAL"},{"code":"S652487","type":"LOCAL"}],"standard_charges":[{"gross_charge":235.86,"discounted_cash":176.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089643 = Hospital System Supply Identifier | S652487 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 26D 7 HALF WEDGE 18.5MM NSTRL CELCON TIBIA NEXGEN","code_information":[{"code":"Sx00-5989-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089657","type":"LOCAL"},{"code":"S652486","type":"LOCAL"}],"standard_charges":[{"gross_charge":266.63,"discounted_cash":199.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089657 = Hospital System Supply Identifier | S652486 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 16D 7 HALF WEDGE 11.5MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089620","type":"LOCAL"},{"code":"S652485","type":"LOCAL"}],"standard_charges":[{"gross_charge":266.63,"discounted_cash":199.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089620 = Hospital System Supply Identifier | S652485 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 7 10MM NSTRL FULL BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089703","type":"LOCAL"},{"code":"S652484","type":"LOCAL"}],"standard_charges":[{"gross_charge":481.98,"discounted_cash":361.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089703 = Hospital System Supply Identifier | S652484 = Lawson ID"}]},{"description":"PLATE BONE 7 WEDGE NSTRL PLATE STEM CELCON TIBIA NEXGEN","code_information":[{"code":"Sx00-5989-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1100281","type":"LOCAL"},{"code":"S651497","type":"LOCAL"}],"standard_charges":[{"gross_charge":1852.2,"discounted_cash":1389.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1100281 = Hospital System Supply Identifier | S651497 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 7 20MM NSTRL REVISION ROTATING HINGE HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089709","type":"LOCAL"},{"code":"S652492","type":"LOCAL"}],"standard_charges":[{"gross_charge":802.3,"discounted_cash":601.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089709 = Hospital System Supply Identifier | S652492 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 22D 8-9 THIRD WEDGE 10.5MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089644","type":"LOCAL"},{"code":"S652512","type":"LOCAL"}],"standard_charges":[{"gross_charge":235.86,"discounted_cash":176.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089644 = Hospital System Supply Identifier | S652512 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 26D 8-9 HALF WEDGE 18.5MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089659","type":"LOCAL"},{"code":"S652511","type":"LOCAL"}],"standard_charges":[{"gross_charge":266.63,"discounted_cash":199.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089659 = Hospital System Supply Identifier | S652511 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 7D 8 FULL WEDGE 10MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089724","type":"LOCAL"},{"code":"S652513","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.37,"discounted_cash":192.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089724 = Hospital System Supply Identifier | S652513 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 16D 8-9 HALF WEDGE 11.5MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089621","type":"LOCAL"},{"code":"S652510","type":"LOCAL"}],"standard_charges":[{"gross_charge":266.63,"discounted_cash":199.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089621 = Hospital System Supply Identifier | S652510 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 8 15MM NSTRL REVISION ROTATING HINGE HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089730","type":"LOCAL"},{"code":"S652516","type":"LOCAL"}],"standard_charges":[{"gross_charge":802.3,"discounted_cash":601.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089730 = Hospital System Supply Identifier | S652516 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 8 20MM NSTRL REVISION ROTATING HINGE HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089732","type":"LOCAL"},{"code":"S652517","type":"LOCAL"}],"standard_charges":[{"gross_charge":802.3,"discounted_cash":601.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089732 = Hospital System Supply Identifier | S652517 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 8-9 5MM NSTRL HALF BLOCK CELCON TIBIA NEXGEN","code_information":[{"code":"Sx00-5989-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089735","type":"LOCAL"},{"code":"S652514","type":"LOCAL"}],"standard_charges":[{"gross_charge":802.3,"discounted_cash":601.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089735 = Hospital System Supply Identifier | S652514 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 8 20MM NSTRL REVISION ROTATING HINGE HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089733","type":"LOCAL"},{"code":"S652509","type":"LOCAL"}],"standard_charges":[{"gross_charge":802.3,"discounted_cash":601.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089733 = Hospital System Supply Identifier | S652509 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 8 10MM NSTRL HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089729","type":"LOCAL"},{"code":"S652515","type":"LOCAL"}],"standard_charges":[{"gross_charge":802.3,"discounted_cash":601.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089729 = Hospital System Supply Identifier | S652515 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 8-9 10MM NSTRL HALF BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089734","type":"LOCAL"},{"code":"S652507","type":"LOCAL"}],"standard_charges":[{"gross_charge":802.3,"discounted_cash":601.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089734 = Hospital System Supply Identifier | S652507 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 8-9 5MM NSTRL HALF BLOCK CELCON TIBIA NEXGEN","code_information":[{"code":"Sx00-5989-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089736","type":"LOCAL"},{"code":"S652506","type":"LOCAL"}],"standard_charges":[{"gross_charge":802.3,"discounted_cash":601.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089736 = Hospital System Supply Identifier | S652506 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 7D 8 FULL WEDGE 10MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089725","type":"LOCAL"},{"code":"S652505","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.37,"discounted_cash":192.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089725 = Hospital System Supply Identifier | S652505 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 22D 8-9 THIRD WEDGE 10.5MM NSTRL CELCON TIBIA NEXGEN","code_information":[{"code":"Sx00-5989-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089645","type":"LOCAL"},{"code":"S652504","type":"LOCAL"}],"standard_charges":[{"gross_charge":235.86,"discounted_cash":176.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089645 = Hospital System Supply Identifier | S652504 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 26D 8 9 HALF WEDGE 18.5MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089658","type":"LOCAL"},{"code":"S652503","type":"LOCAL"}],"standard_charges":[{"gross_charge":266.63,"discounted_cash":199.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089658 = Hospital System Supply Identifier | S652503 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 16D 8-9 HALF WEDGE 11.5MM NSTRL CELCON TIBIA NEXGEN","code_information":[{"code":"Sx00-5989-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089622","type":"LOCAL"},{"code":"S652502","type":"LOCAL"}],"standard_charges":[{"gross_charge":266.63,"discounted_cash":199.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089622 = Hospital System Supply Identifier | S652502 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 8 15MM NSTRL REVISION ROTATING HINGE HALF BLOCK CELCON TIBIA NEXGEN","code_information":[{"code":"Sx00-5989-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089731","type":"LOCAL"},{"code":"S652508","type":"LOCAL"}],"standard_charges":[{"gross_charge":802.3,"discounted_cash":601.