{"hospital_name":"Methodist Hospital Plainview","last_updated_on":"2026-04-01","version":"3.0.0","location_name":["Covenant Hospital Plainview"],"hospital_address":["2601 Dimmitt Rd, Plainview, TX 79072"],"license_information":{"license_number":"000146","state":"TX"},"type_2_npi":["1073580726","1831220904","1578670592"],"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":"Cora Rivera"},"financial_aid_policy":["58% off of standard gross charges."],"modifier_information":[{"description":"Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. 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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":4050.0,"discounted_cash":1701.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TVM 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":4050.0,"discounted_cash":1701.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TVM 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":4050.0,"discounted_cash":1701.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TVM LOCATION | 146869 = Hospital System Supply Identifier | 223309 = 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":4050.0,"discounted_cash":1701.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TVM LOCATION | 178238 = Hospital System Supply Identifier | 223312 = Lawson ID"}]},{"description":"IMP TIB INS NXGN 7-10 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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":529.0,"discounted_cash":222.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TVM LOCATION | 145669 = Hospital System Supply Identifier | 223415 = 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":4050.0,"discounted_cash":1701.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TVM LOCATION | 329216 = Hospital System Supply Identifier | 298138 = Lawson ID"}]},{"description":"IMP TIB INS NXGN PL 1-2 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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":4050.0,"discounted_cash":1701.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TVM LOCATION | 329219 = Hospital System Supply Identifier | 298141 = 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":4050.0,"discounted_cash":1701.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TVM LOCATION | 329220 = Hospital System Supply Identifier | 298142 = Lawson ID"}]},{"description":"IMP KNEE TIB INS NXGN 1-2 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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":8974.5,"discounted_cash":3769.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TVM LOCATION | 327175 = Hospital System Supply Identifier | 412372 = 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":8974.5,"discounted_cash":3769.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TVM LOCATION | 198028 = Hospital System Supply Identifier | 443264 = Lawson ID"}]},{"description":"IMP KNEE INS NXGN LOK 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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":8974.5,"discounted_cash":3769.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TVM LOCATION | 322051 = Hospital System Supply Identifier | 535265 = 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":8974.5,"discounted_cash":3769.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TVM LOCATION | 194029 = Hospital System Supply Identifier | 324227 = Lawson ID"}]},{"description":"IMP TIB INS POST NXGN SZ3-4 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40X22","code_information":[{"code":"Sx00-6320-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304305","type":"LOCAL"},{"code":"523262","type":"LOCAL"}],"standard_charges":[{"gross_charge":3712.5,"discounted_cash":1559.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TVM LOCATION | 304305 = Hospital System Supply Identifier | 523262 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 20D 42X26","code_information":[{"code":"Sx00-6320-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304307","type":"LOCAL"},{"code":"523264","type":"LOCAL"}],"standard_charges":[{"gross_charge":6424.88,"discounted_cash":2698.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TVM LOCATION | 304307 = Hospital System Supply Identifier | 523264 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 20D 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46X22","code_information":[{"code":"Sx00-6320-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304311","type":"LOCAL"},{"code":"523268","type":"LOCAL"}],"standard_charges":[{"gross_charge":3712.5,"discounted_cash":1559.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TVM LOCATION | 304311 = Hospital System Supply Identifier | 523268 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 20D 46X26","code_information":[{"code":"Sx00-6320-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304312","type":"LOCAL"},{"code":"523269","type":"LOCAL"}],"standard_charges":[{"gross_charge":6424.88,"discounted_cash":2698.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TVM LOCATION | 304312 = Hospital System Supply Identifier | 523269 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 20D 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48X32","code_information":[{"code":"Sx00-6320-048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304317","type":"LOCAL"},{"code":"523274","type":"LOCAL"}],"standard_charges":[{"gross_charge":3712.5,"discounted_cash":1559.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TVM LOCATION | 304317 = Hospital System Supply Identifier | 523274 = Lawson ID"}]},{"description":"IMP HIP ACET LNR LGVTY50/52/54","code_information":[{"code":"Sx00-6320-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"150025","type":"LOCAL"},{"code":"237682","type":"LOCAL"}],"standard_charges":[{"gross_charge":3712.5,"discounted_cash":1559.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TVM LOCATION | 150025 = Hospital System Supply Identifier | 237682 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 20D 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50-54X26","code_information":[{"code":"Sx00-6320-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304319","type":"LOCAL"},{"code":"523276","type":"LOCAL"}],"standard_charges":[{"gross_charge":6424.88,"discounted_cash":2698.