{"hospital_name":"Providence Health System - Southern California","last_updated_on":"2026-04-01","version":"3.0.0","location_name":["Providence Little Co of Mary Med Center San Pedro"],"hospital_address":["1300 W 7th St, San Pedro, CA 90732"],"license_information":{"license_number":"930000142","state":"CA"},"type_2_npi":["1942247291","1154349371"],"attestation":{"attestation":"To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.","confirm_attestation":true,"attester_name":"Jason Kell"},"financial_aid_policy":["65% off of standard gross charges."],"modifier_information":[{"description":"Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities","code":"TC","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Anthem Vivity City of LA Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Anthem Vivity Non City of LA Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"EPN/IFP Benefit Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"Tandem PPO/Blue High Performance PPO/EPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Brand New Day","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"CalOptima","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareMore","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Central Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"OA/OAP HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"Coventry All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Gold Coast Health PLan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthNet","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthNet","plan_name":"Ambetter HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthNet","plan_name":"Ambetter PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthNet","plan_name":"Blue and Gold Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthNet","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthNet","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Heritage Provider Network","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Heritage Provider Network","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Heritage Provider Network","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Inland Empire Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Inland Empire Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"LA Care Health Plan","plan_name":"Covered CA Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"LA Care Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"LA Care Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge 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5001-57-28","code_information":[{"code":"Sx00-5001-057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"168556","type":"LOCAL"},{"code":"208837","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLS LOCATION | 168556 = Hospital System Supply Identifier | 208837 = Lawson ID"}]},{"description":"SHELL MULTIPOLAR 5001-57","code_information":[{"code":"Sx00-5001-057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"168552","type":"LOCAL"},{"code":"208826","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLS LOCATION | 168552 = Hospital System Supply Identifier | 208826 = Lawson ID"}]},{"description":"IMP HIP SHELL 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60X26MM","code_information":[{"code":"Sx00-5001-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303199","type":"LOCAL"},{"code":"522145","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLS 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":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLS 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":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLS LOCATION | 323414 = Hospital System Supply Identifier | 208829 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 64X26MM","code_information":[{"code":"Sx00-5001-064","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303201","type":"LOCAL"},{"code":"522147","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLS LOCATION | 303201 = Hospital System Supply Identifier | 522147 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 64X32MM","code_information":[{"code":"Sx00-5001-064","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303202","type":"LOCAL"},{"code":"522148","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLS LOCATION | 303202 = Hospital System Supply Identifier | 522148 = Lawson ID"}]},{"description":"SHELL MULTIPOLAR 5001-64","code_information":[{"code":"Sx00-5001-064","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"323415","type":"LOCAL"},{"code":"208830","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLS LOCATION | 323415 = Hospital System Supply Identifier | 208830 = Lawson ID"}]},{"description":"LINER MULTIPOLAR 5001-64-28","code_information":[{"code":"Sx00-5001-064","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329021","type":"LOCAL"},{"code":"208839","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLS LOCATION | 329021 = Hospital System Supply Identifier | 208839 = Lawson ID"}]},{"description":"IMP HIP ACET SHELL BPLR 66MM","code_information":[{"code":"Sx00-5001-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303203","type":"LOCAL"},{"code":"522149","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLS LOCATION | 303203 = Hospital System Supply Identifier | 522149 = Lawson ID"}]},{"description":"IMP HIP SHELL MULTPLR 68-70","code_information":[{"code":"Sx00-5001-068","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326954","type":"LOCAL"},{"code":"408143","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLS LOCATION | 326954 = Hospital System Supply Identifier | 408143 = Lawson ID"}]},{"description":"IMP HIP ACET SHELL BPLR 68MM","code_information":[{"code":"Sx00-5001-068","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303204","type":"LOCAL"},{"code":"522150","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLS LOCATION | 303204 = Hospital System Supply Identifier | 522150 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 68X26MM","code_information":[{"code":"Sx00-5001-068","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303205","type":"LOCAL"},{"code":"522151","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLS LOCATION | 303205 = Hospital System Supply Identifier | 522151 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 68X32MM","code_information":[{"code":"Sx00-5001-068","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303206","type":"LOCAL"},{"code":"522152","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLS LOCATION | 303206 = Hospital System Supply Identifier | 522152 = Lawson