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089731 = Hospital System Supply Identifier | S652508 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 8 10MM NSTRL FULL BLOCK CELCON NEXGEN","code_information":[{"code":"Sx00-5989-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089728","type":"LOCAL"},{"code":"S652501","type":"LOCAL"}],"standard_charges":[{"gross_charge":481.98,"discounted_cash":361.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089728 = Hospital System Supply Identifier | S652501 = Lawson ID"}]},{"description":"PLATE BONE 8 WEDGE NSTRL PLATE STEM CELCON TIBIA NEXGEN","code_information":[{"code":"Sx00-5989-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1100287","type":"LOCAL"},{"code":"S651498","type":"LOCAL"}],"standard_charges":[{"gross_charge":1852.2,"discounted_cash":1389.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1100287 = Hospital System Supply Identifier | S651498 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 7D 9 FULL WEDGE 11MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089727","type":"LOCAL"},{"code":"S652518","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.37,"discounted_cash":192.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089727 = Hospital System Supply Identifier | S652518 = Lawson ID"}]},{"description":"AUGMENT TIBIAL 7D 9 FULL WEDGE 11MM NSTRL CELCON NEXGEN","code_information":[{"code":"Sx00-5989-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1089726","type":"LOCAL"},{"code":"S652519","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.37,"discounted_cash":192.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 1089726 = Hospital System Supply Identifier | S652519 = Lawson ID"}]},{"description":"IMP KNEE FEM AUG DST SZB 15","code_information":[{"code":"Sx00-5990-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322817","type":"LOCAL"},{"code":"536032","type":"LOCAL"}],"standard_charges":[{"gross_charge":2743.96,"discounted_cash":2057.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322817 = Hospital System Supply Identifier | 536032 = Lawson ID"}]},{"description":"IMP KNEE FEM AUG NXGN SZB 10MM","code_information":[{"code":"Sx00-5990-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322038","type":"LOCAL"},{"code":"535252","type":"LOCAL"}],"standard_charges":[{"gross_charge":2030.0,"discounted_cash":1522.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322038 = Hospital System Supply Identifier | 535252 = Lawson ID"}]},{"description":"IMP KNEE FEM AUG NXGN SZB 5MM","code_information":[{"code":"Sx00-5990-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322037","type":"LOCAL"},{"code":"535251","type":"LOCAL"}],"standard_charges":[{"gross_charge":2030.0,"discounted_cash":1522.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322037 = Hospital System Supply Identifier | 535251 = Lawson ID"}]},{"description":"IMP KNEE FEM AUG NXGN SZB 5MM","code_information":[{"code":"Sx00-5990-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322036","type":"LOCAL"},{"code":"535250","type":"LOCAL"}],"standard_charges":[{"gross_charge":2030.0,"discounted_cash":1522.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322036 = Hospital System Supply Identifier | 535250 = Lawson ID"}]},{"description":"IMP KNEE FEM AUG NXGN P SZC5MM","code_information":[{"code":"Sx00-5990-033","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326346","type":"LOCAL"},{"code":"395766","type":"LOCAL"}],"standard_charges":[{"gross_charge":2030.0,"discounted_cash":1522.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 326346 = Hospital System Supply Identifier | 395766 = Lawson ID"}]},{"description":"IMP KNEE FEM AUG NXGN SZC 20MM","code_information":[{"code":"Sx00-5990-033","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326347","type":"LOCAL"},{"code":"395767","type":"LOCAL"}],"standard_charges":[{"gross_charge":2957.92,"discounted_cash":2218.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 326347 = Hospital System Supply Identifier | 395767 = Lawson ID"}]},{"description":"IMP KNEE FEM AUG NXGN SZC 5MM","code_information":[{"code":"Sx00-5990-033","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326348","type":"LOCAL"},{"code":"395768","type":"LOCAL"}],"standard_charges":[{"gross_charge":2030.0,"discounted_cash":1522.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 326348 = Hospital System Supply Identifier | 395768 = Lawson ID"}]},{"description":"IMP KNEE FEM AUG NXGN SZC 5MM","code_information":[{"code":"Sx00-5990-033","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"196927","type":"LOCAL"},{"code":"426954","type":"LOCAL"}],"standard_charges":[{"gross_charge":2030.0,"discounted_cash":1522.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 196927 = Hospital System Supply Identifier | 426954 = Lawson ID"}]},{"description":"IMP KNEE FEM AUG NXGN SZC 10MM","code_information":[{"code":"Sx00-5990-033","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322039","type":"LOCAL"},{"code":"535253","type":"LOCAL"}],"standard_charges":[{"gross_charge":2030.0,"discounted_cash":1522.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322039 = Hospital System Supply Identifier | 535253 = Lawson ID"}]},{"description":"IMP KNEE FEM AUG NXGN SZC 10MM","code_information":[{"code":"Sx00-5990-033","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322040","type":"LOCAL"},{"code":"535254","type":"LOCAL"}],"standard_charges":[{"gross_charge":2030.0,"discounted_cash":1522.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322040 = Hospital System Supply Identifier | 535254 = Lawson ID"}]},{"description":"IMP KNEE FEM AUG DST SZC 15","code_information":[{"code":"Sx00-5990-033","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322818","type":"LOCAL"},{"code":"536033","type":"LOCAL"}],"standard_charges":[{"gross_charge":2743.96,"discounted_cash":2057.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322818 = Hospital System Supply Identifier | 536033 = Lawson ID"}]},{"description":"IMP KNEE FEM AUG DST SZD 20","code_information":[{"code":"Sx00-5990-034","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322819","type":"LOCAL"},{"code":"536034","type":"LOCAL"}],"standard_charges":[{"gross_charge":2957.92,"discounted_cash":2218.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322819 = Hospital System Supply Identifier | 536034 = Lawson ID"}]},{"description":"IMP FEM AUG POST NXGN SZD 10MM","code_information":[{"code":"Sx00-5990-034","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"328647","type":"LOCAL"},{"code":"462720","type":"LOCAL"}],"standard_charges":[{"gross_charge":2030.0,"discounted_cash":1522.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 328647 = Hospital System Supply Identifier | 462720 = Lawson ID"}]},{"description":"IMP FEM AUG DST NXGN SZD 15MM","code_information":[{"code":"Sx00-5990-034","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202214","type":"LOCAL"},{"code":"452312","type":"LOCAL"}],"standard_charges":[{"gross_charge":2743.96,"discounted_cash":2057.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 202214 = Hospital System Supply Identifier | 452312 = Lawson ID"}]},{"description":"IMP FEM AUG POST NXGN SZD 5MM","code_information":[{"code":"Sx00-5990-034","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"194017","type":"LOCAL"},{"code":"324204","type":"LOCAL"}],"standard_charges":[{"gross_charge":2030.0,"discounted_cash":1522.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 194017 = Hospital System Supply Identifier | 324204 = Lawson ID"}]},{"description":"IMP FEM AUG DST NXGN SZD 10MM","code_information":[{"code":"Sx00-5990-034","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"194019","type":"LOCAL"},{"code":"324206","type":"LOCAL"}],"standard_charges":[{"gross_charge":2030.0,"discounted_cash":1522.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 194019 = Hospital System Supply Identifier | 324206 = Lawson ID"}]},{"description":"IMP FEM AUG DST NXGN SZD 5MM","code_information":[{"code":"Sx00-5990-034","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"194018","type":"LOCAL"},{"code":"324205","type":"LOCAL"}],"standard_charges":[{"gross_charge":2030.0,"discounted_cash":1522.