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TVM LOCATION | 304319 = Hospital System Supply Identifier | 523276 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 20D 56X32","code_information":[{"code":"Sx00-6320-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"198410","type":"LOCAL"},{"code":"443663","type":"LOCAL"}],"standard_charges":[{"gross_charge":3712.5,"discounted_cash":1559.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TVM LOCATION | 198410 = Hospital System Supply Identifier | 443663 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 20D 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56X28","code_information":[{"code":"Sx00-6320-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304322","type":"LOCAL"},{"code":"523279","type":"LOCAL"}],"standard_charges":[{"gross_charge":3712.5,"discounted_cash":1559.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TVM LOCATION | 304322 = Hospital System Supply Identifier | 523279 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 20D 58X32","code_information":[{"code":"Sx00-6320-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304326","type":"LOCAL"},{"code":"523283","type":"LOCAL"}],"standard_charges":[{"gross_charge":3712.5,"discounted_cash":1559.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TVM LOCATION | 304326 = Hospital System Supply Identifier | 523283 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 20D 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28X52MM","code_information":[{"code":"Sx00-7105-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"198403","type":"LOCAL"},{"code":"443655","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TVM LOCATION | 198403 = Hospital System Supply Identifier | 443655 = Lawson ID"}]},{"description":"IMP HIP ACET SHELL 0D 32X54MM","code_information":[{"code":"Sx00-7105-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202086","type":"LOCAL"},{"code":"452182","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TVM LOCATION | 202086 = Hospital System Supply Identifier | 452182 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 54X28","code_information":[{"code":"Sx00-7105-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320928","type":"LOCAL"},{"code":"534142","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TVM LOCATION | 320928 = Hospital System Supply Identifier | 534142 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 56X28","code_information":[{"code":"Sx00-7105-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320929","type":"LOCAL"},{"code":"534143","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TVM LOCATION | 320929 = Hospital System Supply Identifier | 534143 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 56X32","code_information":[{"code":"Sx00-7105-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320930","type":"LOCAL"},{"code":"534144","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TVM LOCATION | 320930 = Hospital System Supply Identifier | 534144 = Lawson ID"}]},{"description":"LINER REV HIP TM NEU LNG 36X58","code_information":[{"code":"Sx00-7105-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"195289","type":"LOCAL"},{"code":"372221","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TVM LOCATION | 195289 = Hospital System Supply Identifier | 372221 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 58X28","code_information":[{"code":"Sx00-7105-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320931","type":"LOCAL"},{"code":"534145","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TVM LOCATION | 320931 = Hospital System Supply Identifier | 534145 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 58X32","code_information":[{"code":"Sx00-7105-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320932","type":"LOCAL"},{"code":"534146","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TVM LOCATION | 320932 = Hospital System Supply Identifier | 534146 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 60X28","code_information":[{"code":"Sx00-7105-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320933","type":"LOCAL"},{"code":"534147","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TVM LOCATION | 320933 = Hospital System Supply Identifier | 534147 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 60X36","code_information":[{"code":"Sx00-7105-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320934","type":"LOCAL"},{"code":"534148","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TVM LOCATION | 320934 = Hospital System Supply Identifier | 534148 = Lawson ID"}]},{"description":"IMP HIP ACET SHELL 0D 32X60MM","code_information":[{"code":"Sx00-7105-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"198402","type":"LOCAL"},{"code":"443654","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TVM LOCATION | 198402 = Hospital System Supply Identifier | 443654 = Lawson ID"}]},{"description":"IMP HIP ACET SHELL 0D 40X62MM","code_information":[{"code":"Sx00-7105-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"198400","type":"LOCAL"},{"code":"443652","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TVM LOCATION | 198400 = Hospital System Supply Identifier | 443652 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 62/64X28","code_information":[{"code":"Sx00-7105-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320935","type":"LOCAL"},{"code":"534149","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TVM LOCATION | 320935 = Hospital System Supply Identifier | 534149 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 62/64X32","code_information":[{"code":"Sx00-7105-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320936","type":"LOCAL"},{"code":"534150","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TVM LOCATION | 320936 = Hospital System Supply Identifier | 534150 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 