ID"}]},{"description":"IMP HIP ACET SHELL BPLR 70MM","code_information":[{"code":"Sx00-5001-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303207","type":"LOCAL"},{"code":"522153","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLS LOCATION | 303207 = Hospital System Supply Identifier | 522153 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 72X32MM","code_information":[{"code":"Sx00-5001-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303210","type":"LOCAL"},{"code":"522156","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLS LOCATION | 303210 = Hospital System Supply Identifier | 522156 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 72X26MM","code_information":[{"code":"Sx00-5001-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303209","type":"LOCAL"},{"code":"522155","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLS LOCATION | 303209 = Hospital System Supply Identifier | 522155 = Lawson ID"}]},{"description":"IMP HIP SHELL MULTPLR 72","code_information":[{"code":"Sx00-5001-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326955","type":"LOCAL"},{"code":"408144","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLS LOCATION | 326955 = Hospital System Supply Identifier | 408144 = Lawson ID"}]},{"description":"IMP HIP ACET SHELL BPLR 72MM","code_information":[{"code":"Sx00-5001-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303208","type":"LOCAL"},{"code":"522154","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLS LOCATION | 303208 = Hospital System Supply Identifier | 522154 = Lawson ID"}]},{"description":"IMP HIP LNR PRVSNL 22 38-43MM","code_information":[{"code":"Sx00-5003-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"449578","type":"LOCAL"},{"code":"310982","type":"LOCAL"}],"standard_charges":[{"gross_charge":630.0,"discounted_cash":220.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLS LOCATION | 449578 = Hospital System Supply Identifier | 310982 = Lawson ID"}]},{"description":"IMP HIP LNR PRVSNL 28 44-49MM","code_information":[{"code":"Sx00-5003-044","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"324475","type":"LOCAL"},{"code":"310983","type":"LOCAL"}],"standard_charges":[{"gross_charge":630.0,"discounted_cash":220.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLS LOCATION | 324475 = Hospital System Supply Identifier | 310983 = Lawson ID"}]},{"description":"IMP HIP LNR PRVSNL 28 50-58MM","code_information":[{"code":"Sx00-5003-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"449579","type":"LOCAL"},{"code":"310984","type":"LOCAL"}],"standard_charges":[{"gross_charge":630.0,"discounted_cash":220.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLS LOCATION | 449579 = Hospital System Supply Identifier | 310984 = Lawson ID"}]},{"description":"IMP HIP LNR PRVSNL 28 60-72MM","code_information":[{"code":"Sx00-5003-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"449577","type":"LOCAL"},{"code":"310981","type":"LOCAL"}],"standard_charges":[{"gross_charge":630.0,"discounted_cash":220.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLS LOCATION | 449577 = Hospital System Supply Identifier | 310981 = Lawson ID"}]},{"description":"BLADE MICRO MILL 19 204","code_information":[{"code":"Sx00-5052-204","type":"CDM"},{"code":"272","type":"RC"},{"code":"72589","type":"LOCAL"},{"code":"100437","type":"LOCAL"}],"standard_charges":[{"gross_charge":482.4,"discounted_cash":168.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLS 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":441.8,"discounted_cash":154.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLS 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":75.9,"discounted_cash":26.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLS LOCATION | 149980 = Hospital System Supply Identifier | 237595 = Lawson ID"}]},{"description":"SYSTEM BONE CEMENT NSTRL REMOV","code_information":[{"code":"Sx00-5061-084","type":"CDM"},{"code":"272","type":"RC"},{"code":"932071","type":"LOCAL"},{"code":"816445","type":"LOCAL"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLS LOCATION | 932071 = Hospital System Supply Identifier | 816445 = Lawson ID"}]},{"description":"PRESSURIZER FEM HARRIS CEM","code_information":[{"code":"Sx00-5069-012","type":"CDM"},{"code":"272","type":"RC"},{"code":"155466","type":"LOCAL"},{"code":"303052","type":"LOCAL"}],"standard_charges":[{"gross_charge":1820.49,"discounted_cash":637.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLS LOCATION | 155466 = Hospital System Supply Identifier | 303052 = Lawson ID"}]},{"description":"NOZZLE CEM BONE MILLER 90","code_information":[{"code":"Sx00-5069-091","type":"CDM"},{"code":"272","type":"RC"},{"code":"155467","type":"LOCAL"},{"code":"303053","type":"LOCAL"}],"standard_charges":[{"gross_charge":757.8,"discounted_cash":265.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLS LOCATION | 155467 = Hospital System Supply Identifier | 303053 = Lawson ID"}]},{"description":"BLADE EXTRACTOR EXODUS HIP STEM REMOVAL 0051040000","code_information":[{"code":"Sx00-510-400-","type":"CDM"},{"code":"272","type":"RC"},{"code":"1182618","type":"LOCAL"},{"code":"1008181","type":"LOCAL"}],"standard_charges":[{"gross_charge":7008.75,"discounted_cash":2453.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLS LOCATION | 1182618 = Hospital System Supply Identifier | 1008181 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP MGII LT 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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":35868.99,"discounted_cash":12554.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLS LOCATION | 321732 = Hospital System Supply Identifier | 534946 = 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":35868.99,"discounted_cash":12554.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLS LOCATION | 321731 = Hospital System Supply Identifier | 534945 = 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":35868.99,"discounted_cash":12554.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLS 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":35868.99,"discounted_cash":12554.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLS 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":35868.99,"discounted_cash":12554.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLS 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":35868.99,"discounted_cash":12554.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLS LOCATION | 321735 = Hospital System Supply Identifier | 534949 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP MGII LT 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