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 194018 = Hospital System Supply Identifier | 324205 = Lawson ID"}]},{"description":"IMP KNEE FEM AUG NXGN SZD 5MM","code_information":[{"code":"Sx00-5990-034","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"195909","type":"LOCAL"},{"code":"395500","type":"LOCAL"}],"standard_charges":[{"gross_charge":2030.0,"discounted_cash":1522.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 195909 = Hospital System Supply Identifier | 395500 = Lawson ID"}]},{"description":"IMP KNEE FEM AUG DST SZE 15","code_information":[{"code":"Sx00-5990-035","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322820","type":"LOCAL"},{"code":"536035","type":"LOCAL"}],"standard_charges":[{"gross_charge":2743.96,"discounted_cash":2057.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322820 = Hospital System Supply Identifier | 536035 = Lawson ID"}]},{"description":"IMP KNEE FEM AUG NXGN SZE","code_information":[{"code":"Sx00-5990-035","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322042","type":"LOCAL"},{"code":"535256","type":"LOCAL"}],"standard_charges":[{"gross_charge":2030.0,"discounted_cash":1522.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322042 = Hospital System Supply Identifier | 535256 = Lawson ID"}]},{"description":"IMP KNEE FEM AUG NXGN SZE 10MM","code_information":[{"code":"Sx00-5990-035","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"195910","type":"LOCAL"},{"code":"395501","type":"LOCAL"}],"standard_charges":[{"gross_charge":2030.0,"discounted_cash":1522.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 195910 = Hospital System Supply Identifier | 395501 = Lawson ID"}]},{"description":"IMP KNEE FEM AUG DST SZE 20","code_information":[{"code":"Sx00-5990-035","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322821","type":"LOCAL"},{"code":"536036","type":"LOCAL"}],"standard_charges":[{"gross_charge":2957.92,"discounted_cash":2218.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322821 = Hospital System Supply Identifier | 536036 = Lawson ID"}]},{"description":"IMP KNEE FEM AUG NXGN SZE 10MM","code_information":[{"code":"Sx00-5990-035","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"194021","type":"LOCAL"},{"code":"324209","type":"LOCAL"}],"standard_charges":[{"gross_charge":2030.0,"discounted_cash":1522.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 194021 = Hospital System Supply Identifier | 324209 = Lawson ID"}]},{"description":"IMP KNEE FEM AUG NXGN SZE 5MM","code_information":[{"code":"Sx00-5990-035","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"194020","type":"LOCAL"},{"code":"324208","type":"LOCAL"}],"standard_charges":[{"gross_charge":2030.0,"discounted_cash":1522.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 194020 = Hospital System Supply Identifier | 324208 = Lawson ID"}]},{"description":"IMP KNEE FEM AUG NXGN SZE 10MM","code_information":[{"code":"Sx00-5990-035","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"194022","type":"LOCAL"},{"code":"324210","type":"LOCAL"}],"standard_charges":[{"gross_charge":2030.0,"discounted_cash":1522.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 194022 = Hospital System Supply Identifier | 324210 = Lawson ID"}]},{"description":"IMP FEM AUG NXGN SZF 05MM POST","code_information":[{"code":"Sx00-5990-036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"158932","type":"LOCAL"},{"code":"324211","type":"LOCAL"}],"standard_charges":[{"gross_charge":2030.0,"discounted_cash":1522.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 158932 = Hospital System Supply Identifier | 324211 = Lawson ID"}]},{"description":"IMP KNEE FEM AUG NXGN SZF 10MM","code_information":[{"code":"Sx00-5990-036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"194023","type":"LOCAL"},{"code":"324212","type":"LOCAL"}],"standard_charges":[{"gross_charge":2030.0,"discounted_cash":1522.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 194023 = Hospital System Supply Identifier | 324212 = Lawson ID"}]},{"description":"IMP FEM AUG NXGN SZF 05MM DST","code_information":[{"code":"Sx00-5990-036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"194024","type":"LOCAL"},{"code":"324213","type":"LOCAL"}],"standard_charges":[{"gross_charge":2030.0,"discounted_cash":1522.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 194024 = Hospital System Supply Identifier | 324213 = Lawson ID"}]},{"description":"IMP FEM AUG NXGN SZF 10MM DST","code_information":[{"code":"Sx00-5990-036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"194025","type":"LOCAL"},{"code":"324214","type":"LOCAL"}],"standard_charges":[{"gross_charge":2030.0,"discounted_cash":1522.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 194025 = Hospital System Supply Identifier | 324214 = Lawson ID"}]},{"description":"IMP KNEE FEM AUG NXGN SZF","code_information":[{"code":"Sx00-5990-036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322043","type":"LOCAL"},{"code":"535257","type":"LOCAL"}],"standard_charges":[{"gross_charge":2030.0,"discounted_cash":1522.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322043 = Hospital System Supply Identifier | 535257 = Lawson ID"}]},{"description":"IMP KNEE FEM AUG DST SZF 15","code_information":[{"code":"Sx00-5990-036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322822","type":"LOCAL"},{"code":"536037","type":"LOCAL"}],"standard_charges":[{"gross_charge":2743.96,"discounted_cash":2057.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322822 = Hospital System Supply Identifier | 536037 = Lawson ID"}]},{"description":"IMP KNEE FEM AUG DST SZF 20","code_information":[{"code":"Sx00-5990-036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322823","type":"LOCAL"},{"code":"536038","type":"LOCAL"}],"standard_charges":[{"gross_charge":2957.92,"discounted_cash":2218.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322823 = Hospital System Supply Identifier | 536038 = Lawson ID"}]},{"description":"IMP KNEE FEM AUG DST SZG 15","code_information":[{"code":"Sx00-5990-037","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322824","type":"LOCAL"},{"code":"536039","type":"LOCAL"}],"standard_charges":[{"gross_charge":2743.96,"discounted_cash":2057.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322824 = Hospital System Supply Identifier | 536039 = Lawson ID"}]},{"description":"IMP KNEE FEM AUG DST SZG 20","code_information":[{"code":"Sx00-5990-037","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322825","type":"LOCAL"},{"code":"536040","type":"LOCAL"}],"standard_charges":[{"gross_charge":2957.92,"discounted_cash":2218.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322825 = Hospital System Supply Identifier | 536040 = Lawson ID"}]},{"description":"IMP KNEE FEM AUG NXGN SZG 10MM","code_information":[{"code":"Sx00-5990-037","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322046","type":"LOCAL"},{"code":"535260","type":"LOCAL"}],"standard_charges":[{"gross_charge":2030.0,"discounted_cash":1522.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322046 = Hospital System Supply Identifier | 535260 = Lawson ID"}]},{"description":"IMP FEM AUG NXGN POST SZG 5MM","code_information":[{"code":"Sx00-5990-037","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"324830","type":"LOCAL"},{"code":"324216","type":"LOCAL"}],"standard_charges":[{"gross_charge":2030.0,"discounted_cash":1522.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 324830 = Hospital System Supply Identifier | 324216 = Lawson ID"}]},{"description":"IMP FEM AUG NXGN DST SZG 10MM","code_information":[{"code":"Sx00-5990-037","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"324832","type":"LOCAL"},{"code":"324218","type":"LOCAL"}],"standard_charges":[{"gross_charge":2030.0,"discounted_cash":1522.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 324832 = Hospital System Supply Identifier | 324218 = Lawson ID"}]},{"description":"IMP KNEE FEM AUG NXGN SZG 10MM","code_information":[{"code":"Sx00-5990-037","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"327210","type":"LOCAL"},{"code":"412557","type":"LOCAL"}],"standard_charges":[{"gross_charge":2030.0,"discounted_cash":1522.