62/64X36","code_information":[{"code":"Sx00-7105-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320937","type":"LOCAL"},{"code":"534151","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TVM LOCATION | 320937 = Hospital System Supply Identifier | 534151 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 66-70X36","code_information":[{"code":"Sx00-7105-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320940","type":"LOCAL"},{"code":"534154","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TVM LOCATION | 320940 = Hospital System Supply Identifier | 534154 = Lawson ID"}]},{"description":"IMP HIP ACET SHELL 0D 40X66-70","code_information":[{"code":"Sx00-7105-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202085","type":"LOCAL"},{"code":"452181","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TVM LOCATION | 202085 = Hospital System Supply Identifier | 452181 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 66-70X28","code_information":[{"code":"Sx00-7105-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320938","type":"LOCAL"},{"code":"534152","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TVM LOCATION | 320938 = Hospital System Supply Identifier | 534152 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 66-70X32","code_information":[{"code":"Sx00-7105-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320939","type":"LOCAL"},{"code":"534153","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TVM LOCATION | 320939 = Hospital System Supply Identifier | 534153 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 72/74X40","code_information":[{"code":"Sx00-7105-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320944","type":"LOCAL"},{"code":"534158","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TVM LOCATION | 320944 = Hospital System Supply Identifier | 534158 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 72/74X36","code_information":[{"code":"Sx00-7105-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320943","type":"LOCAL"},{"code":"534157","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TVM LOCATION | 320943 = Hospital System Supply Identifier | 534157 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 72/74X28","code_information":[{"code":"Sx00-7105-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320941","type":"LOCAL"},{"code":"534155","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TVM LOCATION | 320941 = Hospital System Supply Identifier | 534155 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 72/74X32","code_information":[{"code":"Sx00-7105-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320942","type":"LOCAL"},{"code":"534156","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TVM LOCATION | 320942 = Hospital System Supply Identifier | 534156 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 76-80X36","code_information":[{"code":"Sx00-7105-076","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320947","type":"LOCAL"},{"code":"534161","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TVM LOCATION | 320947 = Hospital System Supply Identifier | 534161 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 76-80X28","code_information":[{"code":"Sx00-7105-076","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320945","type":"LOCAL"},{"code":"534159","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TVM LOCATION | 320945 = Hospital System Supply Identifier | 534159 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 76-80X32","code_information":[{"code":"Sx00-7105-076","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320946","type":"LOCAL"},{"code":"534160","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TVM LOCATION | 320946 = Hospital System Supply Identifier | 534160 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 76-80X40","code_information":[{"code":"Sx00-7105-076","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320948","type":"LOCAL"},{"code":"534162","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TVM LOCATION | 320948 = Hospital System Supply Identifier | 534162 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 48X28","code_information":[{"code":"Sx00-7110-048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320949","type":"LOCAL"},{"code":"534163","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TVM LOCATION | 320949 = Hospital System Supply Identifier | 534163 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 50X28","code_information":[{"code":"Sx00-7110-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320950","type":"LOCAL"},{"code":"534164","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TVM LOCATION | 320950 = Hospital System Supply Identifier | 534164 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 52X28","code_information":[{"code":"Sx00-7110-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320951","type":"LOCAL"},{"code":"534165","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TVM LOCATION | 320951 = Hospital System Supply Identifier | 534165 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 32X54MM","code_information":[{"code":"Sx00-7110-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202098","type":"LOCAL"},{"code":"452194","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TVM LOCATION | 202098 = Hospital System Supply Identifier | 452194 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 54X28","code_information":[{"code":"Sx00-7110-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320952","type":"LOCAL"},{"code":"534166","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TVM LOCATION | 320952 = Hospital System Supply Identifier | 534166 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 56X28","code_information":[{"code":"Sx00-7110-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320953","type":"LOCAL"},{"code":"534167","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TVM LOCATION | 320953 = Hospital System Supply Identifier | 534167 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 56X32","code_information":[{"code":"Sx00-7110-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320954","type":"LOCAL"},{"code":"534168","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TVM