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 327210 = Hospital System Supply Identifier | 412557 = Lawson ID"}]},{"description":"IMP FEM AUG NXGN POST SZG 10MM","code_information":[{"code":"Sx00-5990-037","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"324831","type":"LOCAL"},{"code":"324217","type":"LOCAL"}],"standard_charges":[{"gross_charge":2030.0,"discounted_cash":1522.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 324831 = Hospital System Supply Identifier | 324217 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN SZ B-LT","code_information":[{"code":"Sx00-5992-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303678","type":"LOCAL"},{"code":"522635","type":"LOCAL"}],"standard_charges":[{"gross_charge":5225.0,"discounted_cash":3918.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303678 = Hospital System Supply Identifier | 522635 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN SZ B-RT","code_information":[{"code":"Sx00-5992-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303679","type":"LOCAL"},{"code":"522636","type":"LOCAL"}],"standard_charges":[{"gross_charge":5225.0,"discounted_cash":3918.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303679 = Hospital System Supply Identifier | 522636 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN SZ C-LT","code_information":[{"code":"Sx00-5992-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303680","type":"LOCAL"},{"code":"522637","type":"LOCAL"}],"standard_charges":[{"gross_charge":5225.0,"discounted_cash":3918.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303680 = Hospital System Supply Identifier | 522637 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN SZ C-RT","code_information":[{"code":"Sx00-5992-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303681","type":"LOCAL"},{"code":"522638","type":"LOCAL"}],"standard_charges":[{"gross_charge":5225.0,"discounted_cash":3918.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303681 = Hospital System Supply Identifier | 522638 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN SZ D-LT","code_information":[{"code":"Sx00-5992-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303682","type":"LOCAL"},{"code":"522639","type":"LOCAL"}],"standard_charges":[{"gross_charge":5225.0,"discounted_cash":3918.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303682 = Hospital System Supply Identifier | 522639 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN SZ D-RT","code_information":[{"code":"Sx00-5992-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303683","type":"LOCAL"},{"code":"522640","type":"LOCAL"}],"standard_charges":[{"gross_charge":5225.0,"discounted_cash":3918.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303683 = Hospital System Supply Identifier | 522640 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN SZ E-LT","code_information":[{"code":"Sx00-5992-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303684","type":"LOCAL"},{"code":"522641","type":"LOCAL"}],"standard_charges":[{"gross_charge":5225.0,"discounted_cash":3918.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303684 = Hospital System Supply Identifier | 522641 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZE","code_information":[{"code":"Sx00-5992-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"163383","type":"LOCAL"},{"code":"364406","type":"LOCAL"}],"standard_charges":[{"gross_charge":5225.0,"discounted_cash":3918.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 163383 = Hospital System Supply Identifier | 364406 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN SZ F-RT","code_information":[{"code":"Sx00-5992-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303686","type":"LOCAL"},{"code":"522643","type":"LOCAL"}],"standard_charges":[{"gross_charge":5225.0,"discounted_cash":3918.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303686 = Hospital System Supply Identifier | 522643 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN SZ F-LT","code_information":[{"code":"Sx00-5992-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303685","type":"LOCAL"},{"code":"522642","type":"LOCAL"}],"standard_charges":[{"gross_charge":5225.0,"discounted_cash":3918.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303685 = Hospital System Supply Identifier | 522642 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN SZ G-LT","code_information":[{"code":"Sx00-5992-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303687","type":"LOCAL"},{"code":"522644","type":"LOCAL"}],"standard_charges":[{"gross_charge":5225.0,"discounted_cash":3918.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303687 = Hospital System Supply Identifier | 522644 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN SZ G-RT","code_information":[{"code":"Sx00-5992-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303688","type":"LOCAL"},{"code":"522645","type":"LOCAL"}],"standard_charges":[{"gross_charge":5225.0,"discounted_cash":3918.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 303688 = Hospital System Supply Identifier | 522645 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP LCCK LT SZC","code_information":[{"code":"Sx00-5994-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"194026","type":"LOCAL"},{"code":"324219","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 194026 = Hospital System Supply Identifier | 324219 = Lawson ID"}]},{"description":"IMP KNEE REV FEM SZC 53.5X60MM","code_information":[{"code":"Sx00-5994-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326349","type":"LOCAL"},{"code":"395769","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 326349 = Hospital System Supply Identifier | 395769 = Lawson ID"}]},{"description":"NO USAGE - COMPONENT FEM D LFT CONDYLAR KNEE ZIMALOY CONSTRAINED NEXGEN LEGACY","code_information":[{"code":"Sx00-5994-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"449606","type":"LOCAL"},{"code":"324220","type":"LOCAL"}],"standard_charges":[{"gross_charge":8239.75,"discounted_cash":6179.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 449606 = Hospital System Supply Identifier | 324220 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP LCCK LT SZD","code_information":[{"code":"Sx00-5994-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"194027","type":"LOCAL"},{"code":"324221","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 194027 = Hospital System Supply Identifier | 324221 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP LCCK RT SZD","code_information":[{"code":"Sx00-5994-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"194972","type":"LOCAL"},{"code":"360631","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 194972 = Hospital System Supply Identifier | 360631 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP LCCK RT SZE","code_information":[{"code":"Sx00-5994-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"178505","type":"LOCAL"},{"code":"360632","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 178505 = Hospital System Supply Identifier | 360632 = Lawson ID"}]},{"description":"NO USAGE - COMPONENT FEM E RT CONDYLAR KNEE ZIMALOY CONSTRAINED NEXGEN LEGACY","code_information":[{"code":"Sx00-5994-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"449607","type":"LOCAL"},{"code":"324222","type":"LOCAL"}],"standard_charges":[{"gross_charge":8239.75,"discounted_cash":6179.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 449607 = Hospital System Supply Identifier | 324222 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP LCCK LT SZE","code_information":[{"code":"Sx00-5994-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"178367","type":"LOCAL"},{"code":"324223","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 178367 = Hospital System Supply Identifier | 324223 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP LCCK LT SZF","code_information":[{"code":"Sx00-5994-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"194028","type":"LOCAL"},{"code":"324224","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 194028 = Hospital System Supply Identifier | 324224 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP LCCK RT SZF","code_information":[{"code":"Sx00-5994-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"194973","type":"LOCAL"},{"code":"360633","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 194973 = Hospital System Supply Identifier | 360633 = Lawson ID"}]},{"description":"IMP KNEE FEM NXGN SZG RT 70.5","code_information":[{"code":"Sx00-5994-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"169785","type":"LOCAL"},{"code":"324225","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 169785 = Hospital System Supply Identifier | 324225 = Lawson ID"}]},{"description":"IMP KNEE REV FEM SZG 70.5X76.5","code_information":[{"code":"Sx00-5994-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326350","type":"LOCAL"},{"code":"395770","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 326350 = Hospital System Supply Identifier | 395770 = Lawson ID"}]},{"description":"IMP KNEE INS NXGN LOK CD1-2/20","code_information":[{"code":"Sx00-5994-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202245","type":"LOCAL"},{"code":"452343","type":"LOCAL"}],"standard_charges":[{"gross_charge":4278.0,"discounted_cash":3208.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 202245 = Hospital System Supply Identifier | 452343 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC CD 1-2 10","code_information":[{"code":"Sx00-5994-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322047","type":"LOCAL"},{"code":"535261","type":"LOCAL"}],"standard_charges":[{"gross_charge":4278.0,"discounted_cash":3208.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322047 = Hospital System Supply Identifier | 535261 = Lawson ID"}]},{"description":"IMP KNEE INS NXGN LOK CD1-2/17","code_information":[{"code":"Sx00-5994-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202244","type":"LOCAL"},{"code":"452342","type":"LOCAL"}],"standard_charges":[{"gross_charge":4278.0,"discounted_cash":3208.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 202244 = Hospital System Supply Identifier | 452342 = Lawson ID"}]},{"description":"IMP TIB NXGN SZ1-2 23MM","code_information":[{"code":"Sx00-5994-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"198028","type":"LOCAL"},{"code":"443264","type":"LOCAL"}],"standard_charges":[{"gross_charge":4278.0,"discounted_cash":3208.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 198028 = Hospital System Supply Identifier | 443264 = Lawson ID"}]},{"description":"IMP KNEE TIB INS NXGN MIC","code_information":[{"code":"Sx00-5994-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"327175","type":"LOCAL"},{"code":"412372","type":"LOCAL"}],"standard_charges":[{"gross_charge":4278.0,"discounted_cash":3208.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 327175 = Hospital System Supply Identifier | 412372 = Lawson ID"}]},{"description":"IMP KNEE INS NXGN LOK CD1-2/12","code_information":[{"code":"Sx00-5994-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202243","type":"LOCAL"},{"code":"452341","type":"LOCAL"}],"standard_charges":[{"gross_charge":4278.0,"discounted_cash":3208.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 202243 = Hospital System Supply Identifier | 452341 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC CD 3-4 12","code_information":[{"code":"Sx00-5994-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322050","type":"LOCAL"},{"code":"535264","type":"LOCAL"}],"standard_charges":[{"gross_charge":4278.0,"discounted_cash":3208.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322050 = Hospital System Supply Identifier | 535264 = Lawson ID"}]},{"description":"IMP TIB INS NXGN 3-4 10MM","code_information":[{"code":"Sx00-5994-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329394","type":"LOCAL"},{"code":"324226","type":"LOCAL"}],"standard_charges":[{"gross_charge":4278.0,"discounted_cash":3208.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329394 = Hospital System Supply Identifier | 324226 = Lawson ID"}]},{"description":"IMP TIB INS NXGN 3-4 17MM","code_information":[{"code":"Sx00-5994-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"194029","type":"LOCAL"},{"code":"324227","type":"LOCAL"}],"standard_charges":[{"gross_charge":4278.0,"discounted_cash":3208.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 194029 = Hospital System Supply Identifier | 324227 = Lawson ID"}]},{"description":"IMP TIB INS POST NXGN SZ3-4 20","code_information":[{"code":"Sx00-5994-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329395","type":"LOCAL"},{"code":"324228","type":"LOCAL"}],"standard_charges":[{"gross_charge":4278.0,"discounted_cash":3208.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329395 = Hospital System Supply Identifier | 324228 = Lawson ID"}]},{"description":"IMP LCCK ART SURF CD 3-4 YE","code_information":[{"code":"Sx00-5994-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"317062","type":"LOCAL"},{"code":"446541","type":"LOCAL"}],"standard_charges":[{"gross_charge":4278.0,"discounted_cash":3208.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 317062 = Hospital System Supply Identifier | 446541 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC CD 3-4 23","code_information":[{"code":"Sx00-5994-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322051","type":"LOCAL"},{"code":"535265","type":"LOCAL"}],"standard_charges":[{"gross_charge":4278.0,"discounted_cash":3208.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322051 = Hospital System Supply Identifier | 535265 = Lawson ID"}]},{"description":"IMP KNEE TIB INS NXGN SZE-F","code_information":[{"code":"Sx00-5994-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"327176","type":"LOCAL"},{"code":"412373","type":"LOCAL"}],"standard_charges":[{"gross_charge":4278.0,"discounted_cash":3208.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 327176 = Hospital System Supply Identifier | 412373 = Lawson ID"}]},{"description":"IMP KNEE TIB INS NXGN 3-4 20MM","code_information":[{"code":"Sx00-5994-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"171767","type":"LOCAL"},{"code":"402008","type":"LOCAL"}],"standard_charges":[{"gross_charge":4278.0,"discounted_cash":3208.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 171767 = Hospital System Supply Identifier | 402008 = Lawson ID"}]},{"description":"IMP KNEE INS NXGN LOK EF3-4/12","code_information":[{"code":"Sx00-5994-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202246","type":"LOCAL"},{"code":"452344","type":"LOCAL"}],"standard_charges":[{"gross_charge":4278.0,"discounted_cash":3208.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 202246 = Hospital System Supply Identifier | 452344 = Lawson ID"}]},{"description":"IMP TIB INS NXGN SZ3-4 17MM","code_information":[{"code":"Sx00-5994-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"195110","type":"LOCAL"},{"code":"364331","type":"LOCAL"}],"standard_charges":[{"gross_charge":4278.0,"discounted_cash":3208.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 195110 = Hospital System Supply Identifier | 364331 = Lawson ID"}]},{"description":"IMP KNEE TIB INS NXGN 3-4 14MM","code_information":[{"code":"Sx00-5994-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"196067","type":"LOCAL"},{"code":"402007","type":"LOCAL"}],"standard_charges":[{"gross_charge":4278.0,"discounted_cash":3208.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 196067 = Hospital System Supply Identifier | 402007 = Lawson ID"}]},{"description":"IMP KNEE TIB INS NXGN 3-4 10MM","code_information":[{"code":"Sx00-5994-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"178421","type":"LOCAL"},{"code":"337485","type":"LOCAL"}],"standard_charges":[{"gross_charge":4278.0,"discounted_cash":3208.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 178421 = Hospital System Supply Identifier | 337485 = Lawson ID"}]},{"description":"IMP TIB INS NXGN LOK 5-6 14MM","code_information":[{"code":"Sx00-5994-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329397","type":"LOCAL"},{"code":"324230","type":"LOCAL"}],"standard_charges":[{"gross_charge":4278.0,"discounted_cash":3208.