LOCATION | 320954 = Hospital System Supply Identifier | 534168 = Lawson ID"}]},{"description":"IMP HIP ACET LNR LGVTY 58X36","code_information":[{"code":"Sx00-7110-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202100","type":"LOCAL"},{"code":"452196","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TVM LOCATION | 202100 = Hospital System Supply Identifier | 452196 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 58X28","code_information":[{"code":"Sx00-7110-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320955","type":"LOCAL"},{"code":"534169","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TVM LOCATION | 320955 = Hospital System Supply Identifier | 534169 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 58X32","code_information":[{"code":"Sx00-7110-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320956","type":"LOCAL"},{"code":"534170","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TVM LOCATION | 320956 = Hospital System Supply Identifier | 534170 = Lawson ID"}]},{"description":"IMP HIP ACET LNR10D 60X36MM","code_information":[{"code":"Sx00-7110-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202101","type":"LOCAL"},{"code":"452197","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TVM LOCATION | 202101 = Hospital System Supply Identifier | 452197 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 60X28","code_information":[{"code":"Sx00-7110-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320957","type":"LOCAL"},{"code":"534171","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TVM LOCATION | 320957 = Hospital System Supply Identifier | 534171 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 60X32","code_information":[{"code":"Sx00-7110-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320958","type":"LOCAL"},{"code":"534172","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TVM LOCATION | 320958 = Hospital System Supply Identifier | 534172 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 40X62/64","code_information":[{"code":"Sx00-7110-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202099","type":"LOCAL"},{"code":"452195","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TVM LOCATION | 202099 = Hospital System Supply Identifier | 452195 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 62/64X28","code_information":[{"code":"Sx00-7110-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320959","type":"LOCAL"},{"code":"534173","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TVM LOCATION | 320959 = Hospital System Supply Identifier | 534173 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 62X32","code_information":[{"code":"Sx00-7110-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320960","type":"LOCAL"},{"code":"534174","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TVM LOCATION | 320960 = Hospital System Supply Identifier | 534174 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 62X32","code_information":[{"code":"Sx00-7110-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320961","type":"LOCAL"},{"code":"534175","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TVM LOCATION | 320961 = Hospital System Supply Identifier | 534175 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 66-70X28","code_information":[{"code":"Sx00-7110-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320962","type":"LOCAL"},{"code":"534176","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TVM LOCATION | 320962 = Hospital System Supply Identifier | 534176 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 66-70X32","code_information":[{"code":"Sx00-7110-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320963","type":"LOCAL"},{"code":"534177","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TVM LOCATION | 320963 = Hospital System Supply Identifier | 534177 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 40MM","code_information":[{"code":"Sx00-7110-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"194975","type":"LOCAL"},{"code":"360636","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TVM LOCATION | 194975 = Hospital System Supply Identifier | 360636 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 36X62/64","code_information":[{"code":"Sx00-7110-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202102","type":"LOCAL"},{"code":"452198","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TVM LOCATION | 202102 = Hospital System Supply Identifier | 452198 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 72/74X28","code_information":[{"code":"Sx00-7110-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320964","type":"LOCAL"},{"code":"534178","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TVM LOCATION | 320964 = Hospital System Supply Identifier | 534178 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 72/74X32","code_information":[{"code":"Sx00-7110-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320965","type":"LOCAL"},{"code":"534179","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TVM LOCATION | 320965 = Hospital System Supply Identifier | 534179 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 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NO.4033","code_information":[{"code":"Sx00000004033","type":"CDM"},{"code":"275","type":"RC"},{"code":"C1898","type":"HCPCS"},{"code":"168178","type":"LOCAL"},{"code":"206388","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.0035,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TVM LOCATION | 168178 = Hospital System Supply Identifier | 206388 = Lawson ID"}]},{"description":"LEAD EPICARDIAL R/S 4046","code_information":[{"code":"Sx00000004046","type":"CDM"},{"code":"275","type":"RC"},{"code":"C1898","type":"HCPCS"},{"code":"149544","type":"LOCAL"},{"code":"236954","type":"LOCAL"}],"standard_charges":[{"gross_charge":2063.1,"discounted_cash":866.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TVM LOCATION | 149544 = Hospital System Supply Identifier | 236954 = Lawson ID"}]},{"description":"LEAD EPICARDIAL 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