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 329397 = Hospital System Supply Identifier | 324230 = Lawson ID"}]},{"description":"IMP KNEE TIB INS NXGN 5-6 17MM","code_information":[{"code":"Sx00-5994-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326832","type":"LOCAL"},{"code":"402009","type":"LOCAL"}],"standard_charges":[{"gross_charge":4278.0,"discounted_cash":3208.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 326832 = Hospital System Supply Identifier | 402009 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC NXGN SZ10","code_information":[{"code":"Sx00-5994-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"178907","type":"LOCAL"},{"code":"424144","type":"LOCAL"}],"standard_charges":[{"gross_charge":4278.0,"discounted_cash":3208.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 178907 = Hospital System Supply Identifier | 424144 = Lawson ID"}]},{"description":"IMP TIB NXGN SZ5-6 12MM","code_information":[{"code":"Sx00-5994-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"198027","type":"LOCAL"},{"code":"443263","type":"LOCAL"}],"standard_charges":[{"gross_charge":4278.0,"discounted_cash":3208.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 198027 = Hospital System Supply Identifier | 443263 = Lawson ID"}]},{"description":"IMP KNEE ART SURF NEXGN 5-6 20","code_information":[{"code":"Sx00-5994-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"328546","type":"LOCAL"},{"code":"458224","type":"LOCAL"}],"standard_charges":[{"gross_charge":4278.0,"discounted_cash":3208.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 328546 = Hospital System Supply Identifier | 458224 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC EF 5-6 23","code_information":[{"code":"Sx00-5994-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322055","type":"LOCAL"},{"code":"535269","type":"LOCAL"}],"standard_charges":[{"gross_charge":4278.0,"discounted_cash":3208.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322055 = Hospital System Supply Identifier | 535269 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC CD 5-6 33","code_information":[{"code":"Sx00-5994-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322063","type":"LOCAL"},{"code":"535277","type":"LOCAL"}],"standard_charges":[{"gross_charge":5904.42,"discounted_cash":4428.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322063 = Hospital System Supply Identifier | 535277 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC CD 5-6 28","code_information":[{"code":"Sx00-5994-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322062","type":"LOCAL"},{"code":"535276","type":"LOCAL"}],"standard_charges":[{"gross_charge":5904.42,"discounted_cash":4428.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322062 = Hospital System Supply Identifier | 535276 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC CD 5-6 23","code_information":[{"code":"Sx00-5994-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322061","type":"LOCAL"},{"code":"535275","type":"LOCAL"}],"standard_charges":[{"gross_charge":4278.0,"discounted_cash":3208.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322061 = Hospital System Supply Identifier | 535275 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC CD 5-6 14","code_information":[{"code":"Sx00-5994-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322060","type":"LOCAL"},{"code":"535274","type":"LOCAL"}],"standard_charges":[{"gross_charge":4278.0,"discounted_cash":3208.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322060 = Hospital System Supply Identifier | 535274 = Lawson ID"}]},{"description":"IMP KNEE ART SURF NXGN 5/6","code_information":[{"code":"Sx00-5994-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"327955","type":"LOCAL"},{"code":"433427","type":"LOCAL"}],"standard_charges":[{"gross_charge":4278.0,"discounted_cash":3208.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 327955 = Hospital System Supply Identifier | 433427 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC CD 5-6 10","code_information":[{"code":"Sx00-5994-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322058","type":"LOCAL"},{"code":"535272","type":"LOCAL"}],"standard_charges":[{"gross_charge":4278.0,"discounted_cash":3208.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322058 = Hospital System Supply Identifier | 535272 = Lawson ID"}]},{"description":"IMP KNEE ART SURF NXGN17X46X74","code_information":[{"code":"Sx00-5994-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326298","type":"LOCAL"},{"code":"395502","type":"LOCAL"}],"standard_charges":[{"gross_charge":4278.0,"discounted_cash":3208.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 326298 = Hospital System Supply Identifier | 395502 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC CD 5-6 12","code_information":[{"code":"Sx00-5994-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322059","type":"LOCAL"},{"code":"535273","type":"LOCAL"}],"standard_charges":[{"gross_charge":4278.0,"discounted_cash":3208.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322059 = Hospital System Supply Identifier | 535273 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC G 5-6 10","code_information":[{"code":"Sx00-5994-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322064","type":"LOCAL"},{"code":"535278","type":"LOCAL"}],"standard_charges":[{"gross_charge":4278.0,"discounted_cash":3208.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322064 = Hospital System Supply Identifier | 535278 = Lawson ID"}]},{"description":"IMP KNEE ART SURF NXGN 5-6 12M","code_information":[{"code":"Sx00-5994-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"328591","type":"LOCAL"},{"code":"459447","type":"LOCAL"}],"standard_charges":[{"gross_charge":4278.0,"discounted_cash":3208.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 328591 = Hospital System Supply Identifier | 459447 = Lawson ID"}]},{"description":"IMP KNEE TIB INS NXGN SZG 14","code_information":[{"code":"Sx00-5994-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"170310","type":"LOCAL"},{"code":"412374","type":"LOCAL"}],"standard_charges":[{"gross_charge":4278.0,"discounted_cash":3208.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 170310 = Hospital System Supply Identifier | 412374 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF SZG23X46X74","code_information":[{"code":"Sx00-5994-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326351","type":"LOCAL"},{"code":"395771","type":"LOCAL"}],"standard_charges":[{"gross_charge":4278.0,"discounted_cash":3208.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 326351 = Hospital System Supply Identifier | 395771 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN 17MM","code_information":[{"code":"Sx00-5994-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"324833","type":"LOCAL"},{"code":"324231","type":"LOCAL"}],"standard_charges":[{"gross_charge":4278.0,"discounted_cash":3208.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 324833 = Hospital System Supply Identifier | 324231 = Lawson ID"}]},{"description":"IMP KNEE TIB INS NXGN 5-6 20MM","code_information":[{"code":"Sx00-5994-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326833","type":"LOCAL"},{"code":"402010","type":"LOCAL"}],"standard_charges":[{"gross_charge":4278.0,"discounted_cash":3208.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 326833 = Hospital System Supply Identifier | 402010 = Lawson ID"}]},{"description":"IMP KNEE TIB INS NXGNSZ7-10 12","code_information":[{"code":"Sx00-5994-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"324834","type":"LOCAL"},{"code":"324232","type":"LOCAL"}],"standard_charges":[{"gross_charge":4278.0,"discounted_cash":3208.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 324834 = Hospital System Supply Identifier | 324232 = Lawson ID"}]},{"description":"IMP KNEE TIB INS NXGN 7-10 14","code_information":[{"code":"Sx00-5994-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326834","type":"LOCAL"},{"code":"402011","type":"LOCAL"}],"standard_charges":[{"gross_charge":4278.0,"discounted_cash":3208.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 326834 = Hospital System Supply Identifier | 402011 = Lawson ID"}]},{"description":"IMP KNEE TIB INS NXGN 7-10 23","code_information":[{"code":"Sx00-5994-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326835","type":"LOCAL"},{"code":"402012","type":"LOCAL"}],"standard_charges":[{"gross_charge":4278.0,"discounted_cash":3208.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 326835 = Hospital System Supply Identifier | 402012 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC G 7-10 10","code_information":[{"code":"Sx00-5994-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322067","type":"LOCAL"},{"code":"535281","type":"LOCAL"}],"standard_charges":[{"gross_charge":4278.0,"discounted_cash":3208.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322067 = Hospital System Supply Identifier | 535281 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC G 7-10 17","code_information":[{"code":"Sx00-5994-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322068","type":"LOCAL"},{"code":"535282","type":"LOCAL"}],"standard_charges":[{"gross_charge":4278.0,"discounted_cash":3208.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322068 = Hospital System Supply Identifier | 535282 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC G 7-10 20","code_information":[{"code":"Sx00-5994-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322069","type":"LOCAL"},{"code":"535283","type":"LOCAL"}],"standard_charges":[{"gross_charge":4278.0,"discounted_cash":3208.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322069 = Hospital System Supply Identifier | 535283 = Lawson ID"}]},{"description":"IMP KNEE ART SUF NEXGN 7-10 12","code_information":[{"code":"Sx00-5994-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"328547","type":"LOCAL"},{"code":"458225","type":"LOCAL"}],"standard_charges":[{"gross_charge":4278.0,"discounted_cash":3208.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 328547 = Hospital System Supply Identifier | 458225 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC EF 7-10 23","code_information":[{"code":"Sx00-5994-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322073","type":"LOCAL"},{"code":"535287","type":"LOCAL"}],"standard_charges":[{"gross_charge":4278.0,"discounted_cash":3208.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322073 = Hospital System Supply Identifier | 535287 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC EF 7-10 17","code_information":[{"code":"Sx00-5994-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322072","type":"LOCAL"},{"code":"535286","type":"LOCAL"}],"standard_charges":[{"gross_charge":4278.0,"discounted_cash":3208.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322072 = Hospital System Supply Identifier | 535286 = Lawson ID"}]},{"description":"IMP KNEE NXGN SURF ART EF 20MM","code_information":[{"code":"Sx00-5994-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"328149","type":"LOCAL"},{"code":"437446","type":"LOCAL"}],"standard_charges":[{"gross_charge":4278.0,"discounted_cash":3208.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 328149 = Hospital System Supply Identifier | 437446 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC EF 7-10 10","code_information":[{"code":"Sx00-5994-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322070","type":"LOCAL"},{"code":"535284","type":"LOCAL"}],"standard_charges":[{"gross_charge":4278.0,"discounted_cash":3208.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322070 = Hospital System Supply Identifier | 535284 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC EF 7-10 14","code_information":[{"code":"Sx00-5994-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322071","type":"LOCAL"},{"code":"535285","type":"LOCAL"}],"standard_charges":[{"gross_charge":4278.0,"discounted_cash":3208.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 322071 = Hospital System Supply Identifier | 535285 = Lawson ID"}]},{"description":"IMP KNEE TIB COMP LPS 14MM","code_information":[{"code":"Sx00-5996-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"324241","type":"LOCAL"},{"code":"258392","type":"LOCAL"}],"standard_charges":[{"gross_charge":2232.0,"discounted_cash":1674.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 324241 = Hospital System Supply Identifier | 258392 = Lawson ID"}]},{"description":"IMP KNEE TIB COMP LPS 10MM","code_information":[{"code":"Sx00-5996-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"324239","type":"LOCAL"},{"code":"258390","type":"LOCAL"}],"standard_charges":[{"gross_charge":2232.0,"discounted_cash":1674.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 324239 = Hospital System Supply Identifier | 258390 = Lawson ID"}]},{"description":"IMP KNEE TIB COMP LPS 12MM","code_information":[{"code":"Sx00-5996-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"324240","type":"LOCAL"},{"code":"258391","type":"LOCAL"}],"standard_charges":[{"gross_charge":2232.0,"discounted_cash":1674.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 324240 = Hospital System Supply Identifier | 258391 = Lawson ID"}]},{"description":"IMP KNEE TIB COMP LPS 17MM","code_information":[{"code":"Sx00-5996-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"324242","type":"LOCAL"},{"code":"258393","type":"LOCAL"}],"standard_charges":[{"gross_charge":2232.0,"discounted_cash":1674.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 324242 = Hospital System Supply Identifier | 258393 = Lawson ID"}]},{"description":"IMP KNEE TIB COMP LPS 14MM","code_information":[{"code":"Sx00-5996-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"324245","type":"LOCAL"},{"code":"258396","type":"LOCAL"}],"standard_charges":[{"gross_charge":2232.0,"discounted_cash":1674.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 324245 = Hospital System Supply Identifier | 258396 = Lawson ID"}]},{"description":"IMP KNEE TIB COMP LPS 17MM","code_information":[{"code":"Sx00-5996-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"324246","type":"LOCAL"},{"code":"258397","type":"LOCAL"}],"standard_charges":[{"gross_charge":2232.0,"discounted_cash":1674.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 324246 = Hospital System Supply Identifier | 258397 = Lawson ID"}]},{"description":"IMP KNEE TIB COMP LPS 12MM","code_information":[{"code":"Sx00-5996-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"324244","type":"LOCAL"},{"code":"258395","type":"LOCAL"}],"standard_charges":[{"gross_charge":2232.0,"discounted_cash":1674.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 324244 = Hospital System Supply Identifier | 258395 = Lawson ID"}]},{"description":"IMP KNEE TIB COMP LPS 10MM","code_information":[{"code":"Sx00-5996-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"324243","type":"LOCAL"},{"code":"258394","type":"LOCAL"}],"standard_charges":[{"gross_charge":2232.0,"discounted_cash":1674.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 324243 = Hospital System Supply Identifier | 258394 = Lawson ID"}]},{"description":"IMP KNEE TIB COMP LPS 10MM","code_information":[{"code":"Sx00-5996-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"324215","type":"LOCAL"},{"code":"258366","type":"LOCAL"}],"standard_charges":[{"gross_charge":2232.0,"discounted_cash":1674.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 324215 = Hospital System Supply Identifier | 258366 = Lawson ID"}]},{"description":"IMP KNEE TIB COMP LPS 12MM","code_information":[{"code":"Sx00-5996-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"324216","type":"LOCAL"},{"code":"258367","type":"LOCAL"}],"standard_charges":[{"gross_charge":2232.0,"discounted_cash":1674.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 324216 = Hospital System Supply Identifier | 258367 = Lawson ID"}]},{"description":"IMP KNEE TIB COMP LPS 14MM","code_information":[{"code":"Sx00-5996-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"324217","type":"LOCAL"},{"code":"258368","type":"LOCAL"}],"standard_charges":[{"gross_charge":2232.0,"discounted_cash":1674.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 324217 = Hospital System Supply Identifier | 258368 = Lawson ID"}]},{"description":"IMP KNEE TIB COMP LPS 17MM","code_information":[{"code":"Sx00-5996-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"324218","type":"LOCAL"},{"code":"258369","type":"LOCAL"}],"standard_charges":[{"gross_charge":2232.0,"discounted_cash":1674.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 324218 = Hospital System Supply Identifier | 258369 = Lawson ID"}]},{"description":"IMP KNEE TIB COMP LPS 10MM","code_information":[{"code":"Sx00-5996-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"324247","type":"LOCAL"},{"code":"258398","type":"LOCAL"}],"standard_charges":[{"gross_charge":2232.0,"discounted_cash":1674.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 324247 = Hospital System Supply Identifier | 258398 = Lawson ID"}]},{"description":"IMP KNEE TIB COMP LPS 12MM","code_information":[{"code":"Sx00-5996-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"324248","type":"LOCAL"},{"code":"258399","type":"LOCAL"}],"standard_charges":[{"gross_charge":2232.0,"discounted_cash":1674.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 324248 = Hospital System Supply Identifier | 258399 = Lawson ID"}]},{"description":"IMP KNEE TIB COMP LPS 14MM","code_information":[{"code":"Sx00-5996-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"324249","type":"LOCAL"},{"code":"258400","type":"LOCAL"}],"standard_charges":[{"gross_charge":2232.0,"discounted_cash":1674.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 324249 = Hospital System Supply Identifier | 258400 = Lawson ID"}]},{"description":"IMP KNEE TIB COMP LPS 17MM","code_information":[{"code":"Sx00-5996-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"324250","type":"LOCAL"},{"code":"258401","type":"LOCAL"}],"standard_charges":[{"gross_charge":2232.0,"discounted_cash":1674.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 324250 = Hospital System Supply Identifier | 258401 = Lawson ID"}]},{"description":"IMP KNEE TIB COMP LPS 17MM","code_information":[{"code":"Sx00-5996-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"324222","type":"LOCAL"},{"code":"258373","type":"LOCAL"}],"standard_charges":[{"gross_charge":2232.0,"discounted_cash":1674.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 324222 = Hospital System Supply Identifier | 258373 = Lawson ID"}]},{"description":"IMP KNEE TIB COMP LPS 14MM","code_information":[{"code":"Sx00-5996-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"324221","type":"LOCAL"},{"code":"258372","type":"LOCAL"}],"standard_charges":[{"gross_charge":2232.0,"discounted_cash":1674.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 324221 = Hospital System Supply Identifier | 258372 = Lawson ID"}]},{"description":"IMP KNEE TIB COMP LPS 10MM","code_information":[{"code":"Sx00-5996-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"324219","type":"LOCAL"},{"code":"258370","type":"LOCAL"}],"standard_charges":[{"gross_charge":2232.0,"discounted_cash":1674.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 324219 = Hospital System Supply Identifier | 258370 = Lawson ID"}]},{"description":"IMP KNEE TIB COMP LPS 12MM","code_information":[{"code":"Sx00-5996-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"324220","type":"LOCAL"},{"code":"258371","type":"LOCAL"}],"standard_charges":[{"gross_charge":2232.0,"discounted_cash":1674.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 324220 = Hospital System Supply Identifier | 258371 = Lawson ID"}]},{"description":"IMP KNEE TIB COMP LPS 10MM","code_information":[{"code":"Sx00-5996-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"324223","type":"LOCAL"},{"code":"258374","type":"LOCAL"}],"standard_charges":[{"gross_charge":2232.0,"discounted_cash":1674.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 324223 = Hospital System Supply Identifier | 258374 = Lawson ID"}]},{"description":"IMP KNEE TIB COMP LPS 12MM","code_information":[{"code":"Sx00-5996-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"324224","type":"LOCAL"},{"code":"258375","type":"LOCAL"}],"standard_charges":[{"gross_charge":2232.0,"discounted_cash":1674.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 324224 = Hospital System Supply Identifier | 258375 = Lawson ID"}]},{"description":"IMP KNEE TIB COMP LPS 14MM","code_information":[{"code":"Sx00-5996-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"324225","type":"LOCAL"},{"code":"258376","type":"LOCAL"}],"standard_charges":[{"gross_charge":2232.0,"discounted_cash":1674.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 324225 = Hospital System Supply Identifier | 258376 = Lawson ID"}]},{"description":"IMP KNEE TIB COMP LPS 17MM","code_information":[{"code":"Sx00-5996-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"324226","type":"LOCAL"},{"code":"258377","type":"LOCAL"}],"standard_charges":[{"gross_charge":2232.0,"discounted_cash":1674.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 324226 = Hospital System Supply Identifier | 258377 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP LPS LT SZA","code_information":[{"code":"Sx00-5996-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"191970","type":"LOCAL"},{"code":"204789","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 191970 = Hospital System Supply Identifier | 204789 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP LPS RT SZA","code_information":[{"code":"Sx00-5996-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"191971","type":"LOCAL"},{"code":"204790","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 191971 = Hospital System Supply Identifier | 204790 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP LPS RT SZB","code_information":[{"code":"Sx00-5996-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"191972","type":"LOCAL"},{"code":"204792","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 191972 = Hospital System Supply Identifier | 204792 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP LPS LT SZB","code_information":[{"code":"Sx00-5996-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"167976","type":"LOCAL"},{"code":"204791","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 167976 = Hospital System Supply Identifier | 204791 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP LCCK LT SZC","code_information":[{"code":"Sx00-5996-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"193250","type":"LOCAL"},{"code":"259391","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 193250 = Hospital System Supply Identifier | 259391 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP LCCK RT SZC","code_information":[{"code":"Sx00-5996-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"152080","type":"LOCAL"},{"code":"259396","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 152080 = Hospital System Supply Identifier | 259396 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP LCCK LT SZD","code_information":[{"code":"Sx00-5996-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"193251","type":"LOCAL"},{"code":"259392","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 193251 = Hospital System Supply Identifier | 259392 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP LCCK RT SZD","code_information":[{"code":"Sx00-5996-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"193254","type":"LOCAL"},{"code":"259397","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 193254 = Hospital System Supply Identifier | 259397 = Lawson ID"}]},{"description":"IMP KNEE TIB COMP LPS 10MM","code_information":[{"code":"Sx00-5996-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"324251","type":"LOCAL"},{"code":"258402","type":"LOCAL"}],"standard_charges":[{"gross_charge":2232.0,"discounted_cash":1674.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OMD LOCATION | 324251 = Hospital System Supply Identifier | 258402 = Lawson ID"}]},{"description":"IMP KNEE TIB COMP LPS 12MM","code_information":[{"code":"Sx00-5996-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"324252","type":"LOCAL"},{"code":"258403","type":"LOCAL"}],"standard_charges":[{"gross_charge":2232.0,"discounted_cash":1674.0